A Dive into Drowning – Part One

For the arrested drowning patient, begin with rescue breaths first, not chest compressions. Avoid outdated and irrelevant drowning terms such as secondary, near, dry, wet, freshwater and saltwater drowning.

 A Dive into Drowning – Part Two

If the patient in-front of you is well-appearing 6-hours out from the drowning event, with normal vitals and a clear chest, you should confidently reassure them. They will not drown in their sleep! This is a terrifying myth that we should work to dispel.

Air Care Series: Drowning

Terms like “near-drowning” or “dry drowning” are ambiguous and have fallen out of favor with drowning experts and the medical community in general. If the patient has no respiratory impairment this is considered a water rescue and not a drowning.

Definitions and Debunking Drowning Myths

Despite the prevalence of drowning, there is no widely-accepted protocol for the management of pediatric drowning victims. For example, the utility of a chest x-ray will stir significant debate, even without supporting evidence to obtain one.

Drowning & Submersion Injury: No Lifeguard on Duty

Any symptomatic patient requiring supplemental oxygen requires ICU admission. Duration of submersion is the most important factor for survival outcomes and carries a much higher mortality rate if >5 minutes.

Drowning and Resuscitation: It's ABC not CAB

Symptomatic patients should be intubated if there are signs of neurologic deterioration, inability to protect the airway, or inability to maintain oxygen saturation above 90% despite use of a high-flow oxygen-delivery system or noninvasive ventilation.

Drowning and Submersion Injuries

The care of a submerged person should focus on ventilation. Loss of surfactant, pulmonary edema, and hypoxia from V/Q mismatch are all results of fluid aspiration in submersion injuries. Hypoxemia is the leading cause for cardiac arrest and neurologic dysfunction, and therefore ventilation should be the main priority

Drowning Myths, Missteps, and Pro-Tips: The Truth about Submersion Events

The best predictor of outcome is neurologic status over the first 24 hours after drowning.

Drowning Prevention Tips for Children

Drowning is the number one cause of injury-related death in children ages 1-4 and the number two cause in children ages 5-14 after motor vehicle accidents. And for every death, another seven children receive care in the emergency department for nonfatal drownings. The risk for pediatric drowning triples when children have their first birthday because they are mobile and curious, but most can’t swim. So how do you keep your little ones safe this summer? Remembering to swim “SAFER” can help.

Drowning: A brief primer on submersion injuries

In awake, moderately-ill patients, continuous positive airway pressure (CPAP) is appropriate if their PaO2 is less than 80 (child) or 60 (adult).

Drowning: A brief primer on submersion injuries

As one of the most common causes of death worldwide, drowning is a significant public health problem. Yet, terminology such as near drowning, secondary drowning and dry drowning are often inconsistent and confusing.

Hypoxic, Hypotensive, & Hypothermic: Focused Resuscitation in Drowning

Upon presentation to the ED, patients can be graded using the Szpilman Classification for Drowning to gauge the severity of illness and predict mortality. This is based on physical exam only, where patients presenting without cough and having clear lungs score a Grade 1 classification predicting a 0% mortality rate. However, patients with hypotension, diffuse rales, and foam in the airway have a 20% mortality rate. Those who present in cardiac arrest have only 7% chance of survival.

Pediatric Drowning and Hypothermia

Pediatric hypothermic cardiac arrest is rare, shrouded in urban legend, and confounded by significant publication bias. While amazing outcomes can occur, there is generally a very high mortality rate.

Pediatric Drowning: In Over Your Head

Patients who are breathing spontaneously and maintaining their oxygen saturation >90%, or their partial pressure of oxygen >90 mmHg with a fraction of inspired oxygen (FiO2) of 50%, may be observed with oxygen alone under continuous pulse oximetry monitoring.3 In individuals who do not meet the above criteria, a trial of NIPPV may be considered. For those who are unable to maintain their airway, rapid sequence intubation is definitive management.

POTD: Drowning

Rewarm to 34C as quickly as possible; remove wet clothes, insulate with blankets, forced air warmer, warmed IVF, warmed lavage bladder, peritoneal, and chest lavage.

Resuscitation of a Drowning Victim: A Literature Review

Does the composition of inhaled water matter? Should abdominal thrusts be applied? No and no. Both are common misconceptions. Volume, rather than composition, determines pulmonary derangement. Inhaled water causes loss of surfactant, alveolar collapse, noncardiogenic edema, intrapulmonary shunting, and VQ mismatch.9 Patients often require immediate positive pressure ventilation with high FiO2. Contrary to popular culture, abdominal thrusts are not indicated. These patients are at high risk of regurgitation and further aspiration.

Resuscitation of a Drowning Victim: A Literature Review

Although providers are typically taught to be aware of possible trauma (e.g. cervical spine fracture) when evaluating a drowning case, less than 0.5% of drownings are traumatic. The duration of immersion, volume of aspirated fluid, and water temperature dictate clinical outcomes.

Sink or Swim: The management of submersion injuries

Fluid aspiration can lead to loss of surfactant, pulmonary edema, and hypoxemia from V/Q mismatch. Hypoxemia is the primary cause of end-organ damage in submersion injuries (typically cardiac and neurologic) and treating it should be your top priority.

The Myth of Dry Drowning Remains at Large

Drowning continues to be a leading cause of injury death worldwide, especially among children. Hypoxemia and subsequent cerebral hypoxia are the primary causes of morbidity and mortality, and their immediate reversal should be the goal of any initial intervention.

‘Drowning’ in a Sea of Misinformation

Cases where a person has mild to moderate symptoms after a drowning incident, such as cough, pulmonary edema (fluid in the lungs), or confusion, are far more common than fatal drownings. It is often quoted in the media that this type of drowning is rare, but that is incorrect. It is actually the most common presentation of drowning.

“Dry drowning” the summer medical oxymoron

Undoubtedly you will see a child with a “near drowning” if you work in the ED during the summer. Most children are fine, even those that received some back blows, mouth to mouth or some semblance of bystander rescue maneuvers. Asymptomatic children (no respiratory symptoms) can be safely discharged home. Those that are having difficulty breathing or other symptoms should receive appropriate respiratory support and be followed closely clinically and with chest x-rays when the situation changes. All symptomatic children should be admitted to the hospital.