Drowning is defined as death due to suffocation from submersion in water. The definition implies that a drowning victim develops an air-liquid interface that prevents the breathing of air. ”Near drowning” is the term used when submersion victim survives. ”Wet drowning” is the term used when fluid is aspirated into the lungs.
Clinical Features
Patients with near drowning can be grouped into three categories depending on their severity:
- Category A- Patient is awake and conscious.
- Category B- Victims are stuporous, have respiratory distress, cyanosis and hypothermia.
- Category C- Patients are comatosed and may be in flaccid state. They ultimately develop respiratory failure and apnea.
Risk Factors
- Decreased supervision (Bathtubs, buckets, toilets, swimming pools)
- Risk taking behavior ( Swimming, boating, alcohol/drug).
Sequence of Events in Drowning
- SENSE OF PANIC which is expressed by: violent struggle, automatic swimming movements, Usually followed by period of apnea. Duration: 1-2 minutes. Hypoxemia, hypercapnia may occur.
- ATTEMPT AT TAKING A BREATH: Water may be freely inhaled Or may cause glottic spasm due to impingement. Dry drowning- In 10-15 % victims: glottic spasm severe asphyxia water may not enter the lungs unless subconcious. Wet drowning: In 85-90 % victims: water is swallowed, inducing vomiting, gasping & aspiration of water into lungs. When expiratory effort is made: fine froth, sometimes blood stained.
Treatment
1. Get help
- Notify a lifeguard, if one is close. If not, ask someone to call 911.
- If you are alone, follow the steps below.
2. Move the person
- Take the person out of the water.
3. Check for breathing
- Place your ear next to the person’s mouth and nose. Do you feel air on your cheek?
- Look to see if the person’s chest is moving.
4. If the Person is Not Breathing, Check Pulse
- Check the person’s pulse for 10 seconds.
5. If There Is No Pulse, Start CPR
For an adult:
- Carefully place the person on their back.
- Place the heel of one hand on the center of the chest at the nipple line. You can also push with one hand on top of the other.
- Press down at least 2 inches. Make sure not to press on ribs.
- Do chest compressions only, at the rate of 100-120 per minute or more. Let the chest rise completely between pushes.
- Check to see if the person has started breathing.
For a child, CPR starts with rescue breathing:
- Carefully place the child on their back.
- Tilt head back and lift the chin. For a baby, be careful not to tilt the head back too far.
- With an older child, pinch the nose closed and put your mouth over the child’s mouth, forming a tight seal. With an infant, place your mouth over both the baby’s nose and mouth.
- Blow into the child’s mouth for 1 second. You should see their chest rise.
- Repeat the breath a second time.
Then begin chest compressions:
- For a child, place the heel of one hand on the center of the chest at the nipple line. For an infant, place two fingers on the breastbone.
- Press down at least 2 inches for a child, about 1 and 1/2 inches for an infant. Make sure not to press on the ribs or the end of the breastbone.
- Do 30 chest compressions, at the rate of 100 per minute. Let the chest rise completely between pushes.
- Check to see if the child has started breathing.
If you’re alone, take a break to call 911 after 2 minutes of CPR.
6. Repeat if person Is still not breathing
- If you’ve been trained in CPR, you can now add two rescue breaths to the adult CPR cycle. Open the airway by tilting the head back and lifting the chin.
- Pinch the nose of the victim closed. Take a normal breath, cover the victim’s mouth with yours to create an airtight seal, and then give 2 one-second breaths as you watch for the chest to rise.
- Give two breaths followed by 30 chest compressions.
- Continue the cycle of 30 compressions and two breaths until the person starts breathing or emergency help arrives.
Management
- Remove victim from the water as soon as possible. -Airway, breathing, and circulation.
- The aim of resuscitation at the scene is to prevent irreversible tissue injury from prolonged hypoxia and ischemia.
- Mouth-to-mouth breathing should be performed even while in the water if it can be accomplished. – The stability of the cervical spine
- Avoid prolonged attempts to remove water from the lungs
- Most drowning victims aspirate relatively small amounts of water, the Heimlich maneuver can not remove aspirated fresh water or pulmonary edema fluid.