Drowning
Vasily Perov: The Drowned, 1867 painting
Specialty	Critical care medicine
Symptoms	Event: Often occurs silently with a person found unconscious [1] [2] After rescue: Breathing problems, vomiting, confusion, unconscious [2] [3]
Complications	Hypothermia, aspiration of vomit, acute respiratory distress syndrome [4]
Usual onset	Rapid [3]
Risk factors	Alcohol use, epilepsy, low socioeconomic status, access to water [5]
Diagnostic method	Based on symptoms [3]
Differential diagnosis	Suicide, seizure, hypoglycemia, heart arrhythmia [2]
Prevention	Fencing pools, teaching children to swim, safe boating practices [5] [6]
Treatment	Rescue breathing, CPR, mechanical ventilation [7]
Medication	Oxygen therapy, intravenous fluids, vasopressors [7]
Frequency	4.5 million (2015) [8]
Deaths	324,000 (2015) [9]

Drowning is defined as respiratory impairment as a result of being in or under a liquid. ^{[7] [10]} Drowning typically occurs silently, with only a few people able to wave their hands or call for help. ^[1] Symptoms following rescue may include breathing problems, vomiting, confusion, or unconsciousness. ^{[2] [3]} Occasionally symptoms may not appear until up to six hours afterwards. ^[3] Drowning may be complicated by low body temperature, aspiration of vomit, or acute respiratory distress syndrome. ^{[4] [11]}

Drowning is more common when the weather is warm and among those with frequent access to water. ^{[4] [5]} Risk factors include alcohol use, epilepsy, and low socioeconomic status. ^[5] Common locations of drowning include swimming pools, bathtubs, natural bodies of water, and buckets. ^{[3] [7]} Initially the person holds their breath, which is followed by laryngospasm, and then low oxygen levels. ^[4] Significant amounts of water usually only enter the lungs later in the process. ^[4] It may be classified into three types: drowning with death, drowning with ongoing health problems, and drowning with no ongoing health problems. ^[10]

Efforts to prevent drowning include teaching children to swim, safe boating practices, and limiting or removing access to water such as by fencing pools. ^{[5] [6]} Treatment of those who are not breathing should begin with opening the airway and providing five breaths. ^[7] In those whose heart is not beating and who have been underwater for less than an hour CPR is recommended. ^[7] Survival rates are better among those with a shorter time under the water. ^[7] Among children who survive, poor outcomes occur in about 7.5% of cases. ^[7]

In 2015, there were an estimated 4.5 million cases of unintentional drowning worldwide. ^[8] That year, there were 324,000 drowning deaths, making it the third leading cause from unintentional injuries after falls and motor vehicle collisions. ^[9] Of these deaths, 56,000 occurred in children less than five years old. ^[9] Drowning accounts for 7% of all injury related deaths, with more than 90% of these deaths occurring in developing countries. ^{[5] [9]} Drowning occurs more frequently in males and the young. ^[5]

References