Near-drowning

Encyclopedia of Medicine, Apr 06, 2001 by Howard Baker

In the emergency department, victims continue receiving oxygen until blood tests show a return to normal. About one-third are intubated and initially need mechanical support to breathe. Rewarming is undertaken when hypothermia is present. Victims may arrive needing treatment for cardiac arrest or cardiac dysrhythmias. Comatose patients present a special problem: although various treatment approaches have been tried, none have proved beneficial. Patients can be discharged from the emergency department after four to six hours if their blood oxygen level is normal and no signs or symptoms of near-drowning are present. But because lung problems can arise 12 or more hours after submersion, the medical staff must first be satisfied that the patients are willing and able to seek further medical help if necessary. Admission to a hospital for at least 24 hours for further observation and treatment is a must for patients who do not appear to recover fully in the emergency department.

Neurological damage is the major long-term concern in the treatment of near-drowning victims. Patients who arrive at an emergency department awake and alert usually survive with brain function intact, as do about 90% of those who arrive mentally impaired (lethargic, confused, and so forth) but not comatose. Death or permanent neurological damage is very likely when patients arrive comatose. Early rescue of near-drowning victims (within 5 minutes of submersion) and prompt CPR (within less than 10 minutes of submersion) seem to be the best guarantees of a complete recovery. An analysis of 715 patients admitted to emergency departments in 1971-81 revealed that 69% recovered completely, 25% died, and 6% survived but suffered permanent neurological damage.

Prevention depends on educating parents, other adults, and teenagers about water safety.

Parents must realize that young children who are left in or near water without adult supervision even for a short time can easily get into trouble, not just at the beach or next to a swimming pool, but in bathtubs and around toilets, buckets, washing machines, and other household articles where water can collect. Research on swimming pool drownings involving young children shows that the victims have usually been left unattended less than five minutes before the accident. Experts consider putting up a fence around a home swimming pool an essential precaution, and estimate that 50-90% of child drownings and near-drownings could be prevented if fences were widely adopted. The fence should be at least five feet high and unclimbable, have a self-closing and self-locking gate, and completely surround the pool.

Pool owners--and, indeed, all other adults--should consider learning CPR. Everyone, of course, should follow the rules for safe swimming and boating. Those who have a medical condition that can cause a seizure or otherwise threaten safety in the water are advised always to swim with a partner. And of course, people need to be aware that alcohol and drug use substantially increase the chances of an accident.