One of the leading causes of mortality in children is drowning, specifically for boys between the ages of 5 and 14. Unsurprisingly, over 500,000 drowning related deaths occur around the world each year, with the main causes being hypoxic injury as well as respiratory failure. Read on for more information about drowning, and how a drowning victim should be approached in an emergency medical setting.
Let’s start with explaining what actually occurs in the human body when somebody is drowning. According to the World Health Organization, drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. When a person goes through the experience of drowning, they experience laryngospasm caused by small amounts of water getting into their lungs. This eventually leads to hypoxia, followed by loss of consciousness, respiratory failure and finally cardiac arrest. Pulmonary aspiration can also occur at small volumes which don’t get in the way of airways but have the ability to cause chemical changes in the body. Because of this, resuscitation for drowning focuses on reversing respiratory failure and hypothermia.
The symptoms usually associated with drowning can be different depending on how long they were submerged underwater. Victims with shorter submersion times typically suffer from more mild symptoms, such as coughing and shortness of breath. Occasionally they’ll experience nausea or vomiting as well. In situations where the submersion occurred for a longer period of time, symptoms can be far worse. These victims are usually at risk for hypothermia, cardiac arrest, and sometimes an altered mental status which may be secondary to hypothermia, hypoxia or head injury. It’s also important to find out how they rank on the Glasgow Coma Scale (GCS), as having a decreased score once arriving in the emergency department can increase the odds of cardiac arrest occurring as well as having poor neurological outcomes later down the line.
One of the most difficult aspects of treating a drowning victim is predicting the actual outcome of the drowning. A grading system known as the Szipliman Drowning Classification exists to try and help with that. The system breaks victims down into 6 grades starting with a normal pulmonary exam with coughing to cardiac arrest. Other predictors of poor outcomes include elevated liver enzymes and severe acidemia, in addition to the altered mental status and longer submersion times mentioned previously.
In regards to actual treatment, your main goals should be to provide the victim with positive pressure ventilation, active rewarming to at least 34°C and possibly extracorporeal life support (ECLS). Body temperature is always something to think about in drowning situations, regardless of the temperature of the water itself. Commons strategies for rewarming include radiant heat, heat packs and forced air, with more invasive techniques including warmed IV fluids, peritoneal lavage, and more.