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Saturday, July 26, 2008

Dry drowning: Drowning on dry land

"Did you ever hear about dry drowning before?" my wife asked.

"No." I said.

She told me that according to a woman on one of her nursing websites, one lady was writing about how she took her eight-year-old boy to the beach, and on the way home he lost control of his bowels. It was unusual, but she chocked it up as him just being exhausted from swimming.

When she got home she noticed he seemed very tired, so she had him go to his room and take a nap. He never woke up.

On autopsy, he was diagnosed as being a victim to dry drowning. This occurs to about 100 kids per year about the same age as this ladies son. However other estimates show that it's about 10-20% of all drownings annually.

Usually what happens is kids who think they know how to swim but really don't end up inhaling a bunch of water, and this water sits in their alveoli making it difficult to exchange oxygen.

Actually, the patient may be rescued from a near drowning incident, be considered to be completely fine, and then die 1-24 hours later of dry drowning.

Thus, instead of drowning under water, the child drowns on land. Squidkid wrote an excellent article on this. also has a good write up.

According to WebMD, "This can result in laryngospasms, which minimize the amount of water aspirated into the lungs. Respiratory arrest may follow, leading to an inadequate supply of oxygen in the blood, cardiac arrest, and eventually brain death."

The laryngospasm is your bodies natural response to inhaling a foreign object into the lungs.

According to Wikipedia, "The laryngospasm reflex essentially causes asphyxiation and neurogenic pulmonary edema."

To add to the problem, during this process an increased amount of blood is circulated to the pulmonary system. This overwhelms the heart with blood, and causes it to pump harder. In the lungs, the pulmonary vasculature is narrowed, "narrow enough that red blood cells have to pass through in single file."

The walls of the arteries also become very thin to enhance the lungs ability to exchange oxygen and carbon dioxide, however there is no oxygen to exchange. "This partial vacuum draws some of the fluid from the vasculature and into the air spaces of the lungs, creating pulmonary edema, and the patient is now drowning in their own fluids."

To add to the problem, the sympathetic nervous system causes constriction of arteries and veins, which results in increased blood pressure which further exacerbates the pulmonary edema.

This is not unlike another process we RTs are familiar with: ARDS. ARDS "is an acute, severe injury to most or all of both lungs or electrolyte abnormalities resulting from a dilution of the blood after aspirated water is absorbed into the blood, leading to heart rhythm abnormalities."

Slowly, they die of hypoximic hypoxia. According to one doctor there is nothing that doctors can do to prevent death in these dry drowning kids even if they make it to the hospital. However, I don't necessarily believe that. I think we'd treat it just as we would treat ARDS, and the survival rates of ARDS are going up.

Another time dry drowning can occur is with a torture technique called water boarding. This is where one person will pour water over the head of a prisoner to make it feel like he is drowning. This is done to get people to talk.

So, who is at risk? Definitely first time swimmers, or, as I mentioned above, children who think they are good swimmers but really aren't. Children and adults with pulmonary illnesses such as ASTHMA "may also be at increased risk for drowning."

How do you prevent dry drowning? According to WebMD, "use common sense and never let inexperienced swimmers in the pool without a lot of supervision."

What are signs of dry drowning?

  1. coughing

  2. shortness of breath

  3. chest pain

  4. change in mental status

  5. strange behavior

  6. lethargy

If you witness these symptoms in your child after he or she spent time in the water, you need to get them to the hospital immediately.

And, when your children are in the water, they need to be very closely supervised.


Intubate Em!!! said...

My mother in law just told me something about this. I thought she was just her crazy old self.

amy said...

I think you ought to make this post a static link in your sidebar--I've never heard of dry drowning, and I bet lots of other parents would like the information, too. Thanks for the great post--It'll be in this week's Friday links.

Katrina R. said...

Thanks for linking up to! It is a shocking fact that drownings can occur after the fact -- but parents need to not believe all the media hype and understand the special circumstances that cause one. Great info!

Blessedmomof4 said...

I came over from AsthmaMom. Thanks so much for the great information! I had heard the term dry drowning but never fully understood the physiology of it. Thanks for breaking it down and making it easy to understand. We have taught our kids to swim very early in life, but still have one who is 8 and one just turned 3 and both are over confident in their abilities. Really great info. and I will be sure to pass it on to my family and friends.