Drowning (Source:revision notes)

Question 1

What is the definition of drowning (according to ILCOR)?

Answer 1

A primary respiratory impairment from submersion/immersion in a liquid medium

Question 2

What is the difference between submersion and immersion?

Answer 2

Submersion - the airway goes below the surface

Immersion - liquid splashes over the face

Question 3

What happens when you drown?

Answer 3

The breath cannot be held for much longer than a minute before the desire to breath cannot be resisted
Laryngospasm may protect the lower airways to start with, however this resolves with the onset of hypoxia and water enters the lungs
Hypoxia and LOC result in respiratory arrest

Question 4

What is the pathophysiology of drowning lung injury?

Answer 4

Water within the alveoli leads to surfactant dysfunction
The creation of an osmotic gradient across the alveolar membrane results in increased permeability of the membrane, fluid and electrolyte shift, widespread alveolar membrane-capillary damage
This results in an ARDS like picture of atelectasis, pulmonary oedema, impaired gas exchange, decreased compliance
The trans-alveolar membrane osmotic gradient created by salt water vs fresh water differs the pathophysiological process is the same
Micro-organisms and irritants e.g. chlorine may contribute to the lung injury

Question 5

What is the initial management of drowning?

Answer 5

Get patient out of the water
ABC
5 initial rescue breaths
Regurg of stomach contents very likely if CPR is required

Question 6

What is the on going management of drowning?

Answer 6

Standard ARDS care
Recovery may be faster than other lung insults
No evidence for steroids
Prophylactic antibiotics unnecessary
Severe cases may require ECMO
May have brain injury - avoid hyperthermia