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.
In this Article
- What is drowning and what are the statistics?
- What happens during drowning?
- What are the complications of 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?
- How can drowning be prevented?
- What is the prognosis for a drowning victim?
Salt vs. fresh water drowning
In the lung, the breathing tubes (trachea, bronchi, bronchioles) branch into smaller and smaller segments until they end in an air pocket called an alveolus (plural alveoli). This is the part of the lung where air and red blood cells in capillary blood vessels come near enough to allow the transfer of oxygen and carbon dioxide between the two. Alveoli are covered with a chemical called surfactant that allows the air pocket to open and close easily when breathing occurs.
When fresh water enters an alveolus, it destroys the surfactant and causes the alveoli to collapse, unable to open with breathing. A mismatch can develop where blood is pumped to parts of lung where no oxygen is available to be absorbed. This may lead to a decrease in the concentration of oxygen in the blood called a ventilation-perfusion mismatch.
Salt water doesn't destroy surfactant, rather it washes it away and damages the membrane between the alveolus and the capillary blood vessel. One again, the body sends blood flow to areas of the lung that aren't able to provide it oxygen, and hypoxemia occurs.
Regardless of the type of water, lung function is compromised because of the lack of surfactant, and the effect it has on lung function. In some circumstances, electrolyte abnormalities may occur with fresh water drowning.
What are the risk factors of drowning?
There are two peak ages for drowning: children aged younger than 4 and young adults aged 15 to 25.
- Infants less than one year old most often drown in bathtubs.
- Children younger than age 5 most commonly drown in residential swimming pools.
- Young adults tend to drown in larger bodies of water (for example, rivers and lakes). Neck fractures caused by diving into shallow water are associated with drowning in this age group. Alcohol is also implicated in up to 50% of drownings in this age group.
- Medical emergencies that occur in the water also can lead to drowning. These may include, among others, seizures, heart attack (myocardial infarction), sudden cardiac death, and hypoglycemia (low blood sugar in a person with diabetes).
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