Drowning is death while submerged in water, and near-drowning is suffocation while submerged with survival (at least temporary).
If water does not enter the airway, asphyxia is the main complication.
If the patient inhales water, marked intrapulmonary shunting & significant V/Q mismatching because of loss of pulmonary surfactant (wash-out) and reflex laryngobronchospasm are also mechanisms
Significant volumes of hypotonic fresh water aspiration fresh can lead to hyponatremia and hemodilution.
Cold water drowning leads to loss of consciousness at a temperature below 32°C and ventricular fibrillation can occur at 28° to 30°C. Resuscitation efforts may be very prolonged after cold water aspiration
Aspiration of gastric contents because of unconsciousness and lack of airway reflexes can further complicate lung injury and risk of death.
All patients will have hypoxemia, hypercarbia, and metabolic acidosis from lack of oxygen delivery and subsequent lactic acid production.Also Cerebral edema, ALI, and ARDS can complicate medical courses
Treatment: restore spontaneous circulation and ventilation, focus on improving oxygen delivery further to decrease metabolic acidosis. Because of a significant risk of ALI and ARDS, airway management and lung protection ventilation strategies should be initiated as soon as possible. Cerebral protection maneuvers should also be followed and neurosurgical consultation obtained when appropriate. Electrolyte and temperature derangements should be treated. Patients’ clinical courses will be labile.
