Makindo Medical Notes

Attempts to clear fluid mechanically from the lungs are generally unnecessary as most fluid will be reabsorbed. Drowning can occur with dry lungs in approximately 10% of cases due to a reflexive, severe laryngospasm that prevents water entry but leads to asphyxia.

About Drowning

• Third leading cause of accidental death in the U.S.
• Mandatory lifejacket use can significantly reduce drowning incidents.
• Consider the influence of head injuries and alcohol, which may alter clinical presentation.

Aetiology: Causes of Hypoxia

• Hypoxic brain damage can begin within minutes of submersion due to oxygen deprivation.
• Hypoxia can lead to cardiac arrest and death if left untreated.
• Hypothermia may have a protective effect but can also cause a cold shock response.

Types of Drowning

Complications

• Acute Respiratory Distress Syndrome (ARDS)
• Post-Immersion Syndrome
• Hypoxic brain injury
• Multiorgan Dysfunction Syndrome (MODS)
• Pneumonia due to inhalation of contaminated water

Investigations

• Blood tests: FBC, U&E, Troponin
• ECG, CXR, and ABG analysis
• CT Chest to evaluate ARDS; CT Brain if necessary

Factors Associated with Better Prognosis

• Short submersion time (< 5 minutes)
• Cold water drowning
• Immediate CPR and advanced medical care
• Conscious and breathing
• Unconscious but breathing
• Aspiration of water into lungs without prolonged hypoxia

Management

• Remove patient from water, assess ABCs, and administer 100% oxygen.
• May require ALS: CPR if pulseless/apnoeic.
• Intubate and ventilate if needed; CPAP can be useful for oxygenation.
• Gradual rewarming for hypothermia and close monitoring for ARDS.
• Careful fluid management to prevent worsening pulmonary edema.
• Consider spinal or head injury if trauma was involved.
• Be aware of the potential role of alcohol or drugs in the incident.