Near Drowning
Near Drowning
What is Drowning?
What are the causes of Near Drowning?
What happes in ICU?
How long will the patient remain in ICU?
References
Date of Publishing
What is Near Drowning?
Near drowning (or submersion injury) is severe oxygen deprivation caused by submersion in water. Near drowning may occur when a person is under water, attempts to breathe, and aspirates water. Aspiration is the entry of water or any foreign material into the trachea (wind pipe) and lungs, and usually results from a loss of airway reflexes. Near drowning may also occur if a patient has an uncontrolled spasm or muscle contraction of the vocal cords (laryngospasm). As a result of this, oxygen cannot pass through to the lungs. Both aspiration and laryngospasm can lead to severe hypoxia (lack of oxygen), and may result in loss of consciousness and cardiac arrest. Patients with evidence of fluid aspiration often progress to develop severe inflammation of the lungs (Acute Respiratory Distress Syndrome) within a short time. A person who has been submerged in water is also at risk of hypothermia (extreme cold). The patient with a near drowning injury may end up with brain damage caused by the severe shortage of oxygen.
What is drowning?
Drowning occurs when a person has died within 24 hours of submersion in water however, if the person is alive the injury is called Near Drowning. In Australia in 2006-2007, there were 277 reported drownings. The main activities undertaken prior to drowning were swimming/ leisure activities, followed by people falling into water.
What are the causes of near drowning?
- Rip currents
- Accidental fall into water
- Head and Spinal injury
- Loss of consciousness
- Heart attacks or abnormal heart rhythms
- Drug and alcohol influence
- Road traffic accident near water
- Child abuse
- Suicide
- Murder
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What happens in the ICU?
- The patient will be connected to a bedside monitor with heart rate, blood pressure, respiratory rate and oxygen saturations being continuously measured.
- The patient may be intubated with an endotracheal tube and be mechanically ventilated to provide oxygen and respiratory support.
- An arterial line may be inserted to monitor blood pressure, and so that blood tests such as ABGs can be done regularly.
- A central venous catheter may be inserted so that medications can be given.
- The patient will also have an indwelling bladder catheter inserted to drain and monitor urine output, as well as a nasogastric tube to provide nutrition.
- A warming blanket may be applied to correct hypothermia, as near drowning patients are often very cold due to being submerged in water of low temperature.
- The patient may have other associated injuries (spinal injury, bone fractures etc), which will also be managed in the intensive care unit.
While in the Intensive Care Unit, the patient may have tests including chest x-rays and CT scans. Assessment of neurological status (brain activity), including any seizure activity is an important aspect in looking after the near drowning patient, as a lack of oxygen to the brain may result in seizures.
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How long will the patient remain in ICU?
The prognosis of the near drowning patient depends on how long the patient was submerged in water and if there were any other associated injuries. Please ask the ICU nurse or doctor, as the time a patient remains in ICU varies from patient to patient.
Reference
The Royal Life Saving Society Australia
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The information contained on this page is general in nature and therefore cannot reflect individual patient variation. In addition it reflects Australian intensive care practice which may differ from other countries. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. ICCMU attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.
Near Drowning Version 1
Author Kathleen Ryan CNC ICCMU
First published August 2008
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