Airway and Breathing

Drowned patients may need advanced airways to support oxygenation and ventilation. It also can allow suctioning of the airway to remove excess water or other materials. Finally, providing continuing positive airway pressures (CPAP) or positive end expiration pressure (PEEP) can improve ventilation. 

Circulation and Defibrillation

Most drowning patients who are in cardiac arrest will have asystole; however, other cardiac rhythms may be present. In the young, a shockable rhythm (VF or V-Tach) is a negative indicator of prognosis. Following appropriate management guidelines in these cases. Evaluate for significant hypothermia (temperature under 30 degrees C). Some recommendations include treating patients with: 

Do not delay defibrillation until the patient is warmed. There is no good evidence to support this. 

Prolong the time interval between IV medications if the patient is moderately hypothermic (30 -34 degrees C). Some research suggests the benefit of surfactant if the patient drowns in fresh water. Additionally, research also suggests the benefit of ECMO in patients with significant hypothermia following drowning. However, more research is needed for official recommendations.

Summary

• The best management of drowning is prevention. This includes:
  • Continuous supervision of young children around bodies of water. In public spaces, this should include lifeguards. 
  • Security features surrounding community and personal pools
  • The close proximity of life-saving devices such as rigid backboards, BLS supplies, and AEDs. 
  • Increased education of the lay public in CPR techniques
  • Swimming instruction. 
• Ventilation is the key therapy for the drowned patient
• The Ulstein guidelines provide a definition of drowning events. The severity of drowning events can range from mild aspiration to cardiac arrest. 
• Always evaluate for associated hypothermia or trauma in the drowned patient. 
  • If there is trauma or concern for a cervical spine injury, use immobilization of the cervical spine. Note that routine immobilization of the cervical spine is not recommended. 
  • Hypothermia associated protection in drowning patients is only possible in a severe case of hypothermia in icy waters when hypothermia occurs before hypoxia.