The immediate physiologic response to drowning is breath-holding. After breath-holding, involuntary laryngospasm can occur with entry of fluid into the oropharynx and larynx. At this point, oxygen stores are depleted quickly leading to hypoxia as well as hypercarbia and acidosis. Alternatively, if laryngospasm does not occur, the drowning individual will quickly begin gasping for air and reflexively coughing with entrainment of water into the airways. Thus, drowning results from asphyxiation (with or without aspiration of water). Initial management of cardiac arrest in the drowning victim is to restore ventilation through rescue breathing. This differs from cardiopulmonary resuscitation in a patient with cardiac arrest due to other causes where CPR begins with immediate and uninterrupted chest compressions. In the drowning victim, two rescue breaths should be delivered to produce chest rise. If the patient does not respond, the rescuer should begin high-quality chest compressions and continue CPR according to BLS protocols, with 2 minutes of CPR and a 30:2 compression-to-ventilation ratio.
- Szpilman D, Bierens JJ, Handley AJ, Orlowski JP. Drowning. N Engl J Med. 2012 May 31;366(22):2102-10.
- ACLS Drowing Resource: https://acls.com/free-resources/miscellaneous/drowning
- Drowning (submersion injuries). UpToDate, 2015.
Defined by: Lauren Dunn, MD