drowning

Etiology

• greatest risk factor for adults & teenagers is alcohol (45% of adult victims)
• hypoxic blackout due to prolonged breath-holding

Epidemiology

• 4th leading cause of accidental death
• young children < 5 years of age
• young adults 15-29 years old
• blacks, males
• southern states
• 2/3 of drownings occur in fresh water

Pathology

• aspiration 85%
• laryngospasm 15%
• duration of hypoxemia is most important prognostic factor

Complications

• acute respiratory distress syndrome (ARDS)
• aspiration pneumonia
• metabolic acidosis & respiratory acidosis
• cardiac arrhythmias
• cerebral edema
• shock-induced acute tubular necrosis (ATN)
• hypothermia

Management

• basic life support: give 2 breaths before chest compressions
• American Academy of Pedicatrics Recommendations
  • counsel families of children with seizures, autism, & cardiac arrhythmias about higher risk for drowning
  • counsel adolescents & their parents about increased risk of drowning when alcohol or illicit drugs are used during boating or swimming
  • assure rather than overestimate a child's water competency
  • use the term "nonfatal drowning" rather than "near drowning"
  • increase access to swimming programs

More general terms

• trauma
• environmental exposure