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ESSENTIALS OF DIAGNOSIS
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ESSENTIALS OF DIAGNOSIS
The first requirement of rescue is immediate rescue breathing and CPR.
Clinical manifestations include hypoxemia, pulmonary edema, and hypoventilation.
Patients must be assessed for hypothermia, hypoglycemia, alcohol intake, concurrent injuries, and medical conditions.
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GENERAL CONSIDERATIONS
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Drowning, as defined by the World Health Organization, is any “process resulting in primary respiratory impairment from submersion in a liquid medium.” A panel of experts reached consensus that this definition be universally used to describe all such incidents, regardless of whether the outcome was fatal. The panel recommended previously used terms such as near-drowning, wet-drowning, dry-drowning, and silent drowning be eliminated from use as the final common pathway is the same (ie, hypoxemia leading to cardiopulmonary arrest). Drowning may result in asphyxiation (from fluid aspiration or laryngospasm), hypoxemia, hypothermia, and acidemia. Outcomes from drowning range from life without morbidity to death. Morbidity may be immediate or delayed. The asphyxia of drowning is usually due to aspiration of fluid (previously known as “wet drowning”), but it may result from airway obstruction caused by laryngeal spasm while the person is gasping under water (previously known as “dry drowning”). The rapid sequence of events after submersion—hypoxemia, laryngospasm, fluid aspiration, ineffective circulation, brain injury, and brain death—may take place within 5–10 minutes. This sequence may be delayed for longer periods if the person, especially a child, has been submerged in very cold water or if the person has ingested significant amounts of sedative medications. Laryngospasm develops in about 10% of persons after the first gulp and water is never aspirated. Immersion in cold water can also cause a rapid fall in the person’s core body temperature, so that systemic hypothermia and death may occur before actual drowning. The primary effect is hypoxemia due to perfusion of poorly ventilated alveoli, intrapulmonary shunting, and decreased compliance. A patient may be deceptively asymptomatic during the initial recovery period only to deteriorate or die from acute respiratory failure within the following 12–24 hours. Disseminated intravascular coagulation may also lead to bleeding after asphyxiation from drowning.
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Spontaneous return of consciousness often occurs in otherwise healthy individuals when submersion is very brief. Many patients respond promptly to immediate ventilation. Others, with more severe degrees of drowning, may have frank respiratory failure, pulmonary edema, shock, anoxic encephalopathy, cerebral edema, and cardiac arrest.
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Drowning is a leading cause of death in children worldwide and is highly preventable in all ages with implementation of educational and safety measures. Clinicians must provide patient education and guidance about drowning prevention. In April 2021, the UN General Assembly adopted the first-ever resolution on drowning prevention, providing a comprehensive framework and practical roadmap to address the challenges of drowning prevention on an international level.
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A. Symptoms and Signs
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The patient’s appearance may vary from asymptomatic to marked distress ...