Near Drowning Definition Near-drowning is the term used for survival after suffocation caused by submersion in water or other

fluid or liquid. Description An estimated 15,00070,000 near-drownings occur in the United States each year; insufficient reporting prevents a more precise estimate. A typical person experiencing near-drowning is young and male. Nearly half of all drownings and near-drownings involve children less than four years old. Because home swimming pools are the sites for 6090% of drownings in the 04 age group, they pose the greatest risk for children. Teenage boys are also at heightened risk for drowning and near-drowning; drugs and alcohol are implicated in 4050% of teenage drownings. Overall, roughly four out of five drowning victims are males. Causes and symptoms On many occasions, near-drownings are secondary to an event such as a heart attack that causes unconsciousness or a head or spinal injury that prevents a diver from resurfacing. Neardrownings, moreover, can occur in shallow as well as deep water. Small children have drowned or almost drowned in bathtubs, toilets, industrial-size cleaning buckets, and washing machines. Bathtubs are especially dangerous for infants between six months and one year of age, who can sit up straight in a bathtub but may lack the ability to pull themselves out of the water if they slip under the surface. A reduced concentration of oxygen in the blood (hypoxemia) is common to all near-drownings. When drowning begins, the larynx (air passage) closes involuntarily, preventing both air and water from entering the lungs. In 1015% of cases, hypoxemia results because the larynx stays closed; this is called dry drowning. Hypoxemia also occurs in wet drownings, the 8590% of cases where the larynx relaxes and water enters the lungs. Only a small amount of either freshwater or saltwater is needed to damage the lungs and interfere with the body's oxygen intake. Within three minutes of submersion, most people are unconscious. Within five minutes, the brain begins to suffer from lack of oxygen. Abnormal heart rhythms (cardiac dysrhythmias) often occur in near-drowning cases, and the heart may stop pumping (cardiac arrest). An increase in blood acidity (acidosis) is another consequence of near-drowning and, under some circumstances,near-drowning can cause a substantial increase or decrease in the volume of circulating blood. Many individuals experience a severe drop in body temperature (hypothermia). The signs and symptoms of near-drowning can differ widely from person to person. Some people are alert but agitated, while others are comatose. Breathing may have stopped in one person, while another may be gasping for breath. Bluish skin (cyanosis), coughing, and frothy pink sputum (material expelled from the respiratory tract by coughing) are often observed. Rapid breathing (tachypnea), a rapid heart rate (tachycardia), and a low-grade fever are common during

the first few hours after rescue. People who have experienced near-drowning but remain conscious may appear confused, lethargic, or irritable. Health care team roles First aid can be administered by anyone with proper training. This may include CPR. Paramedics may provide support during transport to a hospital. Physicians commonly evaluate and provide treatment in an emergency department. Nurses provide emergency and supportive care. Therapists may be called upon to provide follow-up counseling. Prevention Prevention depends on educating parents, other adults, and teenagers about water safety. Parents must realize that young children who are left in or near water without adult supervision, even for a short time, can easily get into trouble. Experts consider putting up a fence around a home swimming pool an essential precaution, and estimate that 5090% of child drownings and near-drownings could be prevented if fences were widely adopted. The fence should be at least five feet (1.5 m) high, have a self-closing and self-locking gate, and completely surround the pool. Pool owners and all other adults should consider learning CPR. Everyone should follow the rules for safe swimming and boating. Those who have a medical condition that can cause a seizure or otherwise threaten safety in the water are advised always to swim with a partner. People need to be aware that alcohol and drug use substantially increase the chances of an accident. Nursing Diagnosis Impaired gas exchange related to increased alveolar-capillary permeability, interstitial edema, and decreased lung compliance. Ineffective breathing pattern related to decreased lung compliance and tracheobronchial obstruction. Risk/ Actual aspiration related to ingestion of fluids. Ineffective Airway Clearance related to tracheobronchial obstruction.

Resources BOOKS Dix, Jay. Asphyxia and Drowning: An Atlas. Boca Raton, FL: CRC Press, 2000. Fletemeyer, John A., and Samuel J. Freas. Drowning: New Perspectives on Intervention and Prevention. Boca Raton, FL: CRC Press, 1999. Kallas, Harry J. "Drowning and Near Drowning." In Nelson Textbook of Pediatrics, 16th ed., edited by Richard E. Behrman et al. Philadelphia: W. B. Saunders, 2000, 279-87.

Modell, Jerome H. "Drowning and Near Drowning." In Harrison's Principles of Internal Medicine, 14th ed., edited by Anthony S. Fauci et al. New York: McGraw-Hill, 1998, 2555-56. Piantadosi, Claude A. "Physical, Chemical, and Aspiration Injuries of the Lung." In Cecil Textbook of Medicine, 21st ed., edited by Lee Goldman and J. Claude Bennett. Philadelphia: W. B. Saunders, 2000, 425-33. PERIODICALS Blum, C., and J. Shield."Toddler Drowning in Domestic Swimming Pools." Injury Prevention 6 no. 4 (2000): 288-90. Frison, Y. M. "Pediatric Near-Drownings." Nursing Spectrum 8 no. 16 (1998): 11, 24, 1998. Gheen, K. M. "Near-Drowning and Cold Water Submersion."Seminars in Pediatric Surgery 10 no. 1 (2001): 26-7. Giesbrecht, G. G. "Cold Stress, Near Drowning and Accidental Hypothermia: A Review." Aviation, Space and Environmental Medicine 71 no. 7 (2000): 733-52. Zuckerman, G. B, and E. E. Conway. "Drowning and Near Drowning: A Pediatric Epidemic."Pediatric Annuals 29 no. 6 (2000): 360-66. ORGANIZATIONS American College of Emergency Physicians. P.O. Box 619911, Dallas, TX 75261-9911. (800) 798-1822. (972) 550-0911. (972) 580-2816. <http://www.acep.org/>. info@acep.org. American College of Osteopathic Emergency Physicians. 142 E. Ontario Street, Suite 550, Chicago, IL 60611. (312) 587-3709. (800) 521-3709. (312) 587-9951. <http://www.acoep.org>. National Safe Kids Campaign. 1301 Pennsylvania Avenue, Suite 1000, Washington, D.C. 20004-1707. <http://pedsccm.wustl.edu/AllNet/english/neurpage/protect/dr... >. Search and Rescue Society of British Columbia. P.O. Box 1146, Victoria, BC Canada V8W 2T6. (250) 384-6696. <http://www.sarbc.org/homepage.html>. sarbc@sarbc.org. OTHER Columbia Presbyterian Medical Center.<http://cpmcnet.columbia.edu/texts/guide/hmg13_0005.html>. Consumer Products Safety Commission.<http://www.lifesaver.com/stats.htm>. Diving Medicine Online.<http://www.gulftel.com/~scubadoc/hypoth.htm>. Merck Manual. <http://www.merck.com/pubs/mmanual_home/sec24/283.htm>. National Library of Medicine.<http://medlineplus.adam.com/ency/article/000046.htm>. L. Fleming Fallon, Jr., M.D., Dr.P.H.