Definition
Drowning is defined as death by asphyxiation following submersion in a fluid, which is usually water. During the initial resuscitation it does not seem to make any difference whether this is fresh or salt water. Near-drowning occurs when the victim recovers, however briefly, following submersion.
Epidemiology
Bodies of water act as a strong draw for children and are a favored play area. Every year hundreds of children drown and this is a significant cause of death particularly in the under 4–year-olds who are often oblivious to the potential dangers. Carers should be ever mindful of this and should never leave children unsupervised especially if they suffer with epilepsy. Whether it be the garden pond or the unattended bathtub, they are all potential death traps. Children should be encouraged to learn to swim from an early age.
Pathophysiology
In drowning accidents, the primary event is a respiratory arrest eventually leading to a secondary cardiac arrest. A child submerged in water will initially hold their breath and their heart rate slows as part of the diving reflex. If this process continues, hypoxia develops and the child then becomes tachycardic. Eventually the child will take a breath and inhale water, which on contact with the glottis results in laryngospasm and secondary apnoea. In about 10% of cases no water actually enters the lungs in what is known as ‘dry drowning’. In the remaining cases, secondary apnoea is followed by the disappearance of laryngeal spasm and the development of involuntary respiration. Water and debris are then drawn down into the lungs. The child becomes progressively more hypoxic and acidotic, with a terminal bradycardia or arrhythmia acting as the prelude to eventual cardiac arrest.
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