Drowning

"Drown" redirects here. For other uses, see Drowning (disambiguation) and Drown (disambiguation).

Drowning
Vasily Perov: The Drowned, 1867
SpecialtyCritical care medicine
SymptomsEvent: Often occurs silently with a person found unconscious[1][2]
After rescue: Breathing problems, confusion, unconsciousness[2][3]
ComplicationsHypothermia, aspiration, acute respiratory distress syndrome[4]
Usual onsetRapid[3]
Risk factorsAlcohol use, epilepsy, access to water,[5] cold water shock, storms
Diagnostic methodBased on symptoms[3]
Differential diagnosisSuicide, seizure, murder, hypoglycemia, heart arrhythmia[2]
PreventionFencing pools, teaching children to swim, safe boating practices[6][5]
TreatmentRescue breathing, CPR, mechanical ventilation[7]
MedicationOxygen therapy, intravenous fluids, vasopressors[7]
Frequency4.5 million (2015)[8]
Deaths236,000 (2019)[6]

Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Submersion injury refers to both drowning and near-miss incident. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer assistance. After successful resuscitation, drowning victims may experience breathing problems, confusion, or unconsciousness. Occasionally, victims may not begin experiencing these symptoms until several hours after they are rescued. An incident of drowning can also cause further complications for victims due to low body temperature, aspiration, or acute respiratory distress syndrome (respiratory failure from lung inflammation).

Drowning is more likely to happen when spending extended periods of time near large bodies of water.[4][6] Risk factors for drowning include alcohol use, drug use, epilepsy, minimal swim training or a complete lack of training, and, in the case of children, a lack of supervision.[6] Common drowning locations include natural and man-made bodies of water, bathtubs, and swimming pools.[3][7]

Drowning occurs when a person spends too much time with their nose and mouth submerged in a liquid to the point of being unable to breathe. If this is not followed by an exit to the surface, low oxygen levels and excess carbon dioxide in the blood trigger a neurological state of breathing emergency, which results in increased physical distress and occasional contractions of the vocal folds.[9] Significant amounts of water usually only enter the lungs later in the process.[4]

While the word "drowning" is commonly associated with fatal results, drowning may be classified into three different types: drowning that results in death, drowning that results in long-lasting health problems, and drowning that results in no health complications.[10] Sometimes the term "near-drowning" is used in the latter cases. Among children who survive, health problems occur in about 7.5% of cases.[7]

Steps to prevent drowning include teaching children and adults to swim and to recognise unsafe water conditions, never swimming alone, use of personal flotation devices on boats and when swimming in unfavourable conditions, limiting or removing access to water (such as with fencing of swimming pools), and exercising appropriate supervision.[6][5] Treatment of victims who are not breathing should begin with opening the airway and providing five breaths of mouth-to-mouth resuscitation.[7] Cardiopulmonary resuscitation (CPR) is recommended for a person whose heart has stopped beating and has been underwater for less than an hour.[7]

Causes

Children have drowned in buckets and toilets.

A major contributor to drowning is the inability to swim. Other contributing factors include the state of the water itself, distance from a solid footing, physical impairment, or prior loss of consciousness. Anxiety brought on by fear of drowning or water itself can lead to exhaustion, thus increasing the chances of drowning.

Approximately 90% of drownings take place in freshwater (rivers, lakes, and a relatively small number of swimming pools); the remaining 10% take place in seawater.[11] Drownings in other fluids are rare and often related to industrial accidents.[12] In New Zealand's early colonial history, so many settlers died while trying to cross the rivers that drowning was called "the New Zealand death".[13]

People have drowned in as little as 30 mm (1.2 in) of water while lying face down.[14]

Death can occur due to complications following an initial drowning. Inhaled fluid can act as an irritant inside the lungs. Even small quantities can cause the extrusion of liquid into the lungs (pulmonary edema) over the following hours; this reduces the ability to exchange the air and can lead to a person "drowning in their own body fluid". Vomit and certain poisonous vapors or gases (as in chemical warfare) can have a similar effect. The reaction can take place up to 72 hours after the initial incident and may lead to a serious injury or death.[15]

  1. ^ "Drowning". CDC. 15 September 2017. Archived from the original on 10 May 2016. Retrieved 9 August 2018.
  2. ^ a b c Ferri, Fred F. (2017). Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 404. ISBN 9780323529570.
  3. ^ a b c d "Drowning – Injuries; Poisoning – Merck Manuals Professional Edition". Merck Manuals Professional Edition. September 2017. Archived from the original on 9 August 2018. Retrieved 9 August 2018.
  4. ^ a b c Handley, AJ (16 April 2014). "Drowning". BMJ (Clinical Research Ed.). 348: g1734. doi:10.1136/bmj.g1734. PMID 24740929. S2CID 220103200.
  5. ^ a b c Preventing drowning: an implementation guide (PDF). WHO. 2015. p. 2. ISBN 978-92-4-151193-3. Archived (PDF) from the original on 11 October 2020. Retrieved 9 August 2018.
  6. ^ a b c d e "Drowning". WHO. 2020. Archived from the original on 23 June 2020. Retrieved 4 October 2020.
  7. ^ a b c d e f Mott, TF; Latimer, KM (1 April 2016). "Prevention and Treatment of Drowning". American Family Physician. 93 (7): 576–582. PMID 27035042.
  8. ^ GBD 2013 Mortality and Causes of Death (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". The Lancet. 385 (9963): 117–171. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.
  9. ^ North, Robert (December 2002). "The pathophysiology of drowning". South Pacific Underwater Medicine Society Journal. 32 (4). Archived from the original on 14 March 2021. Retrieved 4 October 2020.
  10. ^ van Beeck, EF; Branche, CM; Szpilman, D; Modell, JH; Bierens, JJ (November 2005). "A new definition of drowning: towards documentation and prevention of a global public health problem". Bulletin of the World Health Organization. 83 (11): 853–6. PMC 2626470. PMID 16302042.
  11. ^ Handley, Anthony J. (16 April 2014). "Drowning". BMJ. 348: bmj.g1734. doi:10.1136/bmj.g1734. ISSN 0959-8138. PMID 24740929. S2CID 220103200. Archived from the original on 5 March 2021. Retrieved 4 October 2020.
  12. ^ "Accident Search Results Page". Occupational Safety and Health Administration. Archived from the original on 18 October 2020. Retrieved 9 December 2020.
  13. ^ Young, David (13 July 2012). "Rivers – The impact of European settlement". Te Ara: The Encyclopedia of New Zealand. Archived from the original on 2 June 2015. Retrieved 7 January 2015.
  14. ^ Gulli, Benjamin; Ciatolla, Joseph A.; Barnes, Leaugeay (2011). Emergency Care and Transportation of the Sick and Injured. Sudbury, Massachusetts: Jones and Bartlett. p. 1157. ISBN 9780763778286. Archived from the original on 25 November 2017.
  15. ^ Clarke, E. B.; Niggemann, E. H. (November 1975). "Near-drowning". Heart & Lung: The Journal of Critical Care. 4 (6): 946–955. ISSN 0147-9563. PMID 1042029.