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A 2-year-old child was found face down in his family's backyard pool. The family lives in Florida and the estimated pool temperature at the time of the near-drowning incident was 85°F. The parents estimate that their son was in the water for 6 to 8 minutes before being pulled out. His father began CPR immediately and Emergency Medical Services (EMS) was called. When EMS arrived, CPR was continued, but intubation was unsuccessful. The patient's heart stopped three separate times before he was eventually stabilized in the emergency department. His body temperature in the emergency room was 94°F. He was unresponsive to painful and verbal stimuli and was reliant on mechanical ventilation. His pupils were fixed and dilated at 4 mm. On admission, he had a PGCS score of 3. Two days later, he had an NSE level of 38. Both parents were emphatic that their child be “saved.” The patient is currently in the pediatric intensive care unit (PICU) 10 days after the near-drowning episode. His PGCS score is now 11. His eyes open spontaneously and he is beginning to focus on people. He is groaning and beginning to respond to tactile input by pulling the touched body part away. He is still intubated but the plan is to begin weaning him over the next few days.

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What are the possible neurologic consequences and secondary musculoskeletal impairments associated with an anoxic incident in a child?

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What is the role of the acute care physical therapist in preventing secondary impairments and preparing the child and family for transfer to a rehabilitation unit?

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What are possible medical and psychosocial complications interfering with physical therapy?

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What precautions should be taken during physical therapy interventions?

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What are function and participation expectations for a typical 2-year-old?

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  • ANOXIA: Complete lack of oxygen in blood; after 4 minutes, brain cells may begin to die; after > 5 minutes, permanent brain injury can occur
  • DECORTICATE POSTURING: Abnormal posture usually indicative of midbrain dysfunction in which the body is stiff with flexed arms and extended legs
  • DROWNING: Death from asphyxia within 24 hours of submersion
  • HYPOXIA/HYPOXEMIA: Often used interchangeably; hypoxia is insufficient oxygenation of tissues; hypoxemia is insufficient oxygenation of arterial blood
  • MAGNETIC RESONANCE IMAGING (MRI): Diagnostic tool based on signals emitted by protons when placed in a magnetic field; may be utilized several days after injury to evaluate hypoxic-ischemic damage secondary to a near-drowning episode
  • NEAR-DROWNING: Submersion episode of sufficient severity to warrant medical attention
  • NEURON SPECIFIC ENOLASE (NSE): Enzymatic marker of ischemic brain damage; increased levels in cerebrospinal fluid (CSF) taken within 72 hours after severe neurologic incident have accepted predictive value for subsequent outcome; normal NSE concentrations in CSF reported as (mean ± SD) 17.3 ± 4.6 ng/mL1,2
  • OPISTHOTONOS: Extreme form of hyperextension of the body in ...

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