Signs of Drowning
The term "dry drowning" should be abandoned as it is not a medically accurate term according to current guidelines. 1 All drownings occur in liquid, and therefore all drownings are wet by definition. The Utstein guidelines and American Heart Association specifically recommend against using terms like "dry drowning," "wet drowning," "secondary drowning," and "near-drowning" as they cause confusion and impede proper categorization and management 1, 2.
Understanding the Drowning Process
The drowning process follows a characteristic sequence:
- Initial phase: The victim's airway lies below the surface of the liquid, during which they voluntarily hold their breath 1
- Laryngospasm phase: Involuntary laryngospasm occurs due to liquid in the oropharynx or larynx 1
- Physiological changes: The victim becomes hypercarbic, hypoxemic, and acidotic due to inability to breathe 1
- Progressive respiratory impairment: As oxygen levels drop further, laryngospasm abates, and the victim may actively breathe liquid 1
Recognizing Signs of Drowning
Since the term "dry drowning" is not medically accurate, it's important to recognize the actual signs of drowning:
Immediate Signs (During Water Distress)
- Instinctive drowning response: Victims may not be able to call for help or wave arms due to prioritizing attempts to breathe 1
- Head low in water with mouth at water level
- Head tilted back with mouth open
- Eyes glassy or closed
- Hyperventilation or gasping
- Attempting to swim but making no forward progress
- Appearing to climb an invisible ladder
Signs After Water Rescue
- Respiratory distress: Coughing, wheezing, rapid breathing, increased work of breathing 3
- Altered mental status: Confusion, lethargy, irritability 3
- Vomiting: Often occurs after swallowing water 3
- Chest pain or discomfort
- Frothy sputum: May be pink-tinged due to pulmonary edema 3
Important Clinical Considerations
- All drowning victims require evaluation: Anyone with respiratory symptoms after submersion should be medically evaluated 4
- Observation period: Research indicates that patients who will develop significant respiratory distress typically show signs within 4-6 hours 4
- No asymptomatic interval: The concept of "secondary drowning" after an asymptomatic interval has been questioned by research 4
- Continuous monitoring: Victims should be monitored for deterioration in respiratory status, as the combined effects of fluid in the lungs, loss of surfactant, and increased capillary-alveolar permeability can result in decreased lung compliance and noncardiogenic pulmonary edema 3
When to Seek Emergency Medical Care
Medical attention should be sought immediately if any of these signs are present after water exposure:
- Breathing difficulties: Any coughing, wheezing, or labored breathing
- Mental status changes: Confusion, extreme fatigue, or irritability
- Vomiting after water exposure
- Persistent cough
- Chest pain
Prevention
Prevention remains the most effective approach to drowning 5:
- Supervision: Constant, attentive supervision of children around water
- Barriers: Proper pool fencing with self-closing and self-latching gates 1
- Personal flotation devices: Wearing life jackets while in, around, or on water 1
- Swimming lessons: Particularly important for children 2-4 years old 5
- Avoid alcohol: Abstain from alcohol when participating in water activities 5
Remember that drowning is a process that can be interrupted at any point with appropriate intervention, and early recognition of signs is crucial for preventing fatal outcomes.