Drowning

• Management

  1. Prehospital / Resuscitation (ABCs):
     • Hypoxic arrest is primary mechanism; prioritize airway & oxygenation.
     • Initiate rescue breathing ASAP (even in water).
     • C-spine immobilization only if trauma is suspected (routine use delays airway mgmt).
     • Remove wet clothing, initiate active rewarming if hypothermic.
  2. Mild/Asymptomatic (Normal SpO2, clear lungs, normal GCS):
     • Observe for 4-8 hours in ED. c
       • Patients are at high risk of developing delayed noncardiogenic pulmonary edema (ARDS). The onset of respiratory failure can occur insidiously up to 8 hours after the initial submersion event.
     • If clinical exam & SpO2 remain normal, safe to discharge.
  3. Symptomatic (Resp distress, SpO2 <95%, abnormal CXR):
     • Supplemental O2.
     • Non-invasive ventilation (CPAP/BiPAP) or Intubation with high PEEP if severe (treats underlying ARDS/surfactant washout).
  4. Refractory/Special Considerations:
     • Target SpO2 94-98%.
     • High-Yield Negative: DO NOT give empiric antibiotics or systemic corticosteroids (no proven benefit, may cause harm). Abx reserved for documented subsequent infection (fever/infiltrates > 72 hrs post-submersion).

• Complications

  • ARDS: Due to aspiration-induced surfactant washout and alveolar capillary membrane injury.
  • Hypoxic-Ischemic Encephalopathy (HIE): Primary determinant of long-term morbidity/mortality. See Elevated intracranial pressure c
  • Pneumonia: Typically late (>48-72 hrs). Pathogens depend on water source (e.g., Aeromonas hydrophila, Pseudomonas, Burkholderia in freshwater/stagnant water).
  • Arrhythmias: V-fib or bradycardia secondary to hypoxemia or severe hypothermia.