2025 – PAGE 216 – EMERGENCY MEDICINE & TOXICOLOGY

POOL SAFETY

Recommend a four-sided fence around the pool (preferably at least 4-feet high) with a locked gate that opens out from the pool for greatest pool safety. Most drowning victims are preschoolers and 16- to 18-year-olds (toward the end of high school). Toddler swimming lessons have NOT been shown to prevent drowning. Inflatable toys should be avoided in the pool area. In-ground pools result in more drownings than above-ground pools. Boys are more likely to drown than girls. African Americans are more likely to drown than Caucasians. Infants drown in tubs, preschoolers drown in pools, and teens most often drown in fresh water. The most common cause of death in epileptic patients is DROWNING, though it’s not always in a pool. (There is almost a 20-fold higher risk of drowning for epileptic patients than non-epileptic patients.)

HYPOTHERMIA

Hypothermia is defined as a core body temperature less than 95° F (35 C). If the temperature is < 90° F, provide core rewarming with bladder irrigation, warm and humidified air, and warm IV fluids. Once areas of the body are warmed, blood can pool in those areas, resulting in HYPOTENSION. Therefore, rewarming should be done carefully and slowly. Passive rewarming includes the use of a warm blanket and warm baths.

HEAD INJURY

Head injury can result in a basilar skull fracture or papilledema. Try to remember the GCS scale.

• Basilar skull fracture= “clear or bloody rhinorrhea and otorrhea.” Suggested by “raccoon eyes” or by bruise over the mastoid. The patient could have a facial nerve palsy. No antibiotics are needed, and there is a good prognosis. Confirm with a CT (not X-ray).
• Nasal septum or ear’s pinna with hematoma/swelling = ENT CONSULT to avoid saddle nose or cauliflower deformity of the ear.
• Papilledema is caused by increased ICP and can develop immediately, after several days, or up to 2 weeks after a head injury.
• If GCS ≤ 8, intubate! 8 = coma. GCS is ONLY for head trauma; it is not validated for other causes of altered consciousness.
• GCS= Eyes (4), Verbal (5), Motor (6). Lowest = 3 = not opening eyes, no sounds, not moving. 15 = opens eyes spontaneously, oriented and talks appropriately, obeys motor commands. 8 = opens eyes to painful stimulus (2), makes inappropriate sounds (3), abnormal flexion to painful stimulus (3). Extension would be GCS 2 for motor = bad. Longer time in a coma = worse prognosis.

GLASGOW COMA SCORE