Near-drowning: epidemiology, pathophysiology, and initial treatment

Drowning is a major cause of accidental deaths, especially in children. The most serious pathophysiologic consequence of near-drowning is hypoxemia, which usually is due to aspiration-induced noncardiogenic edema. Therefore, initial resuscitative efforts need to be directed at establishing adequate oxygenation and ventilation, followed by rewarming and fluid administration. Although completely asymptomatic patients with normal vital signs, oxygenation and chest radiographs require only 4 to 6 hours of observation, many near-drowning victims will require at least 24 hours of observation. Despite these measures, approximately 25% of victims presenting to the Emergency Department will die and another 6% will develop neurological sequelae. Therefore, it is vital that better efforts be made by the community in promoting and instituting water safety programs.