- Definition: "The process of experiencing respiratory impairment from submersion/immersion in liquid"
- Term "near-drowning" no longer used
- Three possible outcomes = death, survival with morbidity, survival without morbidity
- Consider secondary causes such as intoxication, syncope, cardiac arrhythmia, ACS, non-accidental trauma, etc.
- Submersion → voluntary breath holding → aspiration → coughing/laryngospasm → aspiration continues → hypoxia → death
- Aspiration destroys surfactant which → alveolar collapse, atelectasis, non-cardiogenic pulmonary edema, and V-Q mismatch.
- Immersion pulmonary edema
- Marine toxins and envenomations
- Scuba diving emergencies
- Submersion injury (drowning and near-drowning)
- CXR (on arrival and after 4 hours)
- Other work-up generally not needed unless specifically indicated by history or exam, but may consider:
- Labs, EKG
- CT head/C-spine (if history of trauma) - C-spine injury extremely unlikely without evidence or history of trauma (<0.5% in large cohort study)
- Supportive care based on presentation is cornerstone of management.
- Discharge after 4-6 hours of observation if:
- Normal mental status, SpO2 >95% on room air, normal CXR and respiratory exam
- Admit all others
- World Health Organization (WHO) "Global Report on Drowning". http://www.who.int/violence_injury_prevention/global_report_drowning/Final_report_full_web.pdf (Accessed 02/01/2017)
- Szpilman, D., Bierens, J. J., Handley, A. J., & Orlowski, J. P. (2012). Drowning. N Engl J Med, 366(22), 2102-2110. doi: 10.1056/NEJMra1013317
- Watson RS, Cummings P, Quan L, et al. Cervical Spine Injuries Among Submersion victims. J Trauma 2001; 51:658.