Define Drowning. Describe its pathophysiology, management, prevention and complications.

Definition

Drowning is the process of respiratory impairment from submersion/immersion in a liquid. The outcome is determined chiefly by the duration and severity of hypoxia.

Pathophysiology & Features

• Submersion → breath-holding → laryngospasm → hypoxia → cardiac arrest if prolonged.
• Consequences — hypoxic-ischaemic brain injury, aspiration and delayed pulmonary oedema/ARDS, hypothermia, arrhythmias.

Management

• Rescue and immediate CPR with an emphasis on oxygenation/ventilation (arrest is hypoxic).
• Oxygen, ventilatory support, rewarming, and correction of acidosis/electrolytes.
• Observe for delayed respiratory deterioration (ARDS) even if initially well.
• Neuroprotective supportive care after resuscitation.

Prevention

Most drownings are preventable — constant adult supervision, fencing of water bodies/pools, and safe practices are the key measures.

'DRY' VS 'wet' & Temperature

Outcome depends on hypoxia duration, not the water type; cold-water submersion can occasionally be protective (the diving reflex/hypothermia), so resuscitation is continued in hypothermic drowning ('not dead until warm and dead').

Complications

• Hypoxic-ischaemic encephalopathy (the main determinant of long-term outcome), ARDS, arrhythmias and hypothermia.
• Aspiration pneumonia and electrolyte disturbance.

Management Summary

• Prompt rescue and CPR (oxygenation-focused), oxygen/ventilation, rewarming, and correction of metabolic derangements.
• Admit and observe for delayed pulmonary complications; neuroprotective care after resuscitation.