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drowning

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Submersion in and suffocation by a liquid.

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INCIDENCE: In the U.S., drowning is the second most common cause of traumatic death in children and the third most common cause of death by trauma in any age group. In the U.S., approximately 3800 deaths and 5900 ER visits result from drowning each year. Near drowning occurs about 100 times as commonly as drowning.

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CAUSES: The injuries suffered result from holding one's breath ("dry drowning"), the aspiration of water into the lungs ("wet drowning"), and/or hypothermia.

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RISK FACTORS: A primary risk for drowning by children and adolescents is swimming or playing near water without adult supervision. Other important contributing factors to many drowning episodes include: lack of barriers around bodies of water, alcohol and drug use, inadequate use of flotation devices, and boating accidents. Seizure disorders increase the risk of drowning by about 15-fold relative to the population at large. Drowning is also unfortunately a common means of committing suicide.

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SYMPTOMS AND SIGNS: Common symptoms of drowning result from oxygen deprivation, retention of carbon dioxide, or direct damage to the lungs by water. These include cough, dyspnea, coma, and seizures. Additional complications of prolonged immersion may include aspiration pneumonitis, noncardiogenic pulmonary edema, electrolyte disorders, hemolysis, disseminated intravascular coagulation, and arrhythmias.

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PHYSIOLOGY: Drowning is a unique form of respiratory trauma. The drowning victim suffers damage to alveolar capillary membranes in the lungs, which leak fluids into the alveoli, dilute surfactant, and impair gas exchange. The inability to exchange gases results in asphyxia, inadequate oxygen supply to the brain, and within minutes, loss of consciousness.

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DIAGNOSIS: The diagnosis is usually readily apparent, based on the patient's presentation or the reports of witnesses or first responders. The diagnosis is supported by chest x-rays, which typically resemble pneumonia or, when capnography is immediately available, high levels of retained carbon dioxide.

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PREVENTION: Water safety practices reduce the likelihood of drowning. These include: providing lifeguards, skilled rescuers, or adult supervision for young children in swimming areas; avoiding aggressive boating practices; avoiding the use of intoxicants; and wearing personal flotation devices.

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TREATMENT: Resuscitative efforts for the drowning victim should begin in the water. Unlike victims of cardiac arrest, where chest compressions should be given first, in drowning the resuscitation of the patient begins with rescue breathing. As soon as a bag-valve-mask is available, breathing should be supported with this device. One hundred percent oxygen should be provided. Patients who cannot be easily ventilated or who cannot protect their airway, should be intubated and mechanically ventilated.

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IMPACT ON HEALTH: The outlook for the patient who has submerged in liquid is closely linked to the duration of the submersion, the minute ventilation of the patient, ...

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