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Drowning and Near Drowning and Cognitive FunctioningDrowning will be defined as death resulting from suffocation, especially from submersion in water. Near drowning is a term reserved for those victims whose submersion was of sufficient severity to warrant emergency medical evaluation and treatment. Approximately 15% of children will have experienced near drowning by middle-school age and 33% of adults have experienced near drowning (alcohol is involved in 40-50% of drownings). About 4,500 persons die from drowning each year in the United States. This makes it roughly the third leading cause of accidental death. Pool drownings are the most common, even in coastal areas. Bathtub drownings average one a day in the United States; 26% occur in children under 5 years of age. Approximately 16% of these victims had a history for seizures. Peak incidence occurs in the teenage years and in children under 4 years of age (highest risk). More than 40% of drownings are in the under 4 age group. The occurrence of male drownings is 3:1 over females, outside the home. Alcohol use by older victims is also a factor. The association between drowning and neck (cervical) injuries, from shallow water diving, is well established. REASONS FOR NEAR DROWNING1. Inexperience 2. Hyperventilation 3. Hypothermia 4. Alcohol and drugs 5. Head trauma 6. Seizure 7. Myocardial infarction The COMMON CAUSE of immediate death is lack of oxygen, (asphyxiation) either through the inhalation of large volumes of water into the lungs or via laryngospasm (muscle spasms of the throat and airway). In this situation, the victim suffocates with "dry lungs". These "dry drownings" account for approximately 10% of all drownings. Death from drowning can occur later (within 24 hours after injury) as a complication of drowning, known as POST IMMERSION SYNDROME. This refers to a delayed injury to the lungs that leads to an increase in fluid within the lung tissue. Due to these delayed effects, near drowning victims MUST be admitted to the hospital for close observation and treatment. Patients arriving at the hospital with breathing difficulty will usually "get worse before they get better." Early, aggressive airway support is needed, including assisted mechanical ventilation. In this case, a plastic tube is placed into the lungs (endotracheal intubation) to aid the patient's breathing efforts. Oxygen (in high concentrations) may be given using this modality and the airway is simultaneously protected from aspiration [of vomit] into the lungs. Victims who appear without symptoms are often observed in the hospital for 24 hours, to be certain they do not develop serious complications (post-immersion syndrome). Outcome can be predicted on the basis of whether or not the patient required advanced resuscitation at the accident scene (CPR). Statistics show that almost all victims who require advanced resuscitative efforts will eventually die, or suffer severe brain damage. Young victims in COLD water drownings are an exception and have survived with return to normal function, after prolonged CPR. This has been explained by the rapid cooling of the brain that occurs when the cold water first enters the lungs. Studies show that rapid cooling appears to have a protective effect on the brain, allowing for the improved propect of survival. Factors which appear to be important in increasing survivorship include; age less than 2 years and water temperatures less than 20 degrees Celsius. ALL VICTIMS OF NEAR DROWNING REQUIRE PHYSICIAN EVALUATION. Hope this article will provide you infomation about drowning and near drowning.
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