Podcast #108 - Dogmalysis of Dry Drowning

Every year, we see drownings.  In some cases people survive, but unfortunately sometimes they do not.  However, there is confusion in both the medical community and the public regarding what is considered to be a drowning event.  Dogma and myths are everywhere and one of the most common is "dry drowning"  which is why we brought Michelle Perkins on to discuss this important issue.

Introduction

• Stories abound on social media about this myth. These cases are reported after a child dies at a time temporally distant from an incident involving water—they are asymptomatic after water exposure and then dies.
• The myth of this condition is perpetuated by the terminology being widely used, on the internet and in the mainstream media.
• The reality: there has not been a case of somebody dying after a prolonged asymptomatic.

Definition of drowning

• The WHO in 2005 defined drowning as “the process of experiencing respiratory impairment from submersion/immersion in liquid.”
  
• There are only 3 subcategories:
  
  • Fatal drowning
    
  • Non-fatal drowning with injury or illness
    
  • Non-fatal drowning without injury or illness
    
• There are terms that have no acceptable medical definition or validity, but are still widely tossed about, feeding the hysteria and confusion
  • “Dry drowning”—this term was initially actually used to describe pulmonary findings on autopsy, where somebody who drowned was found to have little to no water in their lungs. This is likely due to laryngospasm not allowing much water in. The amount of water is irrelevant. It’s still drowning.
    
  • “Near drowning”—not a thing. You either drown and survive, or you drown and don’t.
  • "Secondary/delayed drowning”—used interchangeably these days with “dry drowning” to describe somebody who develops complications after having a drowning episode. Again, there has not been a case of somebody dying after a prolonged asymptomatic period.
    

 
So how do you manage these cases?

•  Anybody who has respiratory symptoms after such an instance should be evaluated. We’re not talking the initial cough/spluttering that happens when water goes down the wrong pipe, we’re talking severe prolonged coughing, confusion, hypoxia.
• These cases warrant observation for a couple hours. Symptoms should get better or worse within a few hours—watching for, again, severe prolonged coughing, frothing at the nose or mouth, confusion.
  
• It is important to remember that the volume of water ingested is irrelevant—it doesn’t take much to screw up surfactant, and thedisruption of the surfactant is what causes the issues—think pneumonitis, pulmonary edema
  
• If a patient is totally fine, then develops symptoms 8 or more hours out, then something else is at play, and they should be evaluated as such.
  

 
What should we be focusing on instead?

•  Drowning prevention! It is felt that 85% of fatal drownings could be prevented. It is one of the leading causes of accidental death in children. One in 5 people who die from drowning are 14 and under.
• Prevention measures include quality swim instruction, constant vigilance, keeping toddlers within touching distance, fencing pools, PFDs for non- or weak swimmers, and not relying on things like water wings.

 
Take-home points

•  Dry drowning is not a thing. Stop using that term, along with near-drowning and secondary drowning.
• There has never been a case where a totally asymptomatic drowning patient later drops dead from drowning.
• Somebody pulled from the water with severe, prolonged coughing, confusion, frothing at the nose or mouth, or behavior changes needs to be evaluated and monitored for 4 or so hours—they will get better or worse within this time.
• Prevention is key!

​Let us know what you think by giving us feedback here in the comments section or contacting us on Twitter or Facebook.  Remember to look us up on Libsyn and on iTunes.  If you have any questions you can also comment below, email at thetotalem@gmail.com, or send a message from the page.  We hope to talk to everyone again soon.  Until then, continue to provide total care everywhere.

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