Near Drowning
R. Hernandez
Near Drowning
• Suffocation and death as a result of
submersion in liquid.
– Near drowning:
• Liquid submersion survival
– Dry drowning:
• Glottis spasm
– Wet drowning
• Glottis relaxes
– Water floods tracheobronchial tree / alveoli
Pulmonary pathologic and
structure changes
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Laryngospasm and bronchial constriction
Interstitial edema
Decreased pulmonary surfactant
Increased surface tension of alveolar fluid
Atelectasis
Pulmonary edema
Drowning or Near Drowning Sequence
• Panic and violent struggle
• Period of calmness and apnea
• Swallowing of large amounts of fluid, followed
by vomiting
• Gasping inspirations and aspirations
• Convulsions
• Coma
• Death
Favorable Prognostic Factors
Cold Water Drowning
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Age
Submersion time
Water temperature
Water Quality
Other injuries
Amount of struggle
CPR
Suicidal attempt
Near Wet Drowning
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Tachypnea or apnea
Tachycardia, hypertensive
Cyanosis
Frothy pink sputum
Crackles / decrease aeration
Acute ventilatory failure with hypoxemia
Neurologic Status
– Dilated pupils
– Pain response
X-Ray
• Fluffy infiltrates
• Opacities of
atelectasis
• Hypovolemia
• Hypervolemia
Treatment
• Normalize Temperature
• Hyperoxia
– Pa02 > 100 torr
– PEEP
• Hyperventilation
– pH> 7.45
– PaC02 25-30 torr