Pathophysiology

• Breath-holding until eventual involuntary gasp which triggers reflexive laryngospasm. Resultant loss of consciousness may cause laryngeal relaxation and aspiration.
• Fluid aspiration results in decreased surfactant activity and atelectasis. This is complicated by V/Q mismatch and atelectrauma which can lead to ARDS.

Symptoms

• Progressive respiratory distress
• AMS: due to cerebral hypoxia
• Shock: uncommon, consider trauma

Management

• Albuterol
• BiPAP
• Endotracheal intubation
• ECMO

Disposition

• Asymptomatic or minor event: observe 2-3 hours
• Mildly symptomatic: observe 4-6 hours
• Hypoxia: admit
• PPV: ICU