Carol Asks:

I’m writing a scene that involves a child approximately eighteen-months-old. She was submerged for an unknown period of time (no more than a couple of minutes) on a beach after being struck by a rogue wave that knocked her down.

When found, she has a pulse, but is not breathing. Rescue breathing is started within thirty seconds of rescuers reaching her. She coughs up water shortly thereafter and is breathing on her own by the time the ambulance arrives.

This is the outcome I’ve written. Would this be correct?

A couple of days in the hospital for observation. She’s a princess so they insist on whatever tests CAN be done even if they normally wouldn’t be (X-ray, CT to check brain function.)

Neurologist tells the family that given the length of time in the water, how quickly she was given CPR, and the total length of time not breathing, she will likely suffer only minor cognitive issues at worse, and those may will not present until she starts school.

I’m presuming oxygen via nasal cannula or mask as well as an IV started in the ER.

This does not take place in the US, but I’m presuming standard procedure would be an investigation to find out how she ended up unattended long enough to make it to the waterfront. It’s truly an accident– the first time the child escaped from the house. Is this acceptable? Particularly if there was supporting video evidence?

Jordyn Says:

The scenario you have outlined is reasonable.

Here are a few of my thoughts.

This is a patient we would probably admit into the hospital– at least for a day. More depending on what happens in the first twenty-four hours would determine the need for a more lengthy stay.

For instance. as long as the child has an oxygen requirement with this type of mechanism, they can’t go home. Even if they have normal oxygen levels, any type of increased work of breathing would also probably keep them in the hospital until that resolved. However, if the child’s oxygen levels are normal and they exhibit no signs of respiratory distress for twenty-four hours then we might be hard pressed to keep them in the hospital. Remember, you have to be really sick to stay in the hospital these days.

Of course, with her position as princess, it could be easily foreseen that everyone operates with a greater degree of caution.

Chest x-ray would be reasonable and expected in this case. Paramedics starting an IV and oxygen, particularly in the case where the child received rescue breathing, also good. However, one of the first things that will happen when the child get’s to the hospital is that we will remove the oxygen to see where she settles out on room air. This would be an important piece for us to know. She’d be placed on an oxygen and heart monitor with frequent assessments of her breathing.

As far as doing other testing, particularly a CT scan to determine if there’s been any brain damage, I would argue against this. Now, do physicians “cave” sometimes to pressure by royalty. Of course— I’m sure this has happened. Just as here, if it were the president, some testing might be done that might not be necessary to “cover your . . . “.

Medically, however, if she never lost her pulse and was quickly revived, I think the risk of brain damage is extremely low. As long as your heart is beating, your brain is receiving some oxygen. Your blood does have a reserve volume of oxygen molecules on your blood cells for situations just as this. Children are very oxygen sensitive, and it doesn’t take long for them to lose their pulse in an oxygen deprived state. Knowing she still had a pulse when she was pulled from the water, especially considering her age, would mean to me that her down time was probably very little.

Also, the CT scan will likely not show any injury. Absence of injury also doesn’t mean she may not have learning difficulties in the future. So, I don’t think there’s much to be gained by that test— and the subsequent exposure to radiation which is something we balance a lot in pediatrics.

As far as the investigation, I think what you outline is reasonable, particularly if there is supporting video evidence of her slipping from the castle.

Thanks so much for your question. Good luck with your story!