From the Guidelines
In UK practice, drowning is best described as a process resulting in primary respiratory impairment from submersion/immersion in a liquid medium, rather than being classified into distinct types such as wet, dry, secondary, or immersion syndrome. The traditional classification of drowning into types like wet and dry drowning has been deemed outdated and potentially misleading by recent guidelines 1. Instead, the focus should be on understanding the drowning process as a continuum that begins when the victim's airway lies below the surface of the liquid, leading to breath-holding, laryngospasm, and eventually, the inhalation of liquid if the process is not interrupted 1.
Key Aspects of Drowning
- The drowning process involves a sequence of events including breath-holding, laryngospasm, and the potential inhalation of liquid, leading to hypoxemia, hypercarbia, and acidosis 1.
- The amount of liquid inhaled and the duration of submersion can significantly affect the outcome, with changes in lung function, body fluids, and electrolyte concentrations 1.
- Cold water immersion can trigger additional physiological responses, including the cold shock response, which may lead to sudden cardiac arrest 1.
Clinical Considerations
- Healthcare providers should be aware that symptoms of drowning can evolve over time, particularly in cases where there might be delayed respiratory complications 1.
- Monitoring for respiratory distress, decreased oxygen saturation, persistent coughing, or altered mental status is crucial in the management of drowning victims 1.
- The pathophysiology of drowning primarily involves hypoxemia resulting from aspiration, laryngospasm, or cold-induced cardiac effects, with subsequent inflammatory responses potentially worsening lung function over time 1.
Recommendations
- The terms "wet drowning," "dry drowning," "secondary drowning," and "immersion syndrome" should be abandoned in favor of a more unified understanding of the drowning process 1.
- A focus on the immediate and long-term management of drowning victims, including prompt rescue, appropriate resuscitative measures, and monitoring for potential complications, is essential for improving outcomes 1.
From the Research
Types of Drowning
- The World Health Organization defines drowning as the process of respiratory difficulty caused by submersion/immersion in liquid 2.
- There are different types of drowning, including:
- Dry drowning: a myth that has been propagated by the mass media, which can divert attention from appropriate efforts to prevent drowning and rescue and treat those who do drown 3.
- Secondary drowning: also known as delayed drowning, is another myth that is often mentioned in the media, but it is not a recognized medical term 3.
- Wet drowning: the most common type of drowning, which occurs when water enters the lungs 4.
UK Practice
- In the UK, drowning is a leading cause of accidental death, especially in children 4.
- The key pathophysiological feature in drowning is hypoxia, and prompt and aggressive resuscitation attempts are crucial for optimal survival 4.
- Prevention is essential for reducing both mortality and morbidity from drowning, and if prevention fails, the speed of access to and the quality of prehospital and hospital care will determine the prognosis 2.
- Accurate neurological prognosis cannot be predicted from the initial clinical presentation, laboratory, radiological, or electrophysiological examinations 4.