Inamul Haque Khan, Shehbaz A Kureshi.
Near drowning in children two case reports of survival after prolonged immersion.
Pak J Cardiol Jan ;12(3):72-4.

Near drowning in children is a rare cause of hospital presentation and carries a significant mortality and morbidity with neurological handicap. Spontaneous respiratory effort, level of consciousness and fixed dilated pupils are the three important factors on admission, that might predict the outcome in the nearly drowned child. We report two cases of near drowning after prolonged (but undetermined time) immersion in water, who were brought unconscious with fixed dilated pupils, successfully resuscitated in Emergency Department of King Khalid Hospital, Hail and were discharged from the hospital with no short term physical or neurological deficit. We compare our two cases retrospectively with the recently published British Isles study.

Case Reports: A 4 year old Saudi male child was found missing in the house for unknown time, on 9.3.1989. He was found to be in the fresh water tank inside the house. Civil defence personnel were called at 10. 10am. Child was picked up at 10. 18 am, was brought to Emergency Department of King Khalid Hospital, Hail at 10.30 am, clad in a blanket, with no resuscitation at the site of incident or during transfer to hospital. On arrival, he was unconscious, hypothermic, cyanosed, apneic with fixed dilated pupils and no cardiac activity. Cardiopulmonary resuscitation was immediately started, and at 10.40am first ventricular complex was noted on monitor and in a minute sinus rhythm was achieved and respiratory effort was noted. Blood gas analysis (BGA) done at that time revealed severe metabolic acidosis with blood pH of 6.74. Child was transferred to pediatric intensive care unit and put on Servo respirator. Tracheal and gastric aspirations were done. Mannitol, lasix, phenobarbitone and diazepam was administered and cefotaxime was started. First pupillary reactivity was noted at 3.00 pm, four and half hours after CPR. Mediastinal and cutaneous neck emphysema developed and he was disconnected from the ventilator, when regular spontaneous breathing started, after 24 hours of admission. He remained semiconscious and developed bronchopneumonia, but he recovered well and regained his full consciousness after 72 hours. Further hospitalization was uneventful and child was discharged after 11 days without any physical or neurological deficit. He was not brought for follow up in outdoor, but his parents were contacted on telephone, 3 months after the incident and child was apparently doing well.

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