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March 21, 2010
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Drowning and Near-Drowning: Prevention and Treatment
Dipak Chandy, M.D.
Dr. Chandy is Assistant Professor Of Medicine, New York Medical College.
If you do not think of drowning as a major health problem, you probably do not work in an emergency room. Drowning is the third most common cause of accidental death in the United States, causing almost 8,000 deaths each year. Worldwide about 150,000 people drown annually. Statistical reporting on near-drowning is unreliable, but experts have estimated that there may be 600 near-drowning incidents for every reported drowning death.(1) One reason that near-drownings are difficult to count is that the term is not easy to define exactly. The standard medical definition of near-drowning is survival, at least temporarily, after suffocation by submersion in water or other liquid.(2) Authorities differ on whether to include loss of consciousness as a criterion. Others draw a distinction between "wet near-drowning", in which fluid is aspirated into the lungs,(3) and "dry near-drowning." Who is at Risk?
There are two times in your life when you are at the greatest risk of drowning. The first is when you are five years old or younger. The classic scenario is the child left unattended or poorly supervised near a swimming pool or bathtub. The second peak is when you are between 15 and 25 years old. Overwhelmingly males, victims in this category tend to drown while enjoying themselves at rivers, lakes, and beaches. Alcohol or illegal drugs are often involved.(4) More than 50% of adult drowning deaths are believed to be alcohol-related.5
If you were to rank, by importance, the risk factors that contribute to drowning and near-drowning, the list would look like this:
Salt Water vs. Fresh Water Drowning
Medical authorities traditionally made a great distinction between salt water and fresh water drownings.(8) The theory was that because of its high salt content, sea water in the lungs would affect the body very differently from fresh water in a variety of ways. Although this is true in theory, very few survivors of near-drowning ingest enough water to make a difference and this rarely becomes an issue in treating patients who arrive at the hospital.(9) In practice, water temperature and the presence of any contaminants are much more important considerations.
How Near-Drowning Damages the Body
Most of the effects of near-drowning on the body fall into one of two categories. The first includes interference with or stopping of breathing and the damage this does to the lungs, heart, brain and nervous system. The second includes all of the problems brought on by altered (usually lowered) body temperature, something that happens when we spend any length of time immersed in liquid.
When taken into the lungs, both salt and fresh water have the effect of washing out surfactant, the thin coating which bathes the inside of the lungs. The loss of surfactant creates breathing problems of its own, including pulmonary edema, fluid in the lung tissue, which can in turn bring on ARDS, or acute respiratory distress syndrome. Signs and symptoms of ARDS include shortness of breath and wheezing. When the flow of air to the lungs is obstructed, the results include hypoxia (lowered levels of oxygen in the blood) and ischemia (loss of blood flow to the extremities). These lead to immediate neurological problems, including swelling of the brain and dangerous increases in intracranial pressure.(10) About 20% of near-drowning victims sustain neurological damage; this is the number one cause when near-drowning victims cannot be revived after rescue.(11) Hypoxia and heart arrhythmia brought on by lowered body temperature are the most common heart and circulatory problems seen in near-drowning victims.(12) Finally, electrolyte imbalances are a serious but extremely rare occurence in near-drowning survivors. They happen in cases such as immersion in a liquid other than water, or in an exceptional environment such as the Dead Sea, whose high salt content can lead to life-threatening changes in the victim's magnesium and calcium levels.(13) You might also be interested in... 
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Comment by: BIG DAWG
Mon., Feb. 8, 2010 at 4:39 pm EST well what if you dont have a first aid kit and r in the grand canyon? |
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