POST BASIC B.

Sc DEGREE COURSE IN
NURSING-I YEAR
CHILD HEALTH NURSING
UNIT-VII COMMON DISEASES/DISORDERS OF CHILDREN
O. PAEDIATRIC EMERGENCIES
SUB TOPIC
DROWNING

N. SATHIYA
ASSOCIATE PROFESSOR

Dr. A. REENA EVENCY

PRINCIPAL
LEARNING OBJECTIVES
The students will be able to
• define drowning

• list down the Causes of drowning

• enlist the Types of drowning

• explain the pathophysiology of drowning

• list down the clinical manifestations of drowning

• explain the management of drowning.

DROWNING
 INTRODUCTION

Drowning is a cause of accidental death in

children. Accidental drowning may occur
because children do not have adequate
protective supervision. It may be defined as
submersion incident leading to death within
the first 24 hrs.
 DEFINITION

“Drowning is the process of experiencing

respiratory impairment from submersion/
immersion in liquid. Drowning outcomes
are classified as death, morbidity and no
morbidity”
 Causes
Most Childhood drowning occur in fresh water, bathtubs,
Swimming Pools, Ponds, Large Buckets, Washing
Machine, Toilets and Tanks.
In Adolescents drowning occurs in Lakes and Rivers.

Causes of Hypoxemia in Drowning

• Laryngeal Spasm
• Collapse of Alveoli.
• Fluid in Alveoli and pulmonary Edema.
• Decreased Lung Compliance.
• Complications- Aspiration Pneumonitis, Altered Alveolar
Capillary Membrane, Formation of Protein rich exudates
and infection.
 Types of drowning
1. Wet drowning(primary):
 Water is inhaled inside lungs
 Lungs cannot exchange gases properly
 Breathing and circulation is stopped

2. Dry drowning:
 Water doesn’t enter the lungs due to
immediate spasm of the upper airways
 No air entry from upper airways
 Types of drowning contd.
Near drowning(Secondary drowning):
 It means patient nearly died from drowning.

 Survives for more than 24 hrs.

Immersion Syndrome :

Death occurs by cardiac arrest caused by vagal

inhibition (cold water stimulating nerve endings
& water striking epigastrium & Alcohol induce
such effect)
 Pathophysiology

Pathophysiology Reaction to Submersion

1. Panic
Effects occurs as a
Consequence of 2. Frantic
Hypoxemia 3. Struggling
Aspiration and Failure of other 4. An Attempt to hold the
Organs. Breath.
5. Gasping
Death is either due to
Immediate asphyxia 6. Vomit and Aspirate
following Laryngeal spasm, Vomits
Aspiration of Fluid or Due to
late Complication 7. Laryngeal Spasm
8. Unconsciousness
 PATHOPHYSIOLOGY
Fresh water drowning (river, pond, lake)

Alters the surface tension of pulmonary surfactant

Unstable alveoli,atelectasis and hypoxemia

Hemodilution and hypervolemia

Hemolysis of RBC

Pulmonary edema and hyperkalemia

 PATHOPHYSIOLOGY
Salt water drowning

Hypertonic water get into the alveoli

Shift of fluid from vascular bed into the lungs

Hemoconcentration

Hypovolemia and pulmonary edema

Decreased ventilation
CLINICAL MANIFESTATIONS
• Patients with near drowning can be grouped into
three categories depending upon their severity of
illness
• Category A- the patients may be conscious and
awake
CLINICAL MANIFESTATIONS cont…

• Category B- patients may found with

respiratory distress, cyanosis and stupor
and hypothermia
 CLINICAL MANIFESTATIONS cont…

• Category C- patients are comatosed with

apnea, respiratory failure.
 Management
Emergency Care: Start Mouth to mouth ventilation
immediately. Oxygen should be given as soon as possible.

Cardiac Massage: Effective external cardiac massage 80 –

100 Compression/
Min in Children.100 – 120 compression/min in infant.
Maximum Ventilatory and circulatory support should be
continued and transport the patient to Hospital.
Management cont...

• Category A and B requires supportive care

Management cont...

• Category C patients require advanced life

support
Management cont...

Depending upon the presenting features

following can be administered.
• Oxygen therapy
• Diuretics
• Sodium bi carbonate
• Bronchodilators
 Management cont...
 Clear the Airway and administer Oxygen at the
rate of 8 – 10 litre /Min.
 Provide mechanical ventilatory support if
required.
 Stomach content should be aspirated.
 Monitor the circulatory status with frequent BP
measurement.
 Obtain Blood sample for investigation.
 Arterial Blood Gas Analysis (ABG) and Ph
should be monitored.
 Management cont...

 Insertion of CVP (Central Venous Pressure) for

status of blood Volume.
 Keep IV Line open.
 Administer drug as per order.
 Chest X-ray to determine Foreign Bodies.
 Insert Foleys Catheter.
Management cont....
Near Drowning Children admitted to the Hospital Should
be kept under observation and treated for at least 24 to
48 hrs periods which includes;
– Bed rest
– If Patient is unconscious then give care as per
unconscious care.
– Change position frequently.
– Make Continuous Observation and Assessment of
Child.
– Administer Medication and Treatment as per Plan.
– Provide emotional support to child and parents.
 SUMMARY

Drowning is the leading cause of injury and death

in children between one to four years of age.
Vast majority of the drowning are accidental. It
can be prevented by proper parental supervision.
 Reference

 Marlow RD, Redding AB. Textbook of pediatric nursing.6th ed.

New Delhi. Elsevier publishers.
 Yadav M. A textbook of child health nursing.1st ed. Jalandhar
and vikas and company. 2011.
 Suraja G, text book of pediatric Emergencies, 1st ed, Peepee
brothers publication 2009.
 Kyle.T, Susan SR. Maternity and Pediatric Nursing. 1st ed.
Lippincott publication: Newyork ; 2010.
 Jane B, Ruth B. Pediatric Nursing.2nd ed. Appleton publication;
United States: 2000.