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  • • Effects of drowning or near-drowning are due to hypoxemia and aspiration

    • Physiologic effects of salt water aspiration are different than those of fresh water aspiration

    • -Salt water aspiration produces hypovolemia, hemoconcentration, and hypertonicity but not hemolysis

      -Aspirated fresh water is quickly absorbed across the alveoli, leads to hypervolemia, hypotonicity, hemolysis, and electrolyte abnormalities

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Epidemiology

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  • • Major cause of accidental death in United States

    • Particularly common among children

    • 5500 deaths per year

    • Up to 50 deaths per day in summer

    • 25% of victims are teenagers; 20% are younger than 10 years

    • 85% of victims are male

    • Most cases in United States occur in fresh water

    • Alcohol plays a role in 40% of adult drownings

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Symptoms and Signs

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  • • Hypoxemia

    • Neurologic impairment/unconsciousness

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  • • Evaluate for associated injuries (from a dive or fall) or toxic substances (drugs or alcohol)

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  • • After restoring ventilation

    • -Physical exam

      -Chest film

      -ABG measurements

      -Blood alcohol levels and drug screen

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  • • Immediate restoration of ventilation

    • Do not waste time trying to empty lungs of aspirated water

    • Correct residual hypoxemia, acidosis, and electrolyte abnormalities

    • Endotracheal intubation and mechanical ventilation often necessary

    • Aspiration of gastric contents or drowning fluid at time of near-drowning is cause of late fatalities

    • Prophylactic antibiotics and steroids have not shown benefit

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Complications

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  • • Aspiration-related late acute respiratory failure

    • Red cell lysis (hypotonicity) can lead to hemoglobinuria and acute renal failure

    • Neurologic injury related to hypoxia

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References

Thompson DC. Rivara FP. Pool fencing for preventing drowning in children. Cochrane Database of Systematic Reviews, 2000: (2):CD001047.
Kendrick D. Coupland C. Mulvaney C. Simpson J. Smith SJ. Sutton A. Watson M. Woods A. Home safety education and provision of safety equipment for injury prevention. Cochrane Database of Systematic Reviews, 2007 (1):CD005014.

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