Introduction

Drowning is defined as death from asphyxia associated with submersion in a fluid. Near drowning is said to have occurred if there is any recovery (however transient) following a submersion incident.

Epidemiology

The incidence of survival from near drowning is unknown, but death from drownings and near-drowning is the third most common cause of accidental death in children in the UK (after road accidents and burns). In England and Wales 34 children died from drowning or near drowning in 1998. Children most commonly die in private swimming pools, garden ponds, and other inland waterways.

Pathophysiology

When a child is first submerged, apnoea occurs and the heart rate slows because of the diving reflex. As apnoea continues, hypoxia causes tachycardia, a rise in the blood pressure, and acidosis. Between 20 seconds and 2-5 minutes later a break point is reached, and breathing occurs. Fluid is inhaled and on touching the glottis causes immediate laryngeal spasm. Secondary apnoea eventually gives way to involuntary respiratory movements, and water, weeds, and debris enter the lungs. Bradycardia and arrhythmias follow, heralding cardiac arrest and death.

Children who survive because of interruption of this chain of events not only require therapy for near drowning, but also assessment and treatment of concomitant hypothermia, electrolyte imbalance, and injury (particularly spinal).

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