Drowning

What is Drowning?

Drowning is when someone has trouble breathing after being under or in a liquid, usually water. The outcome of drowning can range from death to injury, or even no injury at all. It’s important to specify that terms like ‘wet drowning’, ‘dry drowning’, and ‘near-drowning’ are no longer officially used, but may still be mentioned in conversations about drowning.

Drowning is a significant and widespread issue, especially among children. It usually happens quickly and quietly. Depictions of people flailing around in the water while drowning are not typical. Most often, a person is still and calm before they sink under the water’s surface.

It’s important to note that drowning can happen in both warm and cold water, and surprisingly, cold water can sometimes protect, specifically in children. The biggest risk in drowning is damage to the heart and nervous system. Lack of oxygen and imbalance of body’s acid-base can cause death if not quickly addressed. Even those who survive could end up in a state of minimal consciousness due to extended lack of oxygen to the brain.

What Causes Drowning?

Drowning can happen when a person gets submerged in water or another fluid, which stops their body from getting oxygen to their tissues and organs.

There are a number of factors that could increase someone’s chance of drowning:

* Head injuries
* Seizure
* Irregular heartbeat
* Low blood sugar
* Low body temperature
* Using alcohol and drugs
* Suicide
* Panic attack
* Heart attack
* Depression
* Making poor decisions
* Scuba diving
* Natural disaster

In babies, drowning is usually an accident that can happen in places like a bathtub or even a bucket of water. The majority of infant drownings happen when there is no adult watching for less than 5 minutes. Older children commonly drown in swimming pools. Often, the child gets access to the pool because the gate or fence is left opened. Adults, in contrast, usually drown in natural bodies of water like lakes, rivers, and the ocean. In many adult drownings, an injury may have occurred alongside it, such as diving in shallow water and hitting a rock.

Risk Factors and Frequency for Drowning

Drowning is a significant global problem, causing an estimated 360,000 deaths each year. It equates to 7% of all deaths caused by injury and is the leading cause of death among young men. In the United States alone, around 4,000 people die from drowning each year. Additionally, for each drowning death, four other individuals require medical attention, and half of these individuals will need to be admitted to the hospital for further care.

Most drowning incidents occur in three age groups: young children (below 5 years old), teenagers, and elderly individuals. Drowning can take place in a variety of settings such as bathtubs, swimming pools, large bodies of water, or even buckets filled with rainwater.

• It is most prevalent in children, teenagers, and residents of southern states,
• More incidents of drowning happen during the summer months,
• Use of drugs or alcohol increases the risk,
• Those with existing medical conditions like heart rhythm issues or epilepsy are also more at risk.

Signs and Symptoms of Drowning

When looking at a case of drowning, it’s important to understand the circumstances around the event. This could be an accidental death, or it could be a case of murder or suicide. Notably, intentional deaths among newborns are not rare, and certain risk factors run common in these cases:

• Mother suffering from depression
• Single mother
• Very young mother
• Family experiencing financial trouble
• Difficulty in handling a newborn baby

Typically, someone who has been drowning or close to it shows signs of struggling to breathe after they’ve been under water for a while. Their skin can be blue or pale because they’re not getting enough oxygen in their blood. It’s also common to see signs of breathing problems, like apnea or shallow breaths. The person could be coughing excessively, feel very tired, or have other signs related to their nervous system.

Testing for Drowning

In cases where patients appear to be healthy, show no symptoms, and have normal oxygen levels, lab tests or imaging studies might not be necessary all the time. However, if such tests are conducted, they should be focused on the patient’s history and physical examination. For example, if a patient continues to show low levels of oxygen, they might need a chest X-ray or blood gas test. Or, if a patient has altered mental status, a head CT, blood glucose and gas tests, toxicology analysis, alcohol level test, and a metabolic panel might be required.

The most common lab irregularity in these cases is metabolic acidosis due to lactic acidosis, which refers to an excessive amount of acid in the body. That said, it’s rare to find abnormalities in body salts (electrolytes) in drowning patients who survive, regardless of the type of water they were submerged in.

Not all victims of drowning need a chest X-ray right away, and initial chest X-rays don’t usually correlate well with the patient’s symptoms or how they’ll fare long-term. However, if the patient continues to have low oxygen levels or worsened respiratory symptoms, a chest X-ray should be performed. Some patients may develop fluid build-up in the lungs, mimicking a condition known as ARDS, and this should be treated accordingly. Though, current recommendations do not suggest the routine use of anti-inflammatories, diuretics, and antibiotics as initial treatments. Antibiotics should only be given once signs of an infection start to show.

In the case of patients who are unstable, a treatment called extracorporeal membrane oxygenation (ECMO) can be considered. This is a treatment that uses a machine to take over the work of the lungs (and sometimes also the heart) when they are not functioning effectively. Therapeutic hypothermia, which is a deliberate reduction of the body’s core temperature for medical purposes, has also been suggested as a potential beneficial treatment for such patients.

Treatment Options for Drowning

In cases of non-deadly drowning, the most harm and potential for death comes from a lack of oxygen in the body, especially affecting the brain. So, in trying to save someone who has nearly drowned, the most important thing is to get oxygen flowing in their body quickly. Experts suggest that mouth-to-mouth rescue breaths should ideally start immediately. It’s best to tilt the person’s chin up and extend their airway if it’s safe. They recommend starting with five rescue breaths instead of the usual two before starting chest compressions. They discourage using the Heimlich maneuver anymore.

For those suffering from low body temperature (hypothermia), you should take their pulse for 30 seconds before deciding on whether to give CPR, as their pulse might be weak. Giving CPR to a heart that’s still in rhythm can cause dangerous irregular heartbeats. When examining or handling hypothermic patients, caution is needed to avoid triggering irregular heartbeats. You should use methods that passively and actively warm up the person’s core body temperature.

First steps in managing the patient involve delivering oxygen through a nasal cannula, a mask that covers the mouth and nose, a mask that applies positive air pressure, or a tube inserted into the windpipe (endotracheal tube). The oxygen level should be adjusted to keep the blood oxygen saturation in the range of 92% – 96% and avoid giving too much oxygen. A medication called albuterol can be inhaled via a nebulizer to relieve bronchospasms (tightening of the airways). Treatments to support the heart should be used, including advanced cardiac life support (ACLS) protocol if necessary. Fluids may need to be given intravenously, and sometimes medications to raise the blood pressure are also used if the person’s blood pressure stays low.

What else can Drowning be?

• Irregular heartbeat (arrhythmia)
• Sexual abuse of a child
• Artificially creating health problems in others (Munchausen by proxy)
• Violence related to gang initiation
• Murder (homicide)
• Violence or humiliation as part of hazing rituals
• Physical abuse of a child
• Injuries to the spinal cord
• Ending one’s own life (suicide)
• Uncontrolled heart contractions in emergencies (fibrillation)

What to expect with Drowning

Patients who are awake or slightly confused when first seen by medical staff usually have a positive outcome. However, those who are unconscious tend not to do as well. Particularly, those who are unconscious and resuscitated with CPR often suffer from severe brain injury and a condition known as hypoxic encephalopathy.

Unfortunately, between 10-30% of children with brain damage from such incidents require long-term rehabilitation. A particular technique called ‘hypothermia’ can sometimes shield the brain in some kids.

Other complications that might arise from drowning include inhalation of water, a serious lung condition called ARDs, and the most severe outcome, death.