This document defines and describes near drowning, its causes, signs and symptoms, pathophysiology, diagnostic workup, and management. Near drowning occurs when a person suffers respiratory impairment from submersion in liquid. Common causes are accidents near water and inability to swim. Signs include cold skin, coughing, and shortness of breath. Pathophysiology involves involuntary inhalation of water leading to hypoxia, tissue damage, and cardiac issues. Diagnostic workup includes blood gases, imaging, and monitoring for arrhythmias and hypothermia. Management focuses on airway support, oxygen, treating hypothermia and hypoxia, and monitoring for pulmonary edema.

1. NEAR DROWNING
RAHUL. A.P
Asst Proff;LIAHS
BPT,MPT MIAP
(CRD &ICU CARE)

2. Definition
 "Near drowning" means a person almost died from
not being able to breathe (suffocating) under water.
 A process resulting in primary respiratory
impairment from submersion in a liquid medium

3. • The majority of near-drowning cases are attributed to
accidents that occur near or in the water. The most
common causes of near-drowning include:
• an inability to swim
• panic in the water
• leaving children unattended near bodies of water
• falling through thin ice
• alcohol consumption while swimming or on a boat
• concussion, seizure, or heart attack while in water
• suicide attempt etc…

4. • Infant drownings: 55% in bathtubs
• Age 1-4 years, 56% in artificial pools and 26% in
otherbodies of freshwater
• Children 63% of drownings werein natural
bodies of freshwater

5. Signs & symptoms
• cold or bluish skin
• abdominal swelling
• chest pain
• cough
• shortness or lack of breath
• Vomiting

6. • Rales and Rhonchi An abnormal lung sound that can
be heard through a stethoscope.
• Rales may be sibilant (whistling), dry (crackling), or
wet (sloshy), depending on the amount and density
of fluid refluxing back and forth in the air passages.
• Rhonchi are continuous low pitched, rattling lung
sounds that often resemble snoring. Obstruction or
secretions in larger airways are frequent causes of
rhonchi.
• Signs of associated trauma to the head and neck
should be sought

7. PATHOPHYSIOLOGY
1. Involuntary submersion
 Voluntary apnea, hypoxia, hypercarbia
2. Involuntary inspiration
 Triggered by hypercarbia and hypoxia
 arterial hypoxemia, tissue hypoxia, tissue acidosis, and
tachycardia
3. Water enters lungs
 Increased peripheral airway resistance, pulmonary
vessel vasoconstriction/hypertension, decreased lung
compliance, decreased surfactant

8. 4. Decompensation
-gasping with further inhalation
-swallowing with emesis
-loss of consciousness
5. Neuronal dysfunction
-blood brain barrier breaks down
6. Cardiac dysfunction
-bradycardia, arrhythmias, asystole
7. Brain Death

9. Dry Drowning
• 10-20% of patients experience a laryngospasm that
prevents aspiration of fluid into the lungs
• Tight spasm often persists until cardiac arrest
• Lungs remain dry
• Large volumes of fluid ingested into stomach
• Major cause for electrolyte abnormalities in children
(hyponatremia from fresh water, hypernatremia from salt
water)

10. Wet Drowning
 1-3 mL/kg water aspirated hinders gas exchange
 When fluid is in the lungs, vagus nerve stimulates
vasoconstriction of pulmonary vessels and pulmonary
hypertension
 Freshwater diffuses rapidly across alveolar-capillary
membrane and saltwater damages the membrane
 Surfactant is denatured by freshwater and washed away
by salt water
 In both salt water and freshwater aspiration,
compliance is decreased

11. WORKUP-Laboratory Studies
• The following studies are indicated in near
drowning:
• Blood gas analysis with co-oximetry (A CO-oximeter
is a device that measures the oxygen carrying state
of hemoglobin in a blood specimen, including
oxygen-carrying hemoglobin (O2Hb), non-oxygen-
carrying but normal hemoglobin (HHb)to detect
methemoglobinemia and carboxyhemoglobinemia

12. Methemoglobin- a stable oxidized form of
haemoglobin which is unable to release oxygen to
the tissues
Carboxyhemoglobin- is a stable complex of carbon
monoxide and hemoglobin (Hb) that forms in red
blood cells upon contact with carbon monoxide
(CO).
• CBC count, prothrombin time and partial
thromboplastin time,

13. • Serum electrolytes (with glucose)
• Liver enzymes
• Renal function tests
• Drug screen and ethanol level (consider)
• Continuous pulse oximetry and cardiorespiratory
monitoring (may be needed)

14. Imaging Studies
• Chest radiography
• Head CT and cervical spine imaging if trauma
suspected
• Extremity, abdominal, pelvic imaging if
clinically indicated
• Echocardiography if myocardial dysfunction
present

15. Other Tests
• Consider electrocardiography if the patient
has arrhythmias. Monitor the patient if
rewarming is necessary, because dysrhythmias
are common when rewarming patients who
suffer cold-water immersion injuries.

16. • Swan-Ganz catheter for monitoring cardiac
output and related hemodynamic parameters
may be useful in patients with unstable
cardiovascular status

17. Arrival to the hospital
• General Assessment:
• Appearance
• Work of Breathing
• Circulation
• Primary Assessment:
• Airway
• Breathing
• Circulation
• Disability
• Exposure

18. Management
• ET intubation if unconscious
• 100% O2 by face mask
• Treat hypothermia, hypoglycaemia, seizures, hypovolaemia
and hypotension, if they occur
• If the patient is awake and alert, observe for at least six
hours. Pulmonary oedema may develop late

19. • continuous positive airway pressure (CPAP),
intubation and mechanical ventilation with high
positive end expiratory pressure (PEEP), or even
extracorporeal membrane oxygenation (ECMO) for
severe pulmonary oedema.
• Rewarming by extracorporeal circulation provides
efficient rewarming and full circulatory support

20.  Broncoscopy
Removal of vomit, debris in lungs
• Nasogastric tube +/- urinary catheter.
 Albuterol
For bronchospasm

21. Thank you….