Drowning

• • 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

Epidemiology

• • 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

Symptoms and Signs

• • Hypoxemia

  • Neurologic impairment/unconsciousness

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

• • After restoring ventilation

  • -Physical exam

    -Chest film

    -ABG measurements

    -Blood alcohol levels and drug screen

• • 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

Complications

• • Aspiration-related late acute respiratory failure

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

  • Neurologic injury related to hypoxia

References