- Drowning is the second most common cause of nonintentional death in children and adolescents, with a bimodal distribution of peak incidence between the ages of 1 and 4 years and 11 and 14 years.
- While wet, dry, fresh water, and salt water drowning differ in pathophysiology, there is little difference in their clinical presentation and management.
- Early oxygenation and resuscitation, including establishment of an airway and provision of chest compressions, are the most important interventions in determining prognosis and survival.
- Poor prognostic indicators include prolonged submersion, asystole upon emergency department (ED) arrival, and delay in effective cardiopulmonary resuscitation.
- Hypothermia from immersion in extremely cold water may exert a protective effect, especially if the hypothermic event occurs before the immersion.
- Patients who have been asymptomatic and remain so, with a normal CXR and oxygenation, may be discharged after a 6-hour observation period.
In the past, there have been a number of terms associated with drowning that caused much confusion. Medical literature has used terms such as near-drowning (survival from a submersion event beyond 24 hours) and secondary drowning (drowning because of another abnormality that triggered the event).1,2 In 2002, the World Congress on Drowning published the following consensus definition for drowning.
“Drowning is a process resulting from primary respiratory impairment from submersion/immersion in a liquid medium.” Given this definition, duration of survival and initial cause of submersion are irrelevant. This chapter will use this definition for drowning and will identify mortality as “death from drowning.”3
Drowning is the second leading cause of death from unintentional injuries in children aged from 1 to 14 years. It is the leading cause of death in children aged from 1 to 4 years. Males are more likely to drown than females in all age groups, with the highest rate in the 0 to 4 age group.4
Drowning occurs when airway submersion impairs respiration and causes hypoxia. The pathophysiology surrounding this event is complex and influenced by a number of factors (Table 137–1). Drowning medium, water temperature, associated trauma, and patient-specific factors are just a few of them. Despite the multitude of influencing variables, the primary insult is always hypoxia.
Table 137-1. Pathophysiology of Drowning |Favorite Table|Download (.pdf)
Table 137-1. Pathophysiology of Drowning
Fresh water: surfactant washout and atelectasis
Salt water: pulmonary edema
V/Q mismatch and shunt
Cerebral ischemia caused by hypoxia
Cerebral edema and increased ICP
Decreased cardiac output
Significant electrolyte changes are rare
After the patient is submerged, he or she aspirates a small amount of water causing reflex laryngospasm. Apnea leads to hypoxia and loss of consciousness. Once unconscious, most patients will aspirate a moderate amount of water. Approximately 10% of patients will maintain laryngospasm, causing what was previously described ...