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학습 자료 둘러보기 →The primary insult in drowning is cerebral hypoxia. After return of spontaneous circulation, the focus shifts to preventing secondary brain injury from cerebral edema and elevated intracranial pressure (ICP). A child who is conscious but lethargic has already sustained a neurological insult and is at high risk for deterioration.
Serial neurological checks, including pupil reactivity and Glasgow Coma Scale, are the most critical assessments. Any sign of increased ICP (e.g., Cushing's triad, fixed/dilated pupils, posturing) requires immediate intervention. The neurological exam in the emergency department is a strong predictor of outcome.
Do not delay neurological assessment for a chest X-ray or ABG in a lethargic post-submersion patient. While aspiration pneumonia and pulmonary edema are risks, cerebral herniation from unchecked ICP is an immediate life threat. Maintain normothermia; aggressively treating mild hypothermia is not the priority.
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