Drowning is defined as the process of experiencing respiratory impairment from submersion or immersion in liquid.
Drowning is a leading cause of injury and death among young people.
It has been estimated that 80% to 90% of all drownings are preventable.
Hypoxaemia is the primary cause of morbidity and mortality, and its reversal must remain the focus of treatment.
The 'Drowning Chain of Survival' refers to a series of interventions that, when put into action by laypersons or professionals, may reduce morbidity and mortality associated with drowning.
Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. This process is a continuum beginning with respiratory impairment as the victim's airway goes below the surface of the liquid (submersion) or when water splashes over the face (immersion). If the victim is rescued at any time, the process of drowning is interrupted, resulting in a non-fatal drowning. Any submersion or immersion incident without evidence of respiratory impairment (aspiration) should be considered a water rescue rather than a drowning. Terms such as 'near-drowning', 'dry or wet drowning', 'active and passive drowning', 'secondary', and 'delayed onset of respiratory distress' should not be used.
History and exam
Key diagnostic factors
- presence of risk factors
- respiratory impairment
- evidence of submersion or immersion
Other diagnostic factors
- signs of trauma
- age (1-4 years)
- male sex
- alcohol or drug intake
- swimming alone/diving
- lack of awareness of water hazard risks
- lack of swimming ability
- cardiac disease
- seizure disorder
1st investigations to order
- pulse oximetry/arterial blood gases
- chest x-ray
- basic metabolic panel
Investigations to consider
- cervical spine CT
- creatine kinase
- serum alcohol and urine drugs of abuse
- serum cardiac biomarkers
- anticonvulsant medication levels
grade 1 (cough with normal lung auscultation)
grade 2 (rales in some pulmonary fields)
grade 3 (acute pulmonary oedema with no hypotension or shock)
grade 4 (acute pulmonary oedema with hypotension or shock)
grade 5 (no spontaneous ventilation, carotid pulse present)
grade 6 (cardiopulmonary arrest)
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