Cold Water Immersion
                           ====================

þ Case:  66 minutes of cold submersion with complete recovery; after 3 hours of
  CPR and cardiopulmonary bypass (Boite RG, Black PG, Bowers RS, Thorne JK,
  Corneli HM.  The use of extracorporeal rewarming in a child submerged for 66
  minutes.  JAMA 1988;260(3):377-379.)  (19 other case reports:  10 degrees C or
  less, young people)

þ Many people from the Air Florida crash lasted an hour in the cold.

þ How does cold kill?  Skin receptors cause a sudden increase in
  Cardiac arrhythmias
  Laryngospasm
  Hyperventilation (ventilation increases about 5-fold over the first 5 minutes
    then abates); may drown
  Muscle and nerve dysfunction causes ataxia and inability to tread water.

þ Dropping people into 10 degree C water; core temperature doesn't drop for
  about 20 minutes.

þ Diving reflex requires prolonged voluntary breath holding.

þ Agonal respiration and aspiration of cold water is probably main factor in the
  marked hypothermia in survivals of cold-water near drowning.

þ Hot-tub near-drowning: tend to get overwhelming Pseudomonas pneumonia, so
  start antibiotics early; otherwise no need for antibiotics.