DROWNING

Source: http://emedicine.medscape.com/article/772753-overview

Author G Patricia Cantwell, MD, FCCM Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami, Leonard M Miller School of Medicine; Medical Director, Palliative Care Team, Director, Pediatric Critical Care Transport, Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Manager, FEMA, Urban Search and Rescue, South Florida, Task Force 2; Pediatric Medical Director, Tilli Kids Pediatric Initiative, Division of Hospice Care Southeast Florida, Inc

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association,American Trauma Society, National Association of EMS

Physicians, Society of Critical Care Medicine, and Wilderness Medical Society

Drowning remains a significant public health concern, as it is a major cause of disability and death, particularly in children.[1] At least one third of survivors sustain moderate to severe neurologic sequelae. Exact definitions of drowning have varied widely.[2] Drowning was previously defined as death secondary to asphyxia while immersed in a liquid, usually water, or within 24 hours of submersion. At the 2002 World Congress on Drowning, held in Amsterdam, a group of experts suggested a new consensus definition for drowning in order to decrease the confusion over the number of terms and definitions (>20) referring to this process that have appeared in the literature.[3] The group believed that a uniform definition would allow more accurate analysis and comparison of studies, allow researchers to draw more meaningful conclusions from pooled data, and improve the ease of surveillance and prevention activities. The new definition states that drowning is a process resulting in primary respiratory impairment from submersion in a liquid medium. Implicit in this definition is that a liquid-air interface is present at the entrance to the victim's airway, which prevents the individual from breathing oxygen. Outcome may include delayed morbidity, delayed or rapid death, or life

without morbidity. The terms wet drowning, dry drowning, active or passive drowning, neardrowning, secondary drowning, and silent drowning would be discarded. Drowning usually occurs silently and rapidly. The classic image of a victim helplessly gasping and thrashing in the water rarely is reported. A more ominous scenario of a motionless individual floating in the water or quietly disappearing beneath the surface is more typical. Drowning may be further classified as cold-water or warm-water injury. Warm-water drowning occurs at water temperatures of 20C or higher, and cold-water drowning occurs at water temperatures of less than 20C. Although ice-cold water has been reported to be protective, especially in young children,[4] prolonged immersions can nullify the effect of temperature on survivability[5] . Additional classification may include the type of water in which the submersion occurred, such as freshwater and saltwater, or natural bodies of water versus man made. Although initial treatment of submersion victims is not affected by the type of water, serum electrolyte derangements may be related to the salinity of the water (particularly if large amounts of water are ingested), while long-term infectious complications are primarily related to whether the victim was submersed in a natural or a man-made body of water[6] . Immediate threats include effects on the central nervous and cardiovascular systems (see Workup). Thus, the most critical actions in the immediate management of drowning victims include prompt correction of hypoxemia and acidosis (see Treatment). The degree of CNS injury depends on the severity and duration of hypoxia. Posthypoxic cerebral hypoperfusion may occur. Long-term effects of cerebral hypoxia, including vegetative survival, are the most devastating (see Treatment). Prevention is key for reducing morbidity and mortality from drowning. Community education is the key to prevention (see Patient Education and Deterrence/Prevention.)