21 | Submersion Injuries with Dr Sarah Lazarus

21 | Submersion Injuries with Dr. Sarah Lazarus In this episode of PEM CHATT, host Toni Dobson is joined by pediatric emergency physician Dr. Sarah Lazarus to break down the critical topic of pediatric drowning and submersion injuries. Together, they explore real-world clinical scenarios, debunk common myths, and provide practical guidance for both clinicians and caregivers. Drowning remains one of the leading causes of death in children, particularly ages 1–4, and even non-fatal events can result in devastating long-term consequences. This episode emphasizes both clinical management and prevention strategies—highlighting how quickly these events occur and how often they happen despite close supervision.   🔑 Key Takeaways Drowning is fast and silent Often occurs in seconds with little to no splashing or noise Terminology matters “Dry drowning” and “secondary drowning” are outdated and misleading Pathophysiology is respiratory Water aspiration → surfactant washout → impaired gas exchange → hypoxia Observation is critical True aspiration events should be monitored for ~6 hours from the time of incident Imaging isn’t always helpful Chest X-rays can lead to unnecessary admissions without changing outcomes Management is symptom-driven Asymptomatic → observe Symptomatic → oxygen support, VBG, imaging, admission Cardiac arrest cases are severe Focus on oxygenation, ventilation, rewarming, and consider ECMO early Prevention requires layers No single strategy (including swim lessons) is sufficient ⚠️ Clinical Pearls Drowning is an evolving process, not a single moment event Patients should be observed for 6 hours after the event Symptoms appearing days later are NOT due to drowning Pediatric arrests are often respiratory in origin → prioritize ventilation Antibiotics and steroids are not routinely indicated Most toddler submersion injuries do NOT require C-spine immobilization 🧠 Myth Busting “Dry drowning” isn’t real. This term originated from outdated medical concepts but is no longer used. If a child had a true submersion injury, symptoms will present within 6 hours—not days later. 🛟 Prevention Insights Use “arms reach, eyes reach” supervision Perform a home swim test (can the child swim 2 pool lengths?) Understand that: Swim lessons ≠ drowning proof Life jackets ≠ guaranteed safety Drowning prevention requires multiple overlapping layers of safety Resources and references: Brenner’s article: https://pubmed.ncbi.nlm.nih.gov/19255386/ CHOA Algorithm: https://www.choa.org/-/media/Files/Childrens/medical-professionals/clinical-practice-guidelines/submersion-event-ed.pdf NEJM Article: https://www.nejm.org/doi/full/10.1056/NEJMra1013317#figures_media Timeline 00:00 Welcome to PEM CHATT 00:19 Why Drowning Matters 01:12 Meet Dr. Sarah Lazarus 02:14 Bread Pudding is my favorite 03:34 Drowning Terminology 04:38 Who Is Most at Risk 06:08 Silent Drowning Explained 09:15 Systemic Effects Checklist 11:03 Fresh vs Salt vs Cold 11:46 Three Patient Categories 12:36 Case One Asymptomatic Kid 14:12 Avoiding Unneeded X-Rays 16:12 Case Two Symptomatic Infant 18:40 Imaging and Labs Strategy 18:58 When to Skip Antibiotics 20:02 Arrest Scenario Walkthrough 20:30 Resuscitation Priorities And ECMO 21:54 When Resuscitation Is Futile 22:40 C-Spine Immobilization Debate 23:24 Drowning CPR Starts with Breaths 25:29 Injury Prevention Work and Stats 27:14 Layers of Drowning Prevention 30:01 Dry Drowning Myth Busting 33:16 Key Pearls and Closing