Near Drowning

In near drowning, the victim survives (at least temporarily) the physiologic effects of submersion in fluid. Hypoxemia and acidosis are the primary problems in victims of near drowning.

Near drowning occurs in three forms. In dry near drowning, the victim doesn't aspirate fluid but suffers respiratory obstruction or asphyxia (10% to 15% of patients). In wet near drowning, the victim aspirates fluid and suffers from asphyxia or secondary changes from fluid aspiration (about 85% of patients). In secondary near drowning, the victim suffers recurrence of respiratory distress (usually aspiration pneumonia or pulmonary edema) within minutes or 1 to 2 days after a near-drowning incident.

Causes

Near drowning typically results from an inability to swim. In swimmers, it can result from panic, a boating accident, sudden acute illness (seizure or myocardial infarction), a blow to the head while in the water, venomous stings from aquatic animals, excessive alcohol consumption before swimming, a suicide attempt, or decompression sickness from deep-water diving.

Symptoms

• Abdominal distention
• Bluish skin of the face, especially around the lips
• Cold skin and pale appearance
• Irritability
• Chest pain
• Unconsciousness
• Vomiting
• Shallow or gasping respirations

Diagnostic tests

Diagnosis relies on a physical examination of the victim and on a wide range of tests and other procedures. Blood is taken to measure oxygen levels and for many other purposes. Pulse oximetry, another way of assessing oxygen levels, involves attaching a device called a pulse oximeter to the patient's finger. An electrocardiograph is used to monitor heart activity. X rays can detect head and neck injuries and excess tissue fluid ( edema ) in the lungs.

Treatment

Prehospital care includes stabilizing the patient's neck and spine to prevent further injury, cardiopulmonary resuscitation (CPR) as needed, and supplemental oxygen.

After the patient reaches the hospital, resuscitation continues. His oxygenation and circulation are maintained. X-rays confirm cervical spine integrity, and the patient's blood pH and electrolyte imbalances are corrected. If he's hypothermic, steps are taken to rewarm him.

ABG results help guide pulmonary therapy and determine the need for sodium bicarbonate to treat metabolic acidosis.

If the patient can't maintain an open airway, has abnormal ABG levels and pH, or doesn't have spontaneous respirations, he may need endotracheal intubation and mechanical ventilation. If he develops bronchospasm, he may need bronchodilators. Central venous pressure or pulmonary artery wedge pressure indicates the need for fluid replacement and cardiac drug therapy. The patient may also require standard treatment for pulmonary edema. Nasogastric (NG) tube drainage prevents vomiting, and an indwelling urinary catheter allows monitoring of urine output.

Prevention

• Avoid drinking alcohol whenever swimming or boating.
• Observe water safety rules.
• Fence all pools and spas. Secure all the doors to the outside, and install pool and door alarms.
• If your child is missing, check the pool immediately.

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