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23,24 Consider and treat precipitating factors of drowning: trauma, spinal cord injury, seizure, MI, arrhythmia, toxin, syncope or hypoglycemia Monitor for sepsis, disseminated intravascular coagulation (DIC), and renal insufficiency/failure CT head & neck: edema or loss of gray-white matter distinction strongly predicts poor outcome, but normal CT is of little prognostic value POST-CPR CARE: consider 12-24 hours of therapeutic hypothermia in patients with return of spontaneous circulation (ROSC) to improve neurological outcomes similar to cardiac arrest Drowning victims with ROSC who remain comatose should NOT be actively rewarmed above 90-93F/32-34C Drowning victims with ROSC whose core temperature is 93F/34C should be cooled to 90-93F/32-34C as soon as possible Cerebral O2 consumption decreases 5% for each reduction of 1C within the range 37-20C Pulmonary Considerations Hypoxemia decreased levels of oxygen in the blood

Noonan syndrome-causing SHP2 mutants inhibit insulin-like growth factor 1 release via growth hormone-induced ERK hyperactivation, which contributes to short stature