Drowning
Definition
Death caused by water reaching the lungs and
either causing lung tissue damage or spasms of the
air way that prevents the inhalation of air.
Drawing can happen in many different places,
Lake, swamp and spring, rivers etc
Drowning, First aid Management
You should begin artificial respiration as soon as
possible
Do not wait to get water out of the patient’s chest
first If you can not get air into his/her lungs,
quickly turn the patient on his/her side, putting
his head lower than the leg and push the body
Then give mouth-to-mouth artificial respiration.
If the condition of the victim is not improving
refer the victim to the next health facility.
Drowning
Prehospital care and acute interventions — Rescue and immediate
resuscitation by bystanders improves the outcome of drowning
victims. The need for cardiopulmonary resuscitation (CPR) is
determined as soon as possible without compromising the safety of the
rescuer or delaying the removal of the victim from the water.
Ventilation is the most important initial treatment for victims of
submersion injury and rescue breathing should begin as soon as the
rescuer reaches shallow water or a stable surface. Note that the
priorities of CPR in the drowning victim differ from those in the
typical adult cardiac arrest patient, which emphasize immediate
uninterrupted chest compressions. If the patient does not respond to the
delivery of two rescue breaths that make the chest rise, the rescuer
should immediately begin performing high-quality chest compressions.
CPR, including the application of an automated external defibrillator,
is then performed according to standard guidelines.
Drowning…
Cervical spinal cord injury is uncommon in
nonfatal drowning victims, unless there are
clinical signs of injury or a concerning
mechanism (eg, dive into shallow water).
According to the 2010 AHA Guidelines for
Advanced Cardiac Life Support (ACLS),
routine cervical spine immobilization can
interfere with essential airway management
and is not recommended.
Drowning patients can present with life-threatening arrhythmias,
and these are treated according to ACLS protocols. Pulses may be
very weak and difficult to palpate in the hypothermic patient with
sinus bradycardia or atrial fibrillation; a careful search for pulses
should be performed for at least one minute before initiating chest
compressions in the hypothermic patient because these
arrhythmias require no immediate treatment. If the patient does
not respond to the delivery of two rescue breaths that make the
chest rise, the rescuer should immediately begin performing high-
quality chest compressions once the absence of a pulse is
established in the hypothermic patient. CPR is then performed
according to standard BLS guidelines.
END ORGAN EFFECTS
Hypoxemia ultimately produces tissue hypoxia, which
affects virtually all tissues and organs within the body.
Pulmonary — Fluid aspiration results in varying
degrees of hypoxemia. Both salt water and fresh water
wash out surfactant, often producing noncardiogenic
pulmonary edema and the acute respiratory distress
syndrome (ARDS). Pulmonary insufficiency can
develop insidiously or rapidly; signs and symptoms
include shortness of breath, crackles, and wheezing.
END ORGAN EFFECTS…
Neurologic — Hypoxemia and ischemia cause
neuronal damage, which can produce cerebral edema
and elevations in intracranial pressure.
Cardiovascular — Arrhythmias secondary to
hypothermia and hypoxemia are often observed in
nonfatal drowning victims
END ORGAN EFFECTS…
The initial arrhythmias described following nonfatal drowning include
sinus tachycardia, sinus bradycardia, and atrial fibrillation. In addition,
swimming (including diving) can precipitate fatal ventricular arrhythmias
in patients with congenital long QT syndrome type 1.
Acid-base and electrolytes — A metabolic and/or respiratory acidosis is
often observed. Significant electrolyte imbalances generally do not occur
in nonfatal drowning survivors except those submerged in unusual media,
such as the Dead Sea, where the extremely concentrated seawater can
produce life-threatening hypernatremia, hypermagnesemia, and
hypercalcemia due to absorption of swallowed seawater.
Renal — Renal failure rarely can occur after submersion, and is usually
due to acute tubular necrosis resulting from hypoxemia, shock,
hemoglobinuria, or myoglobinuria .
Coagulation — Hemolysis and coagulopathy are rare potential
complications of nonfatal drowning .
PREVENTION
Drowning is preventable in most cases.
Secure fencing and gating of swimming pools can
exclude virtually all children under the age of four
The importance of adequate adult supervision
Swimming with a partner,
Appropriate use of personal flotation devices,
Avoidance of alcohol and illicit drugs while
swimming or boating
Parents must also be warned that toddlers can
drown in shallow areas, including toilets and
buckets of water, if not adequately supervised.
OUTCOME
The following factors at presentation have been
associated with a poor prognosis:
Duration of submersion >10 minutes
Time to effective basic life support >10 minutes
Resuscitation duration >25 minutes
Water temperature >10ºC (50ºF)
Age <3 years
Glasgow coma scale <5 (comatose)
Persistent apnea and requirement of cardiopulmonary
resuscitation in the emergency department
Arterial blood pH <7.1 upon presentation
