(Near-Drowning; Submersion Incident)
Drowning is defined as death caused by lack of oxygen within 24 hours of a drowning accident. The term “near-drowning” indicates a situation when someone lives for 24 hours or more after a drowning accident, whether or not the person survives. Drowning accidents are emergencies that require immediate care from a doctor.
- Drowning and near-drowning injuries are caused by a lack of oxygen because of accidental suffocation in water.
- Water in the lungs, particularly water contaminated by bacteria, algae, sand, dirt, chemicals, or vomit can cause lung injury.
- Fresh water is more dangerous than salt water because it causes more severe injury to the lungs.
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
- Toddler, especially under the age of one
- Ages: 15-24 (especially teenage males)
- Gender: male
- Race: black
- Location: domestic swimming pools, home wells, and unattended canals or quarries
- Inability to swim
- Use of drugs or alcohol prior to incident
- Horseplay or unsafe diving resulting in trauma]]>
- Child abuse
- Prior medical condition, such as seizures, syncopal episodes, cardiac conditions, and ]]>hypoglycemia]]>
Children are most often the victims of drowning. The following factors increase a child’s risk of drowning:
- Not knowing how to swim
- Having an unfenced pool or spa in the home
- Among children less than one year old, the most common risk factor for drowning is being left in a bathtub unattended, even for a few minutes
The following factors increase your risk of drowning:
- Risk-taking behavior around pools or other bodies of water, especially combined with use of drugs and/or alcohol
- Not knowing how to swim
People rescued from drowning may have symptoms ranging from anxiety]]> to near-death. They may be alert, drowsy, or comatose. Some people may not breathe or may gasp for breath, vomit, cough, or wheeze. Breathing problems may not happen until several hours after a drowning accident. Skin may look blue (“cyanotic”) because of too little oxygen in the blood. Cold water exposure may result in low body temperature (hypothermia). Swallowing large quantities of water may result in chemical (electrolyte) disturbances.
Your doctor will diagnose a drowning injury based on the events and the person's symptoms and results of a physical examination. Tests may include the following:
- Oximetry—a test that measures the amount of oxygen in the blood
- Chest X-rays]]> —to find out whether and how badly the lungs are damaged
- Additional X-rays—to look for breaks in the skull, spine, or other bones
- ]]>Computed tomography]]> and ]]>Magnetic Resonance Imaging]]> —tests that use computer images to find injuries inside the body. Doctors may use these tests to look for damage to the spine or to the brain or other organs.
Brain Damage from Lack of Oxygen
Treatment options include:
Cardiopulmonary Resuscitation (CPR)
In all unconscious people and those who have been diving, the head and neck should be supported in case of injuries to the spine.
This is a narrow, flexible, plastic tube that will likely be placed through the nose into the stomach, as people with drowning injuries may have swallowed a lot of water.
This is done if the body has become cold due to being in cold water. This may be done slowly to avoid further injury to the body.
For this treatment, a narrow tube is placed into the large airways of the lungs to keep them from collapsing and to allow mechanical ventilation if necessary.
Nasogastric (purple) and Endotracheal Intubation
To help reduce chances that that you or someone you know will drown, take the following steps:
- Never leave children alone with any body of water (eg, pool, bath tub, spa).
- Have your child take swimming lessons. Remember that even a child who knows how to swim is still at risk for drowning and will need constant supervision.
- A fence or barrier should completely enclose your pool or spa. All gates or doors leading from the house to the pool area should have a self-closing, self-latching mechanism that is above the reach of toddlers and young children. You may want to get a pool alarm or rigid pool cover in addition to the fence and gates.
- If you use a lightweight, floating pool cover, be extra alert to the potential for drowning accidents. These covers do not keep people from falling in, and no one should ever crawl or walk on them.
- Remove any obstacles to allow a full view of the pool or spa from the house.
- Body parts and hair can be trapped in the pool drains. Be sure that the pool has drain covers or a filter system to release the suction.
- Ensure careful supervision of all guests if alcoholic beverages are served at spa- or poolside.
- When swimming in open water, choose an area where there is a lifeguard.
- Always wear life vests when boating.
- There is a risk of drowning during the winter time, as well. Warn children and others about the danger of walking or skating on thin ice.
- Do not allow anyone of any age to swim alone. A supervising adult should be within arm's length of infants and toddlers who are swimming. The adult should know how to swim, be able to rescue someone, and do CPR.
American Academy of Pediatrics
American Red Cross
Canadian Red Cross
Children’s Safety Association of Canada
Auerbach. Wilderness Medicine . 4th ed. Mosby, Inc; 2001.
Driscoll TR, Harrison JA, Steenkamp M. Review of the role of alcohol in drowning associated with recreational aquatic activity. Inj Prev . 2004;10(2):107-113.
Drowning and near-drowning in children and adolescents: a succinct review for emergency physicians and nurses. Pediatr Emerg Care . 2005;21(9):617-619.
Harries M. Near drowning. BMJ . 2003;327(7427):1336-1338.
Salomez F, Vincent JL. Drowning: a review of epidemiology, pathophysiology, treatment, and prevention. Resuscitation . 2004;63(3):261-268.
Sibert J, John N, Jenkins D, et al. Drowning of babies in bath seats: do they provide false reassurance? Child Care Health Dev . 2005;31(3):255-259.
5/28/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Committee on Injury, Violence, and Poison Prevention. Policy statement—prevention of drowning. Pediatrics. 2010 May 24. [Epub ahead of print]
Last reviewed September 2009 by ]]>Ronald Nath, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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