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Drowning (submersion injuries)

Dipak Chandy, MD
Gerald L Weinhouse, MD
Section Editor
Daniel F Danzl, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Every year, drowning accounts for at least 500,000 deaths worldwide, including approximately 4000 fatalities in the United States [1,2]. Statistics for nonfatal drowning are more difficult to obtain, but nonfatal drowning events may occur several hundred times as frequently as reported drowning deaths [3,4].

Drowning and its management are reviewed here. The management of specific complications of nonfatal drowning (eg, hypothermia, acute respiratory distress syndrome, and bradycardia), complications of SCUBA diving, and the general management of trauma are discussed separately. (See "Accidental hypothermia in adults" and "Hypothermia in children: Management" and "Complications of SCUBA diving" and "Acute respiratory distress syndrome: Clinical features and diagnosis in adults" and "Initial management of trauma in adults" and "Trauma management: Approach to the unstable child".)


Multiple definitions of drowning, nonfatal drowning, and submersion injury have been proposed in the medical literature, creating confusion and underlining the need for a more consistent approach to reporting and studying these incidents [1]. Nonfatal drowning generally is defined as survival, at least temporarily, after suffocation by submersion in a liquid medium [5]. Most authors include the loss of consciousness while submerged as a criterion for the syndrome.

However, some authors have argued that since pulmonary complications may follow the aspiration of water without the loss of consciousness, nonfatal drowning should be defined as survival, at least temporarily, after aspiration of fluid into the lungs ("wet nonfatal drowning") or after a period of asphyxia secondary to laryngospasm ("dry nonfatal drowning") [6].

In its 2010 resuscitation guidelines, the American Heart Association recommends that the Utstein definitions and methods of data reporting for drowning and related events be used to improve consistency in reporting and research [7-9]. According to the Utstein guidelines, drowning refers to: "a process resulting in primary respiratory impairment from submersion or immersion in a liquid medium" [7]. The Utstein guidelines further suggest that ambiguous or confusing terms such as "near-drowning," "secondary drowning," and "wet drowning" should not be used.


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Literature review current through: Sep 2016. | This topic last updated: Oct 5, 2016.
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