Question

You and your team members are currently resuscitating a 7-year-old male patient who was found face down in a pool. EMS states the patient was in the water for an unknown amount of time. The patient is currently in asystole, is cyanotic with an advanced airway in place. Inline waveform capnography is showing a small peak upon mechanical ventilation with a ETCO2 of 12. Which of the following is the most appropriate care for this patient?

Answer 1

To care for a 7-year-old drowning victim in asystole and with an ETCO2 of 12, it is crucial to persist with high-quality CPR and mechanical ventilation through an advanced airway. Efforts should continue aggressively given the greater potential for recovery in cold water drownings.

Step-by-step explanation:

The most appropriate care for a 7-year-old patient in asystole after a drowning incident is to continue cardiopulmonary resuscitation (CPR) efforts, with focus on high-quality chest compressions and adequate ventilations through the advanced airway. Given that the patient has an ETCO2 of 12 with a small peak upon mechanical ventilation, it is essential to ensure that CPR is effective, aiming to improve perfusion and increase the ETCO2 towards a more normal range. A low ETCO2 may indicate poor cardiac output or hyperventilation. It's imperative to perform CPR at a rate of 100 compressions per minute, compressing the chest at least 5 cm deep. Resuscitation efforts should continue until there is a return of spontaneous circulation (ROSC) or a healthcare professional declares the patient deceased.

Moreover, since drowning in cold water may present exceptional circumstances, the chance of neurological recovery without severe brain damage can be greater due to reduced metabolic rates. Hence, regardless of the time the child has been submerged, resuscitation efforts should be aggressive. It is a myth that resuscitation is futile after drowning; there have been cases where individuals have been successfully resuscitated after prolonged periods in cold water.