Pediatric Collapse: Drowning Victim at a Backyard Pool
A 4-year-old is pulled from a backyard pool by his mother. He is unresponsive, has vomited water, and is not breathing. You are a lone trained rescuer; the mother is hysterical and holding the child. There is no AED poolside, but one is inside the house about 40 seconds away. You have a barrier device in your pocket. The child appears small - roughly 15 kg. A neighbor arrives and says she 'knows CPR from a class years ago.'
1. State your sequence for this pediatric drowning arrest and explain how it differs from an adult 'call first' approach.
Read the worked answer
Sequence:
- Open the airway (head-tilt/chin-lift - avoid excessive tilt in a child) and give 2 rescue breaths first. Drowning is a hypoxic arrest; oxygenation is the priority, so ventilation comes before compressions.
- Begin compressions - for a small child, either one or two hands is acceptable depending on size; depth about one-third of chest AP diameter (~5 cm / 2 in for a child), rate 100–120/min, ratio 30:2 for a single rescuer (15:2 for two rescuers).
- Call for help and get the AED - but in a lone-rescuer pediatric arrest with a likely hypoxic cause, you provide about 1 minute (5 cycles) of CPR before leaving to call, rather than the adult 'call first' rule. Here the neighbor is present, so delegate the 911 call and the AED retrieval immediately while you ventilate and compress. Judgment point: the pediatric sequence is airway/breathing first, and the lone-rescuer rule is CPR-first for ~1 minute before activating - the opposite of the adult default.
2. How do you handle the vomit and the water, and what is the evidence-based position on attempting to 'drain' the water from the lungs?
Read the worked answer
Clear the mouth of vomit with a wipe or finger sweep of visible material, and use the barrier device for the 2 breaths. Do not attempt to drain water from the lungs - no abdominal thrusts, no inverted positioning, no prolonged drainage maneuvers. Attempted drainage delays ventilation and compressions, risks aspiration of gastric contents, and does not improve oxygenation. A brief lateral roll to clear the oropharynx is acceptable; then return to supine and resume. The judgment tested: the instinct to 'get the water out' is a harmful delay; the treatment for drowning is ventilation and CPR.
3. The neighbor offers to help. Assign roles and specify how you modify compressions and ventilations for a 15 kg child with two rescuers.
Read the worked answer
Assign the neighbor to call 911 on speaker and retrieve the AED, then return to ventilate while you compress (or vice versa based on her comfort) - but confirm she can deliver effective breaths; if not, she calls and you ventilate. With two rescuers, switch to 15:2 for the child. Compression depth ~one-third AP diameter (~5 cm); use one hand or two hands based on what achieves adequate depth without exceeding it. The AED, when it arrives, should be used - pediatric pads/attenuator if available, otherwise adult pads placed so they do not touch each other; do not withhold defibrillation for lack of pediatric pads. Swap compressors every 2 minutes. Judgment point: a rusty helper is useful for calling and AED retrieval even if her CPR skills are stale - match tasks to competence rather than excluding her.