This paper is only available as a PDF. To read, Please Download here.
Abstract
Drowning is a major cause of accidental deaths, especially in children. The most serious
pathophysiologic consequence of near-drowning is hypoxemia, which usually is due to
aspiration-induced noncardiogenic edema. Therefore, initial resuscitative efforts
need to be directed at establishing adequate oxygenation and ventilation, followed
by rewarming and fluid administration. Although completely asymptomatic patients with
normal vital signs, oxygenation and chest radiographs require only 4 to 6 hours of
observation, many near-drowning victims will require at least 24 hours of observation.
Despite these measures, approximately 25% of victims presenting to the Emergency Department
will die and another 6% will develop neurological sequelae. Therefore, it is vital
that better efforts be made by the community in promoting and instituting water safety
programs.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cardiopulmonary resuscitation: lessons from the past.J Emerg Med. 1991; 9: 503-507
- Drown vs. near-drown: A discussion of definitions.Crit Care Med. 1981; 9: 351-352
- Drowning, near-drowning, and ice-water submersions.Pediatr Clin North Am. 1987; 34: 75-92
- The iceberg phenomenon of near-drowning.Crit Care Med. 1976; 4: 127-128
- Drowning.N Engl J Med. 1993; 328: 253-256
- Near-drowning: consensus and controversies in pulmonary and cerebral resuscitation.Heart Lung. 1987; 16: 474-482
- 2nd edn. The injury fact book. DC Heath, Lexington, MA1984: 155-165
- Submersion injury: epidemiology, prevention and management.Pediatr Clin North Am. 1985; 32: 113-125
- Childhood drowning and near-drowning in the United States.Am J Dis Child. 1990; 144: 663-669
- Drowning in childhood and adolescence: a population-based study.Am J Public Health. 1987; 77: 830-832
- Drowning: epidemiology and prevention.Am J Public Health. 1974; 64: 303-312
- Causes of loss of consciousness during underwater swimming.J Appl Physiol. 1961; 16: 583-586
- Drowning and near-drowning involving children: a five-year total population study from the city and county of Honolulu.Am J Public Health. 1979; 69: 450-454
- Drowning mortality in Los Angeles County, 1976–1984.JAMA. 1988; 260: 380-383
- Submersion accidents in children with epilepsy.Am J Dis Child. 1982; 136: 777-780
- Electrolyte changes in human drowning victims.Anesthesiology. 1969; 30: 414-420
- Effects of volume of aspirated fluid during chlorinated fresh water drowning.Anesthesiology. 1966; 27: 662-672
- Physiologic effects of neardrowning with chlorinated fresh water, distilled water and isotonic saline.Anesthesiology. 1966; 27: 33-41
- The effects of fluid volume in sea water drowning.Ann Intern Med. 1967; 67: 68-80
- Near-drowning.Emerg Med Clin North Am. 1992; 10: 339-350
- Near-drowning.Crit Care Med. 1980; 8: 590-595
- Drowning by total immersion: effects on pulmonary surfactant of distilled water, isotonic saline and sea water.Am J Dis Child. 1967; 114: 612-616
- Changes in blood gases and A-a DO2 during near-drowning.Anesthesiology. 1968; 29: 456-465
- Clinical course of 91 consecutive near-drowning victims.Chest. 1976; 70: 231-238
- Fluid administration increases oxygen delivery during continuous positive ventilation after fresh water near-drowning.Crit Care Med. 1983; 11: 693-696
- Near-drowning in the Dead Sea. Electrolyte imbalances and therapeutic implications.Arch Intern Med. 1985; 145: 50-53
- Hypercalcemia complicating an industrial near-drowning.Ann Emerg Med. 1991; 20: 669-671
- Current concepts in the pathophysiology and management of near-drowning.J Intensive Care Med. 1991; 6: 26-35
- Cerebral protection: pathophysiology and treatment of increased intracranial pressure.Chest. 1985; 87: 85-93
- Clinical pathology of human near-drowning.in: 2nd edn. Proc Royal Soc Med. 56. 1963: 33-38
- Drowning: its clinical sequelae and management.Br Med J. 1970; 2: 157-161
- Near-drowning.J Am Coll Emerg Phys. 1978; 7: 249-254
- Near-drowning in children: clinical aspects.Pediatrics. 1976; 58: 573-579
- Feasibility study of CPR in the water.Undersea Biomed Res. 1980; 7: 141-148
- 2nd edn. Textbook of Advanced Cardiac Life Support. American Heart Association, Dallas1990: 227
- Food-choking and drowning deaths prevented by external subdiaphragmatic compression.Ann Thorac Surg. 1975; 20: 188-195
- Subdiaphragmatic pressure to expel water from the lungs of drowning persons.Ann Emerg Med. 1981; 10: 476-480
- Artificial respiration—flow of water from the lung and the stomach.Lancet. 1962; 1: 780-781
- Vomiting as a complication of the Heimlich maneuver.JAMA. 1987; 258: 512-513
- The resuscitation of near-drowning victims.JAMA. 1986; 256: 75-77
- Is the Heimlich maneuver appropriate as first treatment for drowning?.Emerg Med Serv. 1981; 10: 63-66
- The use of Heimlich maneuver in near-drowning: Institute of Medicine Report.J Emerg Med. 1995; 13: 397-405
- Submersion injuries: drowning and near-drowning.Emerg Med Clin North Am. 1989; 7: 355-370
- The effects of dextrose infusion and head position on neurologic outcome after complete cerebral ischemia in primates: examination of a model.Anesthesiology. 1987; 66: 39-48
- Brain lactate and neurologic outcome following incomplete ischemia in fasted, non-fasted, and glucose-loaded rats.Anesthesiology. 1990; 72: 1045-1050
- Med Lett. 1983; 25: 9-11
- The use of extracorporeal rewarming in a child submerged for 66 minutes.JAMA. 1988; 260: 377-379
- Comparison of ventilatory patterns in the treatment of fresh water near-drowning in dogs.Anesthesiology. 1980; 52: 142-148
- Effects of ventilatory patterns on arterial oxygenation after neardrowning in sea water.Anesthesiology. 1974; 40: 376-384
- Treatment of near-drowning.J Fl Med Assoc. 1992; 79: 625-629
- Submersion incidents.in: Averbach PS Wilderness medicine. Mosby, St. Louis1995: 1209-1233
- Methylprednisolone therapy for pulmonary edema following near-drowning.JAMA. 1971; 215: 1793-1795
- The ineffectiveness of steroid therapy for treatment of fresh-water near-drowning.Anesthesiology. 1975; 43: 642-650
- Prognosis and management of victims of near-drowning.J Trauma. 1982; 22: 544-549
- Bacteriology of the freshwater environment: implications for clinical therapy.Ann Emerg Med. 1987; 16: 1016-1021
- Infections associated with swimming and diving.Undersea Biomed Res. 1991; 18: 181-185
- Survival after asphyxia secondary to gravel aspiration.Arch Intern Med. 1976; 136: 471-473
- Sand aspiration in drowning and near-drowning.Radiology. 1978; 128: 301-302
- Potential use of warm butyl alcohol vapor as adjunct agent in the emergency treatment of seawater near-drowning.Am J Emerg Med. 1993; 11: 20-27
- Cerebral salvage in near-drowning following neurological classification by triage.Canad Anaesth Soc J. 1980; 27: 201-209
- Near-drowning: is emergency department cardiopulmonary resuscitation or intensive care unit cerebral resuscitation indicated?.Crit Care Med. 1993; 21: 368-373
- Influence of hypothermia, barbiturate therapy, and intracranial pressure monitoring on morbidity and mortality after near-drowning.Crit Care Med. 1986; 14: 529-533
- Near-drowning: correlation of level of consciousness and survival.Canad Anaesth Soc J. 1980; 27: 211-215
- Outcome following cardiopulmonary resuscitation in severe pediatric near-drowning.Am J Dis Child. 1986; 140: 571-575
Article info
Publication history
Accepted:
February 26,
1996
Received in revised form:
February 5,
1996
Received:
July 7,
1995
Footnotes
☆Critical Care is coordinated by Joseph Varon, md, of the University of Texas M.D. Anderson Cancer Center and Baylor College of Medicine, Houston, Texas.
Identification
Copyright
© 1996 Published by Elsevier Inc.
User license
Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0) | How you can reuse 
Elsevier's open access license policy
Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0)
Permitted
For non-commercial purposes:
- Read, print & download
- Redistribute or republish the final article
- Text & data mine
- Translate the article (private use only, not for distribution)
- Reuse portions or extracts from the article in other works
Not Permitted
- Sell or re-use for commercial purposes
- Distribute translations or adaptations of the article
Elsevier's open access license policy
