Drowning (Dry, Wet, Near)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
- Drowning facts and prevention
- What is drowning and what are the statistics?
- What happens during drowning?
- Does the type of drowning matter?
- Wet vs. dry drowning
- Salt vs. fresh water drowning
- What are the risk factors of drowning?
- What are the symptoms of drowning?
- When should one seek medical care for drowning?
- How is drowning diagnosed?
- How is drowning treated?
- What are the complications of drowning?
- How can drowning be prevented?
- What is the prognosis for a drowning victim?
Drowning facts and prevention
- Drowning is defined by the World Health Organization (WHO) as "...the process of experiencing respiratory impairment from submersion or immersion in liquid."
- Drowning can be classified dry or wet, depending whether the voice box (larynx) goes into spasm and water is allowed to enter the lungs. Regardless of wet or dry, it does not change the treatment or outcome. The term "near" drowning used refer to a victim who did not die; however, this term is no longer widely used.
- Instead, WHO prefers that the type of drowning be classified based on victim outcome:
- Did they die?
- Did they survive with no impairment (morbidity)?
- Or did they survive with some physical or mental impairment.
- The causes of drowning tend to depend upon the age group of the victim.
- Infants most often drown in a bathtub,
- children most often drown in a neighborhood or backyard pool, and
- teens and young adults (age 15-25) tend to drown in natural bodies of water like rivers and lakes.
- Factors that can be a significant factor in drowning are
- Trauma from injuries such as a broken neck from diving into too shallow water, which prevents the victim form swimming.
- Medical emergencies such as
- Drowning tends to be a quiet, silent act. Victims do not usually thrash. Instead they expend significant energy trying to keep their head above water and may be too tired to shout for help; moreover, if water comes into contact with the vocal cords, they can go into spasm and prevent the victim from shouting for help. Often, the victim is found floating or at the bottom of the body of water or the tub.
- Drowning is described as a panicked experience. While the victim may appear to be bobbing in the water with their head back, there may be the expression of panic in their eyes.
- Tips to recognize a person that may be in danger of drowning begin with a reminder that while water is to be enjoyed, it is also a potentially dangerous environment and needs to be treated with respect.
- Try to be within arms reach of small children and do not be distracted by other activities.
- Watch for anyone who seems to be swimming ineffectively or are bobbing in the water in an uncoordinated way, and whose head drops underwater. The victim may try to roll onto their back, but it is not always be successful.
- The victim rarely thrashes, instead they may have feeble attempts at swimming and often there are repeated attempts to roll over onto their back, keeping their head above water. Too often, though, the first sign that the victim is in trouble is when their body is found floating and lifeless.
- Drowning is diagnosed based upon history. The victim is found struggling in the water and most often has difficulty breathing. Any person who has breathing compromised and has been immersed in water can be said to have drowned.
- Treatment for drowning begins with recognizing that the victim is in trouble, and assessing whether they are awake and breathing. If there has been a traumatic event, like diving into shallow water, the risk of a broken neck should be considered and the neck kept immobilized. If the victim is not breathing on their own or breathing ineffectively, then rescue berating needs to be administered. If there is no heartbeat, then CPR needs to be started. This is the one situation when hands only CPR is not adequate. All drowning victims need to be assessed in a hospital and it is reasonable to immediately activate emergency services and call 911.
- Drowning is preventable.
- Learn how to swim, and should swim with a buddy.
- Don't swim alone.
- Never leave infants alone in a bathtub, sink, etc.
- Supervise children when near water.
- Swimming pools should be fenced with locked gates and inaccessible t unsupervised kids.
- Alcohol should be consumed in moderation when swimming or boating.
- Water flotation devices should always be used during activities on the water, for example, kayaking, jet skis, boats. The Coast Guard recommends and many states require wearing lifejackets.
- Drowning victims who arrive in the emergency department awake and breathing on their own have a good prognosis for recovery. Those patients who are not fully awake or who need support breathing have varying recoveries. Prognosis is better if the immersion time is shorter; the water is cleaner and colder. Prognosis also is better for younger individuals compared with the elderly.
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