Drowning is defined as “the process of experiencing respiratory impairment due to submersion/immersion in a liquid.”

 

Pathophysiology:

  • Drowning occurs as the patient’s airway is submerged below water. Initially, the patient will try to hold his/her breath for approx. 1 minute, followed by involuntary inspiration and subsequent introduction of water into the airway. If submersion continues, hypoxia generally leads to LOC.
  • Entrance of water into the airway can lead to alveolar damage and pulmonary edema.¬†Drowning can also cause neurologic damage (2/2 hypoxia) and cardiac injury (ischemia and possible arrest).

Management:

  • Pre-hospital care focuses on the evaluation and support of the patient’s airway, breathing, and circulation.
  • In the ED, assessment of the airway, breathing, circulation, as well as any disability should take place. All wet clothing should be removed and the patient fully exposed to evaluate for possible trauma, and then the patient should be covered with blankets with any additional warming measures to prevent or correct hypothermia.
  • Key tests to consider: VBG/ABG, ethanol level, FSG, troponin, EKG, electrolytes, creatinine and CK, CBC, type and screen and coagulation panel, and CXR.
  • Head CT should be considered in all patients with AMS or focal neurologic deficit to assess for TBI. In patients who cannot participate in a full neurologic exam, CT C-spine should be considered to evaluate for spinal fracture.
  • Patients presenting with hypoxia should receive concentrated oxygen delivery (via NRB, NIPPV or mechanical ventilation, as indicated) to minimize risk of hypoxic injury with goal SaO2 90-95% to reduce potential for hyperoxic lung injury or possible neuronal injury 2/2 hyperoxia. For patients requiring mechanical ventilation, an ARDS-type strategy is advised.

Disposition:

  • Patients who are asymptomatic or have mild symptoms can be observed for 4-8 hrs and discharged if no new symptoms develop and they have normal vitals.
  • Patients with hypoxia refractory to NC/NRB, continued dyspnea, or AMS after 4-8 hrs should be admitted for further care.

Schmidt A, Sempsrott J. Drowning in the Adult Population: Emergency Department Resuscitation and Treatment. Emergency Medicine Practice. 2015;17(5):1-20.