Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- respiratory impairment
- evidence of submersion or immersion
Other diagnostic factors
- hypothermia
- signs of trauma
Risk factors
- age (1-4 years)
- male sex
- alcohol or drug intake
- swimming alone/diving
- lack of awareness of water hazard risks
- exposure to water
- lack of swimming ability
- cardiac disease
- seizure disorder
Diagnostic investigations
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 misuse
- ECG
- serum cardiac biomarkers
- anticonvulsant medication levels
Treatment algorithm
all patients
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)
Contributors
Authors
David Szpilman, MD
Medical Director - Brazilian Lifesaving Society - Sobrasa
Lieutenant Colonel MD, retired - Fire Department of Rio de Janeiro
Civil Defense Rio de Janeiro City - Education adviser Defesa Civil Municipal do Rio de Janeiro
Co-founder - International Drowning Researcher's Alliance - IDRA
Rio de Janeiro
Brazil
Disclosures
DS is an author of several references cited in this topic.
Justin Sempsrott, MD, FAAEM
Executive Director: Lifeguards Without Borders
Medical Director: International Surf Lifesaving Association
Medical Director: Innovative Attraction Management Starguard Elite
Kuna
ID
Disclosures
JS has received compensation for expert testimony in court cases involving drowning.
Andrew Schmidt, DO, MPH
Associate Professor
Department of Emergency Medicine
University of Florida College of Medicine - Jacksonville
Medical Director: Jacksonville Beach Ocean Rescue
Deputy Medical Director: Trauma One
Jacksonville
FL
Disclosures
AS declares that he has no competing interests.
Acknowledgements
Dr David Szpilman, Dr Justin Sempsrott, and Dr Andrew Schmidt would like to gratefully acknowledge Dr Bhakti K. Patel and Dr D. Kyle Hogarth, previous contributors to this topic.
Disclosures
BKP and DKL declare that they have no competing interests.
Peer reviewers
Ajeet G. Vinayak, MD
Assistant Professor of Internal Medicine
Department of Medicine
Division of Pulmonary and Critical Care Medicine
Charlottesville
VA
Disclosures
AGV declares that he has no competing interests.
Richard Franklin, PhD
Associate Professor
James Cook University
Townsville
Queensland
Australia
Disclosures
RF declares that he has no competing interests.
Guidelines
- European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances
- Guideline 9.3.2 - resuscitation in drowning
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