Makindo Medical Notes

🌊 Most drowning morbidity is from hypoxemia (aspiration, surfactant washout, alveolar injury). ⚠️ Routine attempts to “squeeze out water” are unnecessary and harmful. ❌ The old “dry vs wet drowning” terminology is discouraged — a minority may have laryngospasm with little aspiration, but management is the same: oxygenation and ventilation first.

🚑 Drowning – ED Management (Quick Algorithm)

Rescue & Triage: 🛟 Remove from water; assume C-spine injury only if diving, high-impact, or trauma evidence. Airway & Breathing: 🫁 High-flow O2. Suction visible debris. If hypoxemic → CPAP/PEEP. Intubate for ↑ work of breathing, ↓ GCS, or refractory hypoxemia. Circulation: ❤️ Treat shock; give judicious fluids; start vasopressors if needed. ALS: 💓 CPR if pulseless/apnoeic. Defibrillate when indicated. Monitor EtCO2. Hypothermia: 🧊 Check core temp. Gentle handling. Warmed O2/IV fluids; active rewarming if needed. “Not dead until warm and dead.” Ventilation Strategy (if intubated): Use ARDS-style lung-protective: VT ≈6 mL/kg PBW, adequate PEEP, titrate FiO2. Adjuncts: 🌬️ Bronchodilator for wheeze; antiemetic if vomiting. No routine steroids/antibiotics. Observation: 👀 Watch for delayed deterioration (4–8 h typical).

🔑 Key Points

• ❌ No abdominal thrusts/“water squeezing”. Use suction only for visible airway contents.
• 🧪 Fresh vs salt water electrolyte effects are usually minimal — treat both the same.
• 📌 Always consider co-factors: alcohol/drugs, seizures, arrhythmia, syncope, trauma.

🧪 Investigations (tailor to severity)

• ABG/VBG (oxygenation, pH), CXR (may be normal early), ECG, FBC/U&E/glucose/lactate, core temp.
• CT head/C-spine only if trauma, LOC, or focal neuro signs.

⚠️ Complications to Monitor

• ARDS / non-cardiogenic pulmonary edema
• Aspiration pneumonitis → bacterial pneumonia (24–72 h)
• Hypoxic brain injury, arrhythmias
• AKI, rhabdomyolysis (after prolonged submersion/CPR)

🏥 Disposition

• Safe discharge: after ≥6–8 h observation if normal exam, SpO₂ ≥95% RA, stable vitals, no dyspnea/wheeze, ambulant, reliable follow-up.
• Admit/ICU: if O₂ needed, abnormal vitals/mental status, aspiration, ARDS, pneumonia, hypothermia, comorbidities, or social concerns.

📊 Prognosis – Favourable Factors

• Short submersion (<5 min)
• Immediate bystander CPR
• Conscious/respirations on arrival
• Cold-water submersion with rapid rescue

🧾 Myths vs Facts

• Fresh vs Salt Water: electrolyte/hemolysis differences are negligible in practice → treat identically.
• Antibiotics: not prophylactic. Only if fever after 24–48 h, gross contamination, or clear infection.
• “Dry drowning”: avoid the term. Focus on current symptoms/signs after aspiration or laryngospasm.

📚 Optional Reference – Pathophysiology (Teaching)

For understanding only; does not change ED treatment.

Characteristic	Freshwater	Saltwater
Alveolar effect	Surfactant washout → collapse; some absorption	Osmotic draw → alveolar edema
Systemic impact	Electrolyte shifts minor	Hemoconcentration; shifts minor
Clinical takeaway	Treat both as aspiration-related lung injury → O2, CPAP/PEEP, ARDS ventilation as needed.