Drowning

Table of Contents

Aliases

Near-drowning, non-fatal drowning, fatal drowning, submersion, immersion

Patient Care Goals

  1. Rapid assessment and management of life-threatening injuries
  2. Rescue from the water-based environment
  3. Transport all patients suffering from drowning for hospital evaluation

Patient Presentation

Inclusion Criteria

Patients suffering from drowning or drowning events independent of presence or absence of symptoms.

Exclusion Criteria

Patients without history of drowning.

Patient Management

Assessment

  1. Follow Universal Care guideline
  2. History should include circumstances leading to the submersion, details of mechanism of injury, time under water, and water temperature (if available)
  3. Primary survey should include aggressive airway management and restoration of adequate oxygenation and ventilation – unlike the CAB strategy used in standard cardiac arrest, patients suffering cardiac arrest from drowning require an ABC approach with prompt airway management and supplemental breathing
  4. History, mechanism of injury and exam should include consideration of possible c-spine injury – if evaluation suggests injury to the cervical spine, manage c-spine
  5. Assess for other associated injury such as injury to the head or dive-related emergency

Treatment and Interventions

  1. Ensure scene safety for patient and rescuers. Remove patient from water as soon as possible
    1. Practice the safest water rescue technique possible, given circumstances on scene
    2. Evacuate to land or a water craft as soon as possible
    3. If there is a delay to accessing shore or a rescue boat, initiate in-water basic life support consisting of ventilation only
  2. Manage airway per the Airway Management guideline
  3. Follow Cardiac Arrest guideline as indicated with consideration of ABC strategy for drowning victims in cardiac arrest
    1. Initiate 5 rescue breaths followed by 30 chest compressions
    2. After the initial 5 breaths, use a 2 breaths to 30 compression ratio
  4. If mechanism or history suggest cervical spine injury, manage c-spine, per the Spinal Care guideline
  5. Monitor vital signs including oxygen saturations
  6. If O2 saturations are less than 92%, administer oxygen as appropriate with a target of achieving 94-98% saturation. Consider positive pressure ventilation in patients with signs or symptoms of respiratory difficulty
    1. CPAP or BVM with PEEP valve
  7. Consider hypothermia, treat per Hypothermia/Cold Exposure guideline
  8. If the victim was involved in underwater diving and uncertainty exists regarding the most appropriate therapy, consider contacting direct medical oversight and discussing need for hyperbaric treatment. Include discussion regarding:
    1. Submersion time
    2. Greatest depth achieved
    3. Ascent rate
    4. Gas mix
  9. Establish IV access
  10. Fluid bolus as indicated
  11. Advanced airway management as indicated – Consider CPAP in awake patients with respiratory distress
  12. Cardiac monitor

Notes – Drowning