Drowning and Near Drowning
Temple College
EMS Professions
Definitions

Drowning = Death by suffocation
after immersion in liquid
 Near drowning = Episode in
which person initially survives
immersion in liquid
Drowning Types
Dry Lung
 15% of cases
 Small amount of
H20 aspirated
 Laryngospasm
occurs, closes
airway
 Patient
asphyxiates
Wet Lung
 85% of cases
 Large amounts
of water enter
lungs
 Fluid, electrolyte
imbalances
occur
Wet Lung: Fresh Water

Water moves from alveoli to
bloodstream
 Hemodilution occurs
 O2 carrying capacity
Wet Lung - Fresh Water

Water moves into red cells
 Red cells swell, rupture
• Potassium
Arrhythmias
• Release of hemoglobin into
bloodstream
Renal failure

Loss of surfactant
alveoli
Collapse of
Wet Lung: Salt Water

Water moves from bloodstream
to alveoli
 Hemoconcentration occurs
Shock
 Pulmonary edema occurs
Near Drowning

Do not attempt swimming rescue
without proper training
 Throw - Tow - Row - Go
Near Drowning

Consider possible neck injury:
• Diving accidents
• Swimming pools
• Inadequate history

Place patient on spineboard in
water
Near Drowning

If possible, begin pulmonary
resuscitation in water
 Resuscitate all cold water
drowning (<72oF)
• Mammalian Diving Reflex
• Survivability
Transport all near drownings!
Regardless of how good
they look!
Scuba Emergencies
SCUBA



Self-contained underwater breathing
apparatus
Regulator on compressed air
cylinder matches pressure of inhaled
air to surrounding water pressure
Allows diver to expand chest
normally
SCUBA

Use causes:
• Collection of pressurized air in
body air spaces (alveoli, sinuses,
middle ear)
• Dissolving of gas (particularly
nitrogen) in body fluids
SCUBA

Diver must control ascent to
prevent:
• Rapid expansion of gas in lungs,
sinuses, middle ear
• Formation of nitrogen bubbles in
blood and body tissues
SCUBA Problems: Squeeze

Inability to equalize pressure in
sinuses, middle ear
 Causes pain
SCUBA Problems: Ear Drum
Rupture

Inability to equalize pressure in
middle ear Perforation of
tympanic membrane
 Causes disequilibrium
Nitrogen Narcosis
“Rapture of the Deep”
 Caused by breathing
compressed air under pressure
 Pressurized N2 is toxic to CNS
 Disorientation, confusion result
 Problem disappears on surfacing

Air Embolism


Patient holds breath, surfaces
suddenly
Compressed air in alveoli expands 
Lung tissue tears 
Air enters pulmonary circulation, is
pumped to brain
Air embolism can occur in a
swimming pool!
Air Embolism Signs/Symptoms

Sudden extremity weakness,
numbness
 Hemiplegia
 Dilated pupil on affected side
 Seizures, coma
Air Embolism Signs/Symptoms
What problem does air
embolism resemble?
Why?
Management of Air Embolism

High concentration O2
 Assist ventilations, as needed
 Left side, 300 head down
 Transport to recompression
chamber
Decompression Sickness




“Bends”
Diver dives deeply or too long
Does not ascend slowly enough to
let dissolved nitrogen leak out of
blood gradually
Nitrogen bubbles form in tissues,
obstruct vessels
Decompression Sickness Types



Pain only (joint) bends  Aching,
boring pain in joints
CNS bends  Bubbles affect blood
flow to brain or spinal cord
“Chokes”  Bubbles obstruct blood
flow through lungs
Decompression sickness can occur
only if the dive was > 33 feet
Signs, symptoms may be
delayed
Decompression Sickness
Management



High concentration oxygen
Assisted ventilations, as needed
Recompression