Drowning: Pathophysiology and Changing Trends In Management

Surjit Singh, Ovais Karnain Wadoo Wadoo, Sangeeta Gupta, Baljinder Singh, Shikha Baisakhiya


Drowning is the second largest killer among accidental
deaths next only to vehicular accidents. Children at play
and adults enjoying holidays/ recreation are the most
susceptible victims of sheer misfortune. The new definition
adopted by the WHO in 2002, "Drowning is the process of
experiencing respiratory impairment from submersion/
immersion in liquid." When a drowning person is not able
to keep his airway clear, water enters the mouth but is
voluntarily spat out or swallowed. The next conscious
response is to hold one's breath, but this lasts for no more
than about a few minutes depending upon individual (9).
When the inspiratory drive is too high to resist, some
amount of water is aspirated into the airways, and coughing
occurs as a reflex response. The whole drowning process,
from submersion or immersion to cardiac arrest, usually
occurs in seconds to a few minutes, but in unusual
situations, such as hypothermia or drowning in ice water,
this process can last for an hour. For management it is
essential to call for emergency medical services and to
undertake rescue and resuscitation immediately. A doctor,
when approached, should continue resuscitation with
intermittent positive pressure respiration and 100% O . At 2
an organized rescue and life saving set up additional
equipment like AMBU adult and baby resuscitators and
AMBU emergency case system containing resuscitators,
suction pump, intubation equipment and oxygen supply
m u s t b e k e p t . T h i s r e v i e w w i l l h i g h l i g h t t h e
pathophysiology and various forms of drowning and latest
trends in management.

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