Makindo Medical Notes.com

Attempts should not be made to clear the fluid mechanically from the lungs as most fluid will be reabsorbed. Drowning can occur with dry lungs in 10% as there is a reflex severe laryngospasm that protects the lungs but death is due to asphyxia.

About

• Third leading cause of accidental death in the United States
• Mandatory use of lifejackets may reduce events
• Consider head injuries and alcohol which may change picture

Aetiology: they all cause hypoxia

• Hypoxic Brain damage can begin within minutes of submersion due to lack of oxygen
• Leads to potentially leading to cognitive impairments, coma, or death.
• Hypoxia leads to cardiac arrest and death if untreated
• Hypothermia may help and be protective. The cold can also cause a cold shock response

Types

• Freshwater Drowning e.g. rivers and lakes and swimming pools: water can quickly enter the bloodstream through the lungs, leading to haemodilution (dilution of the blood), haemolysis (rupture of red blood cells), and hyperkalemia (elevated potassium levels), which can cause cardiac arrhythmias.
• Saltwater Drowning e.g sea and oceans: Saltwater, being hypertonic, can draw fluid out of the bloodstream into the lungs, causing pulmonary oedema and hypovolemia (reduced blood volume).

Complications

• Acute Respiratory Distress Syndrome (ARDS)
• Post-Immersion Syndrome
• Hypoxic brain injury
• Multiorgan Dysfunction Syndrome (MODS)
• Pneumonia due to Contaminated water

Investigations

• FBC, U&E, Troponin, ECG, CXR, ABG
• CT Chest : ARDS
• CT Brain may be considered

Better Prognosis

• Short Submersion (< 5 minutes):
• Cold Water Drowning
• Immediate CPR and Advanced Medical Care
• Conscious and Breathing
• Unconscious but Breathing:
• Aspiration of water into the lungs

Management

• Remove patient from water. ABCs. Give 100% O₂.
• May need ALS: CPR if pulseless/apnoeic
• Intubated and Ventilate. CPAP may be very useful to improve oxygenation
• Rewarming gradually for hypothermia and monitor for ARDS
• Careful management of fluids is necessary to avoid worsening pulmonary edema.
• Consider the possibility of spinal or head injury if a dive or trauma was involved
• Drowning also seen with alcohol or another drug misuse