By Dr. Glenn Hardesty, a physician on the emergency department medical staff at Texas Health
Representing up to ten percent of all drowning cases, dry drowning is a phenomenon whose pathophysiology still remains at a contentious state. With two young boys of my own under the age of six this topic resonates personally, both as a physician and a father. To give clarity around this subject establishing common vocabulary is important, particularly when describing drowning vs. near drowning. Drowning is defined as death within 24 hours following a submersion event, while near drowning denotes survival beyond 24 hours. Additionally the terms dry and secondary drowning can be confusing to parents. In dry drowning a person does not inhale water but rather suffers a spasm of the vocal cords impairing respiration. This results in a lack of oxygen to the brain causing the victim to have an impaired state of consciousness. Conversely, secondary drowning is the after-effect of injury to the lungs caused by an inhaled liquid. As fluid accumulates in the lungs, respiration becomes difficult resulting in a lack of oxygen. Occurring several hours after the person has left the water is a clear distinction from dry drowning. In both cases the respiratory system is the quarry, however affected by different mechanisms. Ultimately the brain and nervous system are the end organ system to be impacted by low oxygen levels.
So when should parents worry following a near drowning event? For the vast majority of cases, serious complications are unlikely to develop after a brief submersion event. Especially if the child comes to the surface alert, coughing and crying. The literature suggests if six hour have passed after an uncomplicated near drowning event, problems are unlikely. But there are signs that suggest a higher probability of adverse outcomes.
- Ongoing shortness of breath following the event
- Any changes of mental status. i.e. are they confused or acting abnormal
- Any loss of consciousness is a significant finding that warrants further evaluation
In dealing with young children, the signs are more difficult to interpret. The parental sense of “something is wrong” often the best predictor of how a child is doing. Activating 911 early when there is concern (such as ongoing symptoms) will improve survival.
If I had to name the top three ways to avoid drowning or near drowning events they are: prevention, prevention and lastly prevention. Studies have suggested that up to 90% of toddler drowning’s could be avoided simply by a barrier fence. The adage “an ounce of prevention is worth a pound of cure” certainly applies in this area. However, when it comes to protecting our children anything less than 100% is a shortfall. We chose to expose our children early in development to the aquatic environment. I’m a firm believer that swim lessons protect our children beyond the fence.
So let’s enjoy the summer, spending time with family and friends. Trading proactive for paranoid, we can beat the Texas heat poolside safe with our loved ones.