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 tests
1st tests to order
- pulse oximetry/blood gas
- chest radiography
- basic metabolic panel
Tests to consider
- cervical spine CT
- creatine kinase
- serum alcohol and urine drugs of misuse
- ECG
- serum cardiac biomarkers
- anticonvulsant drug levels
Treatment algorithm
all patients
grade 1 (cough with normal lung auscultation)
grade 2 (rales in some pulmonary fields)
grade 3 (acute pulmonary edema with no hypotension or shock)
grade 4 (acute pulmonary edema 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 on behalf of plaintiffs and defense. JS received a monthly stipend as the medical director for a lifeguard training and risk management company, StarGuard Elite.
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 has received compensation for expert testimony in court cases involving drowning on behalf of plaintiffs and defense.
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.
References
Key articles
European Resuscitation Council. European Resuscitation Council Guidelines 2021. 2021 [internet publication].Full text
Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 Oct 20;142(16 suppl 2):S366-468.Full text
The Resuscitation Council (UK). Resuscitation guidelines. 2021 [internet publication].Full text
Davis CA, Schmidt AC, Sempsrott JR, et al. Wilderness Medical Society clinical practice guidelines for the treatment and prevention of drowning: 2024 update. Wilderness Environ Med. 2024 Mar;35(suppl 1):94-111S.Full text Abstract
Dezfulian C, McCallin TE, Bierens J, et al. 2024 American Heart Association and American Academy of Pediatrics focused update on special circumstances: resuscitation following drowning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2024 Dec 3;150(23):e501-16.Full text Abstract
International Life Saving Federation. International Life Saving Federation position statements. 2016 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Guidelines
- Practice guidelines for the prevention and treatment of drowning
- 2024 American Heart Association and American Red Cross guidelines for first aid
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