Tests
1st tests to order
pulse oximetry/blood gas
Test
Pulse oximetry is pivotal in determining drowning severity and need for treatment. Blood gas measurements may be preferred in cases of hypothermia, where peripheral vasoconstriction may make pulse oximetry difficult.[36]
Result
hypoxemia
chest radiography
Test
While chest x-ray does not correlate directly with outcome, early parenchymal abnormalities usually predict respiratory decompensation and need for mechanical ventilation.[42] Early infiltrates are often water or pneumonitis, and not infectious pneumonia.
Result
pulmonary infiltrate/respiratory injury
basic metabolic panel
Test
Electrolyte disturbances may be markers of a precipitating medical event, but are not predictive of outcome.
Acute kidney injury has also been reported, most commonly in grade 6 patients (those in cardiopulmonary arrest) who were successfully resuscitated.
Hypoglycemia and hyponatremia may cause loss of consciousness or seizure, which could lead to drowning.
Result
abnormal in the presence of metabolic or electrolyte abnormalities, or end organ dysfunction
Tests to consider
cervical spine CT
Test
Incidence of cervical spine injury is low in drowning patients.[43][44] Those with confirmed cervical spine injury usually have obvious history, or signs of trauma; cervical spine imaging is not recommended for patients witnessed to have no preceding trauma prior to a drowning.[41]
If cervical spine injury cannot readily be excluded, a validated clinical tool such as the Pediatric Emergency Care Applied Research Network (PECARN), National Emergency X-Radiography Utilization Study (NEXUS) Criteria for C-spine Imaging, or the Canadian C-Spine Rule may be used to determine whether imaging is required.[39][40]
Result
may show cervical spine vertebral misalignment, fracture, and prevertebral soft-tissue swelling
creatine kinase
Test
Prolonged struggle or shivering can lead to rhabdomyolysis. This may cause or worsen kidney injury.
Result
may be elevated
serum alcohol and urine drugs of misuse
Test
Alcohol and illicit drug levels may assist in determining the cause of the drowning.
Result
positive in the setting of intoxication
ECG
Test
Evidence of myocardial infarction may assist in determining the cause of a drowning in those at risk.
Result
ST-segment elevation of at least 1 mm in 2 or more contiguous leads; nonspecific ST-T wave changes or ischemic changes
serum cardiac biomarkers
Test
Evidence of myocardial infarction may assist in determining the cause of a drowning in those at risk.
Result
elevated in the presence of myocardial infarction
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