Drowning

Last reviewed: 27 Aug 2023

Last updated: 13 Jul 2021

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.

Hypoxemia 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.

Definition

Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid.[1] 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 nonfatal 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.[1][2]

History and exam

Key diagnostic factors

presence of risk factors
respiratory impairment
evidence of submersion or immersion

More key diagnostic factors

Other diagnostic factors

hypothermia
signs of trauma

Other diagnostic factors

Risk factors

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

More risk factors

Diagnostic investigations

1st investigations to order

pulse oximetry/arterial blood gases
chest radiography
basic metabolic panel

More 1st investigations to order

Investigations to consider

cervical spine CT
creatine kinase
serum alcohol and urine drugs of abuse
ECG
serum cardiac biomarkers
anticonvulsant medication levels

More investigations to consider

Treatment algorithm

INITIAL

all patients

ACUTE

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: Starfish Aquatics Institute

Medical Director: Innovative Attraction Management Starguard Elite

Board of Directors: Safer 3 Water Safety Foundation

Staff: Global Outreach Doctors

Jacksonville Beach

Disclosures

JS has given expert testimony in court cases involving drowning.

Andrew Schmidt, DO, MPH

Assistant Professor

Department of Emergency Medicine

University of Florida College of Medicine - Jacksonville

Medical Director

Jacksonville Beach Ocean Rescue

Deputy Medical Director

Trauma One

Jacksonville

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. 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

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 European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances
- Resuscitation guidelines
More Guidelines
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Drowning

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

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

Disclosures

Justin Sempsrott, MD, FAAEM

Disclosures

Andrew Schmidt, DO, MPH

Disclosures

Acknowledgements

Peer reviewers

Ajeet G. Vinayak, MD

Disclosures

Richard Franklin, PhD

Disclosures

Guidelines

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