Drowning deaths have increased in recent years, making it more important than ever for emergency physicians manage effectively. In this episode, Corey Williams, MD, reviews current drowning terminology, the pathophysiology that drives treatment decisions, and practical pearls for resuscitation, observation, and disposition. We also discuss common misconceptions and key prevention strategies to share with patients and families (and your own!).

Guest: Corey Williams, MD; Host: Kim Bambach, MD; Audio editor: Nick Roesel

Key Learning Points:

Use the modern drowning terminology:
- Fatal or non-fatal drowning (with or without morbidity). Avoid outdated terms such as near drowning, dry drowning, and secondary drowning.
Demographics:
- Young children, adolescent males, and patients with alcohol use, seizure disorders, or developmental disabilities are at highest risk for drowning.
Pathophysiology:
- Drowning is primarily a hypoxic injury. In cardiac arrest, provide ventilations in addition to chest compressions. Compression-only CPR is not sufficient.
Hypothermia:
- Consider hypothermia when a patient has a drowning event, even in warmer months. Active rewarming remains a critical part of management.
Trauma:
- Consider cervical spine injury only when the mechanism or examination raises concern (e.g., diving injuries, unwitnessed events, neurologic deficits).
Mythbusting:
- Fresh water versus salt water does not change management. Clinically significant electrolyte abnormalities from aspiration are unlikely.
- A normal initial chest X-ray does not rule out delayed pulmonary injury. Patients with non-fatal drowning who remain asymptomatic should generally be observed for at least 4 hours before discharge.
- Routine prophylactic antibiotics and steroids are not recommended after drowning unless there is concern for heavily contaminated water exposure.
Prevention matters:
- Early swim lessons, four-sided pool fencing, close supervision, and CPR training for caregivers remain the most effective ways to reduce drowning-related morbidity and mortality.

Further Reading: