1. DROWNING
By
dr. pirah korai
CMC LARKANA

2. OUTLINES
•Definition
•Epidemiology
•Types
•Key risk factors
•Pathophysiology
•Difference b/w fresh water and sea water drowning
•Rescue and initial resusitation
•Hospital management
•complications
•Medico-legal aspect
•Prevention

3. “Drowning is the process of experiencing
respiratory impairment from
submersion/immersion in liquid.”
WHO

4. 3rd leading cause of death in the world
0.7% of all deaths worldwide — or more than 500,000 deaths each year,
are due to unintentional drowning.
 For every person who dies from drowning, another four persons receive
care in the emergency department for nonfatal drowning
EPIDEMIOLOGY

5. 1) Non-fatal Drowning
2) Fatal Drowning
TYPES

6. Loadshedding
INFLATION
CORRUPTION
UNEMPLOYMENT

7. Any submersionor immersionincident without evidence of respiratory
impairment should be considereda waterrescue and not a drowning.
Terms suchas “near drowning,”“dry or wet drowning,”“secondary
drowning,”“active and passive drowning,”and “delayedonset of
respiratory distress” should be avoided.
WHOGuidelines 2002

8.  Male
 age of less than 14 years
 alcohol use
 lowincome & poor education
 Rural residency
 aquatic exposure
 riskybehavior
 lack of supervision
KEY RISK FACTORs

9. •The victimstruggles to keephis or her head above the water
•After the head submergesor drops belowthe water surface, breathholdingoccurs
•Whenwater enters the upper airways, it causes the larynxto go intospasm
•Most often the spasmrelaxes, allowingwater throughthe larynx intothe bronchial tree and
the lungs.
PATHOPHYSIOLOGY

10. •Approximately10%to 20%of drowningvictims have persistent laryngeal
spasm and no fluid is foundin theirlungs on autopsy.
•The brainstops functioningwithin just a fewminutes without oxygen, and
permanent damage occurs if there is no oxygen for more than six minutes.
•The heart muscleneeds oxygen to function and deadly, irregularheart
rhythms mayoccur withoxygendeprivation

11. DROWNING IN
FRESH WATER
v/S
SALT WATER

13. RESCUE ANDIN-WATER RESUSCITATION
Lessthan6% of allrescuedpersonsneedmedicalattentionandjust0.5%needCPR.
Fora personwhois unconscious, in-waterresuscitationwithventilationaloneisindicated.
Immobilizationof thespineinthe waterisindicatedonlyin casesinwhichheador neckinjuryisstrongly
suspected
 Rescuersshouldtryto maintaintherescuedperson
ina verticalpositionwhilekeepingtheairwayopen.

14. INITIAL RESUSCITATION ON LAND
 If the rescued person is breathing then adopt recovery position
(Lateral Decubitus)
 If he is unconscious then place him supine, with trunK
and head at same level
 Do CPR follow the traditional ABC sequence.
 5 initial rescue breaths followed by 30 chest compressions & continue with 5 rescue breaths & 30 compressions until the
signs of life reappear or advanced life support becomes available
(EUROPEANRESUSITATIONCOUNCIL RECOMMENDATIONS)

16. HOSPITAL
MANAGEMENT

17. Drowning
Signs and Symptoms
 Abdominal distention
 Bluish skin of the face, especially
around the lips
 Chest pain
 Cold skin and pale appearance
 Confusion
 Cough with pink, frothy sputum
 Irritability
 Lethargy
 No breathing
 Restlessness
 Shallow or gasping respirations
 Unconsciousness
 Vomiting

19. ICU MANAGEMENT
GENERAL MEASURES
•NormalizeGlucose
•MaintainpO2 within normal range
•Induce Hypothermiawithcore temperature maintainedb/w 32 to 34 for 24 hours.

20. RESPIRATORY SYSTEM:
•Guidelines of ARDs be followed:
-Bronchodilators
-Glucocorticoids
-Extracorporeal membrane oxygenation
-Artificial surfactant
-Inhaled Nitric oxide
-Partial liquid ventilation with perfluorocarbons
-not to use prophylactic antibiotics
CIRCULATORY SYSTEM:
-Inotropic agents
-vasopressors
-while diuretics and water restriction not recommended

21. • Cardiac(cardiac arrest, bradycardia, myocardial infarction).
• Pulmonary (pulmonary oedema, pneumonia).
• Neurological (stroke, cerebral hypoxia, cerebral oedema).
• Renal (renal failure).
• Haematological (haemolysis).
• Metabolic(hyperkalaemia, acidosis).
• Infective (pneumonia, septicaemia).
COMPLICATIONZ

23. Medico-legal aspects
of Drowning

25. It is estimated that more than 85% of cases of drowning can be prevented by
supervision, swimming instruction, technology, regulation, and public
education
Prevention