Drowning

Regarding drowning, the following statements are true EXCEPT which one?

a) Absence of water in the lungs at post mortem confirms a diagnosis of ‘dry

drowning’, usually caused by laryngospasm

b) In the UK, 25% of cases of drowning occur in salt water

c) Atypical drowning may involve a sudden stopping of the heart on immersion in

cold water

d) The incidence of cervical spine injury in drowning events is 1 in 200

e) Aspiration of as little as 200mL of water by an 80 kg man may increase

intrapulmonary shunt from 10% to 75%

Answer: a

Explanation

Drowning is a major cause of death worldwide and accounts for around 400 deaths per

year in the UK. The majority of victims are under 25 years old. In 2003, the International

Liaison Committee on Resuscitation (ILCOR) published the recommendations from a

consensus conference on the uniformreporting of data from drowning.Adrowning event

was defined as a process resulting in respiratory impairment following immersion or

submersion in a liquid. The report recommended abandoning the terms ‘near drowning’

and ‘secondary drowning’. The mechanism of death in drowning is complex.

The majority of cases of drowning feature hypoxaemia following washout of

pulmonary surfactant, alveolar collapse and intrapulmonary shunting. This may progress

to ARDS in the following 72 hours. There used to be a lot of concern about

whether the drowning had occurred in fresh water or salt water. This was thought to

produce different profiles of electrolyte disturbance, but is now considered to only

rarely be clinically relevant. Of drowning deaths, 15% are atypical and feature

laryngospasm with minimal water entering the lungs or sudden cardiac standstill on

immersion in cold water. However, the presence or absence of water in the lungs at

post mortem does not indicate whether water was inhaled or not. The absence of water

in the lungs may just indicate that the water has been absorbed and ILCOR also

recommended that the term ‘dry drowning’ should be avoided. The most important

factor determining the outcome following a drowning event remains the quality of

immediate care the victim receives, with the target being rapid correction of hypoxaemia

through rescue breathing or positive pressure ventilation.

References

Idris AH, Berg RA, Bierens J, et al. Recommended guidelines for uniform reporting of

data from drowning: the ‘Utstein style’. Circulation. 2003; 108(20): 2565–74.

Soar J, Deakin CD, Nolan JP, et al. European Resuscitation Council. European

Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in

special circumstances. Resuscitation 2005; 67(Suppl 1): S135–70.