Drowning | |
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Vasily Perov: The Drowned, 1867 | |
Specialty | Critical care medicine |
Symptoms | Event: Often occurs silently with a person found unconscious[1][2] After rescue: Breathing problems, confusion, unconsciousness[2][3] |
Complications | Hypothermia, aspiration, acute respiratory distress syndrome[4] |
Usual onset | Rapid[3] |
Risk factors | Alcohol use, epilepsy, access to water,[5] cold water shock, storms |
Diagnostic method | Based on symptoms[3] |
Differential diagnosis | Suicide, seizure, murder, hypoglycemia, heart arrhythmia[2] |
Prevention | Fencing pools, teaching children to swim, safe boating practices[6][5] |
Treatment | Rescue breathing, CPR, mechanical ventilation[7] |
Medication | Oxygen therapy, intravenous fluids, vasopressors[7] |
Frequency | 4.5 million (2015)[8] |
Deaths | 236,000 (2019)[6] |
Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Submersion injury refers to both drowning and near-miss incident. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer assistance. After successful resuscitation, drowning victims may experience breathing problems, confusion, or unconsciousness. Occasionally, victims may not begin experiencing these symptoms until several hours after they are rescued. An incident of drowning can also cause further complications for victims due to low body temperature, aspiration, or acute respiratory distress syndrome (respiratory failure from lung inflammation).
Drowning is more likely to happen when spending extended periods of time near large bodies of water.[4][6] Risk factors for drowning include alcohol use, drug use, epilepsy, minimal swim training or a complete lack of training, and, in the case of children, a lack of supervision.[6] Common drowning locations include natural and man-made bodies of water, bathtubs, and swimming pools.[3][7]
Drowning occurs when a person spends too much time with their nose and mouth submerged in a liquid to the point of being unable to breathe. If this is not followed by an exit to the surface, low oxygen levels and excess carbon dioxide in the blood trigger a neurological state of breathing emergency, which results in increased physical distress and occasional contractions of the vocal folds.[9] Significant amounts of water usually only enter the lungs later in the process.[4]
While the word "drowning" is commonly associated with fatal results, drowning may be classified into three different types: drowning that results in death, drowning that results in long-lasting health problems, and drowning that results in no health complications.[10] Sometimes the term "near-drowning" is used in the latter cases. Among children who survive, health problems occur in about 7.5% of cases.[7]
Steps to prevent drowning include teaching children and adults to swim and to recognise unsafe water conditions, never swimming alone, use of personal flotation devices on boats and when swimming in unfavourable conditions, limiting or removing access to water (such as with fencing of swimming pools), and exercising appropriate supervision.[6][5] Treatment of victims who are not breathing should begin with opening the airway and providing five breaths of mouth-to-mouth resuscitation.[7] Cardiopulmonary resuscitation (CPR) is recommended for a person whose heart has stopped beating and has been underwater for less than an hour.[7]
A major contributor to drowning is the inability to swim. Other contributing factors include the state of the water itself, distance from a solid footing, physical impairment, or prior loss of consciousness. Anxiety brought on by fear of drowning or water itself can lead to exhaustion, thus increasing the chances of drowning.
Approximately 90% of drownings take place in freshwater (rivers, lakes, and a relatively small number of swimming pools); the remaining 10% take place in seawater.[11] Drownings in other fluids are rare and often related to industrial accidents.[12] In New Zealand's early colonial history, so many settlers died while trying to cross the rivers that drowning was called "the New Zealand death".[13]
People have drowned in as little as 30 mm (1.2 in) of water while lying face down.[14]
Death can occur due to complications following an initial drowning. Inhaled fluid can act as an irritant inside the lungs. Even small quantities can cause the extrusion of liquid into the lungs (pulmonary edema) over the following hours; this reduces the ability to exchange the air and can lead to a person "drowning in their own body fluid". Vomit and certain poisonous vapors or gases (as in chemical warfare) can have a similar effect. The reaction can take place up to 72 hours after the initial incident and may lead to a serious injury or death.[15]