Repeat chest film 12 hours later showed mild bilateral interstitial infiltrates. At this time, the patient was admitted to the pediatric floor for further observation. Sputum cultures grew only normal flora; he remained afebrile, and antibiotics were not needed.

After three days in the hospital, the patient no longer had an oxygen requirement, his oxygen saturations were improved, he was completely asymptomatic, and he was discharged home.

Summary

Victims of submersion incidents can present anywhere on the spectrum of illness from completely asymptomatic to cardiorespiratory arrest. Frequently, asymptomatic patients can be safely discharged home if vital signs remain stable and the patient remains asymptomatic after a four- to six-hour period of observation. Patients who develop any symptoms during observation or who have abnormal vital signs should be admitted for further observation and treatment.

Contributor Disclosures

Contributors

Dr. Thomas A. Waters and Dr. Kellie Kirkpatrick wrote “Submersion Incidents.” for the EM Model. Dr. Waters is the team physician for the Cleveland Browns; attending physician in the Emergency Services Institute at The Cleveland Clinic; assistant professor of emergency medicine at Case Western University School of Medicine; and an attending physician at MetroHealth Medical Center in Cleveland, Ohio. Dr. Kirkpatrick is an attending physician in emergency medicine at Northwest Community Hospital in Arlington Heights, Ill. Dr. Robert C. Solomon is the Medical Editor of ACEP News and editor of the “Focus On… Critical Decisions” series, core faculty in the emergency medicine residency at Allegheny General Hospital, Pittsburgh, and assistant professor in the Department of Emergency Medicine at Temple University School of Medicine, Philadelphia. Mary Anne Mitchell is an ACEP staff member who reviews and manages the ACEP “Focus On… Critical Decisions” series.

Disclosures

In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards and American College of Emergency Physicians policy, all individuals in control of content must disclose to the program audience the existence of significant financial interests in or relationships with manufacturers of commercial products that might have a direct interest in the subject matter.

Dr. Waters, Dr. Kirkpatrick, Dr. Solomon, and Ms. Mitchell have disclosed that they have no significant relationships with or financial interests in any commercial companies that pertain to this article. There is no commercial support for this activity. This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME). The American College of Emergency Physicians is accredited by the ACCME to provide continuing medical education for physicians.