DROWNING

Introduction
Epidemiology
Causes
Risk factors
Pathophysiology
Management
Prevention
Complications


Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. It is a panic experience. Contrary to what we watch on Nollywood and Hollywood, drowning tends to be a quiet and silent act. Victims expend significant energy trying to keep their head above water and may be too tired to shout for help.

According to WHO, drowning is among the 10 leading causes of death in children and young people in every region of the world. About 372,000 people drown worldwide annually.


Risk factors include
Age: commoner amongst children and young adults
Male sex: because they are more prone to risky behaviours
Alcohol: results in poor judgement
Injuries: could be due to a broken neck from diving into too shallow water which prevents the victim from swimming
Medical emergencies eg. Seizures, heart attack, hypoglycemic coma, etc
Flood disaster
Travelling on water


Causes of drowning depends on the age group of the victim.
¶ infants most often drown in a bathtub
¶ children most often in a neighborhood or backyard pool
¶ teens and young adults (15-25 years) most often in natural water bodies eg rivers and lakes.


Pathophysiology
Drowning occurs within few seconds. The victim struggles to hold his breath under water voluntarily until the urge to breathe due to hypercapnia becomes overwhelming.
Fluid is aspirated into the airways and or swallowed.
Lack of oxygen to the brain leads to cerebral anoxia which stops breathing and aspiration.
Prolonged anoxia leads to irreversible cerebral injury.


Management
Pre-hospital resuscitation begins at the edge of the water. Take off all wet clothing and cover the victim with a warm blanket.
Begin cardiopulmonary resuscitation.
Rush him to a hospital for proper management.

AVOID abdominal thrust to expel swallowed water as this could lead to aspiration and worsen prognosis.


Prevention
¶ learn how to swim.
¶ never swim alone.
¶ always supervise children closely around water and be certain that they are the objects of your attention.
¶ swimming pools should have barriers to prevent children from entering unattended.
¶ water floatation device eg. Life jackets should always be worn during activities on the water.
¶ never leave infants alone in a bathtub or sink.
¶ alcohol should be consumed in moderation when swimming.
¶ watch out for anyone who seems to be swimming ineffectively or are bobbing in the water in an uncoordinated way and whose head drops under water.


Complications
¶ Brain damage
¶ Aspiration pneumonia
¶ Hypothermia
¶ Acute Respiratory Distress Syndrome