Drowning facts and prevention
What is drowning and what are the statistics?
According to WHO, "Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid." The possible outcomes of drowning are classified as death, morbidity (the development of disability or injury), and no morbidity.
This simple definition was agreed upon at the 2002 World Congress of Drowning held in Amsterdam. Prior to that meeting, some definitions and classifications of drowning were not necessarily well defined, and their meanings were subject to a variety of interpretations by different countries and health organizations. While some people still try to sort drowning events into categories (for example wet vs. dry, primary vs. secondary, fatal vs. non-fatal), these terms may or may not adequately describe a patient's situation, the effects of drowning on their body, or the potential outcome.
Drowning statisticsWhat happens during drowning?
Drowning occurs when water comes into contact with the larynx (voice box).
Does the type of drowning matter?
There have been a variety of theories reported regarding the potential responses of the body to different drowning situations. Most discuss dry vs. wet drowning and salt vs. fresh water drowning.
Wet vs. dry drowning
Most drownings are unwitnessed, and the victim is found floating. While only a small amount of aspirated water is required to cause significant problems with lung function, it is the prolonged submersion time and lack of breathing that causes complications due to hypoxemia.
Approximately 10% to 20% of drowning victims have dry drowning with no water found in the lungs at autopsy, but even most wet drowning victims have less than 4cc/kg of water found in their lungs. For a 50 pound child, this amounts to less than 3 ounces of water.
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 surfactan; 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.
What are the symptoms of drowning?
The consequences and symptoms of drowning vary widely. A drowning victim may show no symptoms and have no complaints, or may be found dead.
It is the rare person who is found thrashing in water. Instead, most drownings are unwitnessed and the person is found floating or submerged in the water.
For those who are alive, they may be anxious, confused, and short of breath. Again, it is the function of the brain and lungs that are the main concerns in drowning victims.
Special situationsYoung children may have a mammalian diving reflex that occurs when drowning occurs in very cold water. When suddenly immersed in cold water less than 68 F (20 C), the victim can stop breathing, slow their heart rate dramatically, and shunt all the blood flow to the heart and brain. Though not common, these children may be resuscitated and return to normal function. Cases have been reported of survival, even after being underwater for an hour.
When should one seek medical care for drowning?
All individuals who are victims of drowning, even if they have no symptoms, should be evaluated by a health care professional. Sometimes, subtle information will be revealed that may make the diagnosis of an underlying medical condition.
How is drowning diagnosed?
The initial evaluation of any drowning victim will begin with a history of the events.
Physical examination will begin with taking and monitoring the vital signs (the ABCs will be evaluated - airway, breathing, and circulation). Careful examination of the whole body will be required, especially focusing on the neurological examination to assess brain function. Lung and heart examination will also be performed.
If trauma or a diving injury is a consideration, the neck and spine may be immobilized to protect against potential spinal cord damage.
Laboratory and X-ray testing will be utilized depending upon the situation and potential injuries.
What is drowning and what are the statistics?
According to WHO, "Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid." The possible outcomes of drowning are classified as death, morbidity (the development of disability or injury), and no morbidity.
This simple definition was agreed upon at the 2002 World Congress of Drowning held in Amsterdam. Prior to that meeting, some definitions and classifications of drowning were not necessarily well defined, and their meanings were subject to a variety of interpretations by different countries and health organizations. While some people still try to sort drowning events into categories (for example wet vs. dry, primary vs. secondary, fatal vs. non-fatal), these terms may or may not adequately describe a patient's situation, the effects of drowning on their body, or the potential outcome.
Drowning statisticsWhat happens during drowning?
Drowning occurs when water comes into contact with the larynx (voice box).
Does the type of drowning matter?
There have been a variety of theories reported regarding the potential responses of the body to different drowning situations. Most discuss dry vs. wet drowning and salt vs. fresh water drowning.
Wet vs. dry drowning
Most drownings are unwitnessed, and the victim is found floating. While only a small amount of aspirated water is required to cause significant problems with lung function, it is the prolonged submersion time and lack of breathing that causes complications due to hypoxemia.
Approximately 10% to 20% of drowning victims have dry drowning with no water found in the lungs at autopsy, but even most wet drowning victims have less than 4cc/kg of water found in their lungs. For a 50 pound child, this amounts to less than 3 ounces of water.
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 surfactan; 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.
What are the symptoms of drowning?
The consequences and symptoms of drowning vary widely. A drowning victim may show no symptoms and have no complaints, or may be found dead.
It is the rare person who is found thrashing in water. Instead, most drownings are unwitnessed and the person is found floating or submerged in the water.
For those who are alive, they may be anxious, confused, and short of breath. Again, it is the function of the brain and lungs that are the main concerns in drowning victims.
Special situationsYoung children may have a mammalian diving reflex that occurs when drowning occurs in very cold water. When suddenly immersed in cold water less than 68 F (20 C), the victim can stop breathing, slow their heart rate dramatically, and shunt all the blood flow to the heart and brain. Though not common, these children may be resuscitated and return to normal function. Cases have been reported of survival, even after being underwater for an hour.
When should one seek medical care for drowning?
All individuals who are victims of drowning, even if they have no symptoms, should be evaluated by a health care professional. Sometimes, subtle information will be revealed that may make the diagnosis of an underlying medical condition.
How is drowning diagnosed?
The initial evaluation of any drowning victim will begin with a history of the events.
Physical examination will begin with taking and monitoring the vital signs (the ABCs will be evaluated - airway, breathing, and circulation). Careful examination of the whole body will be required, especially focusing on the neurological examination to assess brain function. Lung and heart examination will also be performed.
If trauma or a diving injury is a consideration, the neck and spine may be immobilized to protect against potential spinal cord damage.
Laboratory and X-ray testing will be utilized depending upon the situation and potential injuries.
Source: http://www.rxlist.com
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