34. Drowning (Submersion Injury)

Summary Drowning is defined as respiratory impairment caused by submersion in a liquid media. There are 3 outcomes; death, death with long term morbidity, and death without long term morbidity. Children are at particularly high risk. Over half of adult drowning involve alcohol. Most drownings are preventable. Morbidity and Mortality Drowning victims struggle to stay above water or may just be unconscious. Eventually rising blood CO2 levels trigger a breath. This leads to aspiration. Eventually hypoxia develops leading to tissue injury. This leads to hypoxic brain injury and finally death if the victim is not rescued. Worldwide, at least 500,000 people die a year from drowning, mostly in developing nations. Drowning is the leading cause of death in children age 1 to 4 years. Story When New Zealand was first being settled by European colonizers, so many people died trying to cross rivers that drowning became known as the New Zealand Death. Alcohol, dangerous beaches, and flash floods also contributed to the increased incidence of drowning deaths. Key Points 1. Children, men, having a low income, being African American, having seizures, being elderly with health problems, inability to swim, and substance use are all risk factors for drowning. 2. learning to swim, being honest about swimming ability, using the buddy system, putting physical barriers around pools, having proper supervision, and using proper flotation devices can all prevent drowning. 3. Rescuers should be careful to not become a second victim. Remembering scene safety as well as the phrase reach, throw, row, go is very important. 4. Resuscitation should start with 2 good rescue breaths followed by high quality CPR. Remove wet clothing and begin warming the drowning victim immediately. 5. BIPAP and intubation are often utilized in the hospital setting for symptomatic drowning victims with significant pulmonary edema. Be sure to drain the stomach with and nasogastric tube to prevent further aspiration. Asymptomatic drowning victims are usually observed for 4 to 8 hours before they are allowed to return home. References - Auerbach’s Wilderness Medicine, 7th Ed. Chapters on Marine Medicine. Ch 69-78 (1530-1794). 2017 - Schmidt et al. WMS Practice Guidelines for the Prevention and Treatment of Drowning. 27(236-251). 2016. - Uptodate.com. Submersion Injuries - Wikipedia. drowning, free diving blackouts, etc - CDC and WHO websites - The New Zealand Death. Available at: https://ricky1871.wordpress.com/2013/06/14/376/ - Personal Experience as an EMT and physician