PODCAST: Submersion Injuries with Dr Sarah Lazarus

23.04.26

21 | Submersion Injuries with Dr. Sarah Lazarus

In this episode of PEM CHATT, host Toni Dobson is joined by pediatric emergency physician Dr. Sarah Lazarus to break down the critical topic of pediatric drowning and submersion injuries. Together, they explore real-world clinical scenarios, debunk common myths, and provide practical guidance for both clinicians and caregivers.

Drowning remains one of the leading causes of death in children, particularly ages 1–4, and even non-fatal events can result in devastating long-term consequences. This episode emphasizes both clinical management and prevention strategies—highlighting how quickly these events occur and how often they happen despite close supervision.

🔑 Key Takeaways

Drowning is fast and silent
- Often occurs in seconds with little to no splashing or noise
Terminology matters
- “Dry drowning” and “secondary drowning” are outdated and misleading
Pathophysiology is respiratory
- Water aspiration → surfactant washout → impaired gas exchange → hypoxia
Observation is critical
- True aspiration events should be monitored for ~6 hours from the time of incident
Imaging isn’t always helpful
- Chest X-rays can lead to unnecessary admissions without changing outcomes
Management is symptom-driven
- Asymptomatic → observe
- Symptomatic → oxygen support, VBG, imaging, admission
Cardiac arrest cases are severe
- Focus on oxygenation, ventilation, rewarming, and consider ECMO early
Prevention requires layers
- No single strategy (including swim lessons) is sufficient

⚠️ Clinical Pearls

Drowning is an evolving process, not a single moment event
Patients should be observed for 6 hours after the event
Symptoms appearing days later are NOT due to drowning
Pediatric arrests are often respiratory in origin → prioritize ventilation
Antibiotics and steroids are not routinely indicated
Most toddler submersion injuries do NOT require C-spine immobilization

🧠 Myth Busting

“Dry drowning” isn’t real.
This term originated from outdated medical concepts but is no longer used. If a child had a true submersion injury, symptoms will present within 6 hours—not days later.

🛟 Prevention Insights

Use “arms reach, eyes reach” supervision
Perform a home swim test (can the child swim 2 pool lengths?)
Understand that:
- Swim lessons ≠ drowning proof
- Life jackets ≠ guaranteed safety
Drowning prevention requires multiple overlapping layers of safety

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