From the Guidelines
Secondary drowning, also known as delayed drowning or submersion injury, is a life-threatening condition that requires immediate medical attention, and treatment involves restoring breathing and circulation through basic life support guidelines, including in-water rescue breathing and chest compressions.
Diagnosis
The diagnosis of secondary drowning is based on a history of submersion and symptoms such as respiratory distress, coughing, or chest pain, which can occur after an initial rescue, and it is essential to distinguish respiratory arrest from cardiac arrest due to the difficulty in palpating pulses within the recommended 10-second window 1.
Treatment
Treatment for secondary drowning involves restoring breathing and circulation, and it may begin with in-water rescue breathing when safely provided by rescuers trained in the technique, and should continue with chest compressions once the drowned individual and the rescuer are in a safe environment, following basic life support guidelines 1.
- The American Heart Association and American Academy of Pediatrics recommend focusing on restoring breathing as much as circulation in resuscitation from cardiac arrest attributable to drowning.
- Resuscitation efforts should be guided by systematic reviews and updated literature searches, such as those performed by the International Liaison Committee on Resuscitation from 2021 to 2023 1.
From the Research
Diagnosis of Secondary Drowning
- Secondary drowning is defined as deterioration of pulmonary function that follows deficient gas exchange due to loss or inactivation of surfactant 2
- It is characterized by a latent period of one to 48 hours of relative respiratory well-being, followed by rapid onset of symptoms 2
- Diagnosis is based on symptoms of respiratory distress, such as coughing, wheezing, and shortness of breath, which can occur after an asymptomatic interval 3, 2
Treatment of Secondary Drowning
- Treatment consists of artificial respiration, cardiac massage, correction of electrolyte imbalance, and continued observation for complications 4
- Prompt resuscitation at the scene after a shorter duration of submersion is associated with better outcomes 5
- The American Heart Association's Revised Utstein Drowning Form and treatment guidelines are important in guiding care, disposition, and prognosis 5
- Vigorous evaluation and treatment are necessary to promote a good prognosis, especially in fresh water cases 2
Screening for Secondary Drowning
- Emergency department observation for four to six hours could effectively screen for those patients requiring inpatient therapy 3
- Patients who require admission typically display signs of respiratory distress within four hours 3
- Identifying victims at risk could promote vigorous evaluation and reduce unnecessary hospitalization 3