From the Guidelines
Dry drowning is a condition that can occur when water irritates the vocal cords, causing them to spasm and close, which prevents air from entering the lungs, and its risk factors include young age, inability to swim, lack of supervision around water, and certain medical conditions like seizure disorders or cardiac arrhythmias, as stated in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. The main symptoms of dry drowning include persistent coughing, chest pain, difficulty breathing, extreme fatigue, and behavioral changes. Risk factors for dry drowning include:
- Young age (particularly children under 5)
- Inability to swim
- Lack of supervision around water
- Not using proper flotation devices
- Swimming in unguarded areas
- Having certain medical conditions like seizure disorders or cardiac arrhythmias
- Previous near-drowning experiences
- Alcohol or drug use near water
- Swimming in rough water conditions To prevent dry drowning, it is essential to:
- Always supervise children around water
- Teach swimming skills early
- Use proper flotation devices
- Avoid alcohol near water
- Seek immediate medical attention if anyone shows breathing difficulties after water exposure According to the 2024 American Heart Association and American Academy of Pediatrics focused update on special circumstances: resuscitation following drowning, drowning is the third leading cause of death from unintentional injury worldwide, accounting for 7% of all injury-related deaths 1. It is also important to note that the term "dry drowning" has been somewhat controversial, and some studies suggest that it is not a useful or accurate term, as all drownings occur in liquid and therefore all drownings are "wet" 1. However, the concept of dry drowning remains a critical concern in the context of water safety and emergency medicine, and prompt medical attention is crucial if symptoms of dry drowning occur, as stated in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
From the Research
Definition of Dry Drowning
- Dry drowning is not a term used in the provided studies, however, the term "secondary drowning" is mentioned in study 2, which refers to the phenomenon of respiratory distress occurring after an asymptomatic interval following submersion.
- According to study 2, the existence of "secondary drowning" as a distinct entity is questioned, and it is suggested that it may be equivalent to established, detectable respiratory insufficiency.
Risk Factors for Drowning
- Study 3 states that drowning can occur in a deceptively hostile environment, involving an underestimation of the dangers or an overestimation of water competency.
- Alcohol plays a role in approximately one-half of near-drownings of older victims, as mentioned in study 4.
- Study 4 also notes that major factors prolonging survival in near-drowning cases are an age of less than 2 years and immersion in cold water (less than 20 degrees C).
- Hypoxia and acidosis are the primary physiological derangements in near-drowning cases, as stated in study 4.
Pathophysiology of Drowning
- Study 3 explains that when water is aspirated into the airways, coughing is the initial reflex response, followed by acute lung injury, which alters the exchange of oxygen in different proportions.
- The combined effects of fluid in the lungs, loss of surfactant, and increased capillary-alveolar permeability result in decreased lung compliance, increased right-to-left shunting in the lungs, atelectasis, and alveolitis, a noncardiogenic pulmonary edema, as described in study 3.
- Study 5 notes that the dominant pathophysiological mechanism of drowning includes the development of acute hypoxia.
Treatment and Prevention
- Study 5 emphasizes the importance of providing ventilation to increase the chances of survival in drowning cases.
- Study 3 recommends that the decision to admit to an ICU should consider the patient's drowning severity and comorbid or premorbid conditions.
- Prevention of the circumstances that lead to near-drowning must be stressed as a public service, as mentioned in study 4.