Drowning
A concise ED‑facing review of definitions, pathophysiology, initial management and disposition for patients who have experienced respiratory impairment from submersion or immersion in liquid (Resuscitation Council UK).
Definition and classification
- Drowning: respiratory impairment from submersion or immersion in liquid. The outdated term “near‑drowning” should not be used.
- Submersion: airway completely below the liquid surface.
- Immersion: liquid occludes the airway by splash/spray without full submersion.
- Temperature: cold‑water < 20°C; warm‑water ≥ 20°C. Cold water has important prognostic and resuscitation implications.
Epidemiology and risk factors
- Drowning is a major cause of accidental death and non‑fatal injury.
- Risk is greatest in young children and in males (peak incidence in young adult men).
- Common contributing factors: lack of supervision, alcohol or drug use, inability to swim, absence of lifejackets or barriers.
- Public‑health prevention (NICE public‑health guidance) is important, especially for children.
Pathophysiology - why even small volumes matter
Drowning produces hypoxaemia as water interferes with gas exchange; hypoxia then drives multi‑organ dysfunction and acidaemia. Typical aspirated volumes are often small (< 4 mL/kg) but cause major physiological disturbance by:
- diluting and inactivating pulmonary surfactant → alveolar collapse, reduced compliance and atelectasis;