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High-Yield Facts

  • 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.

  • Poor prognostic indicators include prolonged submersion asystole upon emergency department (ED) arrival and delay in effective cardiopulmonary resuscitation.

  • Patients who have been asymptomatic and remain so, with a normal CXR and oxygenation, may be discharged after a 6-hour observation period.

Drowning is a major global health problem with significant mortality and morbidity in children.1,2 It is the most preventable cause of unintentional injury in children. Children younger than 14 years of age comprise about 20% of all drowning victims. For every death secondary to drowning, there are five emergency department visits for submersion-related injuries.3

Drowning is the second leading cause of death from unintentional injuries in children aged from 1 to 14 years.4 It is the leading cause of death in children aged from 1 to 4 years, with home swimming pools being the most common site of occurrence.

Risk Factors57

  • Males are more likely to drown than females in all age groups, with the highest rate in the 0–4-year-old age group.8,9

  • The fatality drowning rate of African-American children is three times that of Caucasian children.

  • Low-income countries have the majority of drowning-related deaths (98.1%) as compared to middle- and high-income countries.5

  • Poverty, education level of parents, number of children in the family, and ethnicity have also been associated with an increased risk of drowning.7

In the past, there have been a number of terms associated with drowning that caused much confusion.10 Therefore, in 2002, the World Congress on Drowning published the following consensus definition for drowning.11

“Drowning is a process resulting from primary respiratory impairment from submersion/immersion in a liquid medium.”4 Drowning outcomes have been given the classification as either: death, morbidity, and no morbidity.

The terminologies that were previously used such as dry drowning, wet, active, silent, secondary and near drowning should no longer be utilized according to The International Liaison Committee on Resuscitation advisory statement recommendations.12

The most common locations where children drown are seas/oceans, lakes, streams, swimming pools, wells, cisterns, buckets, bathtubs, spas, and garden ponds.13

Drowning Process

The drowning process is comprised of a continued series of events beginning from the point when the victim's airway lies below the water surface. This result in lack of oxygen and failure to eliminate carbon dioxide leading to hypoxemia, hypercarbia, and acidosis.14 The pathophysiology surrounding this event is complex and influenced by a number of factors (Table 136-1). Drowning medium, water temperature, associated trauma, and patient-specific factors are just ...

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