What is the treatment for drowning patients?

Treatment of Drowning Patients

The most critical intervention for drowning patients is immediate provision of rescue breathing and CPR, with particular emphasis on early ventilation to reverse hypoxia, which is the primary pathophysiological mechanism in drowning. 1

Initial Rescue and Assessment

• Water Rescue:

  • Remove victim from water as quickly as possible while ensuring rescuer safety
  • In-water ventilation-only resuscitation may be considered by trained rescuers with proper flotation equipment if distance to shore warrants its use 1
  • Never attempt chest compressions while in water 1

• Cervical Spine Management:

  • Routine cervical spine immobilization is NOT recommended unless circumstances suggest spinal injury 1
  • The incidence of cervical spine injury in drowning victims is extremely low (0.009%) 1
  • Unnecessary immobilization can impede airway management and delay critical interventions

Immediate Resuscitation

For Unresponsive Victims:

1. Airway and Breathing (Priority):

   • Open airway immediately
   • Provide 2 rescue breaths that make the chest rise 1
   • Do NOT attempt to remove water from airways by abdominal thrusts or Heimlich maneuver (Class III, LOE C) 1
   • Mouth-to-mouth, mouth-to-nose, or pocket-mask ventilation can be used 1

2. Circulation:

   • After 2 rescue breaths, check for pulse (healthcare providers)
   • If no pulse or uncertain, begin chest compressions 1
   • Follow standard CPR protocol with 30:2 compression-to-ventilation ratio
   • For trained rescuers, conventional CPR with ventilations is preferred over compression-only CPR due to the hypoxic nature of drowning 1

3. Defibrillation:

   • Apply AED as soon as available and follow prompts 1
   • Shockable rhythms are less common in drowning (2-14%) but still possible 1
   • Ensure patient is removed from water and chest is dried before AED use

Advanced Life Support

• Oxygenation:

  • Administer highest possible inspired oxygen concentration initially 1
  • Once oxygen saturation can be measured, titrate to maintain normal range 1

• Airway Management:

  • Healthcare professionals should follow standard advanced life support protocols for airway management 1
  • Early intubation may be necessary for patients with severe respiratory distress or cardiac arrest 2
  • Bag-mask ventilation can be used by trained responders with proper training and equipment 1

• Ventilation Strategy:

  • For patients requiring mechanical ventilation, follow standard acute respiratory distress syndrome management protocols 1
  • Non-invasive ventilation (NIV) may be considered for moderate to severe lung injury in hemodynamically stable patients with adequate mental status 1

Hospital Management

• Transport and Monitoring:

  • All victims requiring any form of resuscitation (even just rescue breathing) should be transported to a hospital for evaluation and monitoring 1
  • Observation for at least 4-6 hours is recommended, as decompensation can occur within this timeframe 1

• ICU Considerations:

  • Ventilation therapy should target intrapulmonary shunt ≤20% or PaO2:FiO2 ≥250 3
  • Avoid premature ventilatory weaning which may cause recurrence of pulmonary edema 3

Special Considerations

• Prognostic Factors:

  • Duration and severity of hypoxia are the most important determinants of outcome 1
  • Even after prolonged submersion, aggressive resuscitation efforts are indicated as successful outcomes have been reported, particularly in cold water submersion 4

• Common Pitfalls to Avoid:

  1. Delaying rescue breathing (the most critical intervention)
  2. Attempting to clear water from airways through abdominal thrusts
  3. Routine cervical spine immobilization without indication
  4. Premature termination of resuscitation efforts, especially in hypothermic patients
  5. Failure to transport for observation after successful initial resuscitation

Algorithm for Treatment

1. Rescue: Remove from water safely
2. Assess: Check responsiveness and breathing
3. Resuscitate: Begin with rescue breathing, then standard CPR if needed
4. Oxygenate: Provide highest available oxygen concentration
5. Transport: All victims requiring any resuscitation must go to hospital
6. Monitor: Observe for at least 4-6 hours for potential decompensation

Remember that hypoxia is the primary pathology in drowning, making early ventilation the cornerstone of successful resuscitation 1, 5.