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Near Drowning

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After establishment of an airway and assessment for other injuries, the team begins to warm the patient.

Name three procedures to warm Triston's body temperature.

How does cold body temperature affect the body's ability to oxygenate its tissues?

How can Triston's ventilation and oxygenation be assessed at this point?

As the initial blood gas is being analyzed the pediatric ventilator arrives. The physician requests you to set the ventilator on the appropriate settings.

What ventilator settings do you choose?

• Mode =
• PIP (peak inspiratory pressure) or VT =
• f (frequency) =
• FiO₂ (fraction of inspired oxygen) =
• PEEP (positive end expiratory pressure) =
• IT (inspiratory time) for PC (pressure control) =
• *Flow for VC (volume control) =
• Alarms=

How will one assess the appropriateness of these ventilator settings?

Prior to intubation ABG results are:   7.04 / 84 / 36 / 19 /78%

Interpret this ABG.

What is the cause of the metabolic acidosis?

1. Renal failure
2. Keto-Acidosis
3. Lactic Acidosis

How should the metabolic component be treated at this early point of resuscitation?

What assessments would be helpful after initiating mechanical ventilation?

• Airway
• Breathing
• Circulation
• Neurologic
• CXR

20 minutes post mechanical ventilation and the return of a spontaneous HR with adequate BP 103/65, and tympanic temp. = 90° F.
ABG results are:   7.23 / 43 / 88 / 19 / 92%

Interpret this ABG.

What actions should the RCP take at this time to fine tune this patient's oxygenation and ventilatory needs?

What will the RCP carefully assess while increasing the PEEP?

How will the RCP assess the appropriateness of the ventilator changes made?

Triston is stable and is moved to the Pediatric ICU (intensive care unit). Two days later you return to work the unit. The night shift has reported that Triston is stable, normal temperature, still unresponsive to command but he is moving around in the bed and restrained to prevent loss of ETT and IV access; and he is no longer being hyperventilated for ICP protection. During your 0800 assessment and ventilator check you note the ventilator settings are PC/CMV/CT, f 25, PIP is set at 22 cm H₂0 to return V_t 200 ml, FiO₂ 0.5, PEEP + 8; you notice a harsh late inspiratory noise on auscultation.

What is the cause of this noise and how do you correct it?

Next you notice that Triston's total RR has been 32-36 bpm throughout the night and the am ABG results are 7.48 / 30 / 102 / 23 / 98%.

Interpret the ABG.

How do you react?

ABG results: 7.46 / 32 / 95 / 23 / 97%

Interpret this ABG.

How do you respond to this ABG?