What emergency department care is indicated in drowning patients?

Updated: Jun 19, 2019
  • Author: G Patricia Cantwell, MD, FCCM; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

The 1960s and 1970s saw a large body of research on drowning pathophysiology, evaluation, and management, including the development of a number of scoring systems to evaluate drowning victims. However, this work, as pointed out in a recent editorial, has not kept pace with work in cardiac and brain resuscitation and has not met the test of large randomized multicenter trials. [80] As such, while clearly very promising, the use of newer resuscitation methodologies, such as compression-only CPR and therapeutic hypothermia, have not been rigorously studied in drowning patients.

Patients who arrive in the emergency department in cardiopulmonary arrest after a warm-water submersion have a dismal prognosis. The benefit of resuscitative efforts should be continuously assessed. Initial management of near drowning should place emphasis on immediate resuscitation and treatment of respiratory failure. Frequent neurologic assessments should occur; the Glasgow Coma Scale is one modality that has been effectively used. Evaluate associated injuries early, particularly since cervical spine injury may complicate airway management. Initially provide all drowning victims with 100% oxygen, yet be cognizant of the goal to avoid or treat hypoxemia while minimizing hyperoxemia.

Early use of intubation and PEEP, or CPAP/bilevel positive airway pressure (BiPAP) in the awake, cooperative, and less hypoxic individual, is warranted if hypoxia or dyspnea persists despite 100% oxygen.

Endotracheal intubation and mechanical ventilation may be indicated in awake individuals who are unable to maintain adequate oxygenation on oxygen by mask or via CPAP or in whom airway protection is warranted.


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