Take Your Breath Away
This month’s topic could be gruesome so the title is intended as a gentle introduction to the tragedy of drowning or, hopefully, the successful treatment of near-drowning.
This is clearly a crucial topic for the maritime world but can affect anyone – for instance, drowning in the United States is the second most common cause of death for children after road deaths but these children are often found in garden pools and even baths rather than swimming or at sea. Some adults have died with their face in a puddle.
Water can be fun but it can transform into a monster taking many different forms – falling through ice as in the recent spate of cold weather in the UK – some warm beaches can be susceptible to overwhelming rip currents – equipment can entrap underwater and dives can go wrong – alcohol can impair judgement and physical ability – cold or injury can incapacitate – the list of scenarios is endless.
Drowning is death from a form of suffocation involving water and near-drowning is the survival of a potentially drowning event involving unconsciousness or water inhalation and can go on to serious secondary complications a few days after the event (secondary drowning).
Forced submersion makes a conscious person hold their breath and try to access air and may produce panic and rapid body movement which hastens the breath-hold break point. Breathing water into the airways when conscious leads to coughing and involuntary inhalation of more water. When water enters the airways, both conscious and unconscious casualties experience spasm of the vocal cords in the larynx which protects against further inhalation of water, but also leads to asphyxia underwater.
Casualties who are still breathing at rescue need oxygen and also treatment for possible hypothermia and shock.
Casualties who are unconscious are clearly in more serious trouble. Unconsciousness rapidly ensues due to shortage of oxygen to the brain and also the heart may stop (cardiac arrest) – death is then inevitable unless rescue and cardiopulmonary resuscitation can be performed within a few minutes. An unconscious casualty who is still breathing (and therefore has not arrested) should be put in the recovery position and given oxygen. An unconscious casualty who is not breathing will need mouth-to-mouth breathing (five initial rescue breaths to help the oxygen depleted situation), followed by chest compression and subsequent rescue breaths in a ratio of thirty compressions to two breaths – ultimately this person will need a defibrillator to restart the heart and then move on to oxygen when they start to breath for themselves.
Secondary drowning is a complication which can follow up to 72 hours after the near-drowning incident or also after water inhalation episodes associated with faulty regulators in diving or with buddy breathing or accidentally inhaling water in surface-swimming. Only a small volume of water is required to start the process which triggers the production of inflammatory fluid in the lungs and interferes with normal lung function. It can be associated with flu-like symptoms of hot and cold flushes and shivering and shortness of breath with heavy coughing, sometimes with blood in phlegm. “Drowning in one’s own fluid” is a serious condition which may well need hospital care involving medication to reduce the fluid and inflammation as well as antibiotics, to reduce the chances of additional chest infection, and oxygen to aid respiration.
Understanding and dealing with near-drowning is a big topic with lots more detail under the surface. It’s an important topic for yacht crew and understanding the condition together with the different practical aspects of management are covered in detail in MCA Courses on Elementary First Aid and Medical First Aid.
Dr Ken Prudhoe, MCA Approved Doctor, can be contacted at Club de Mar Medical Centre, Palma de Mallorca.