Introduction
In recent times, the press and mainstream media have reported on the phenomenon of ‘dry drowning’ citing cases of people who have died days after they had been temporarily submerged in water. Drowning is defined as breathing problems following being submerged or immersed in a liquid, and it doesn’t necessarily kill a person.
What actually happens
The breathing difficulties can be immediate or delayed (even days later though long delays are uncommon). Normally when water gets into the back of the throat, a flap of cartilage snaps down to prevent it from entering the breathing tube. The muscles around the epiglottis spasm to keep the water out of the airway. If you cough out the water, all is well. However, if the water manages to get into the lungs, even in small amounts, it can cause disruption of the surfactant (a slippery fluid that keeps the air sacs in the lungs open) as well as an immune reaction that culminates in a serious condition called Acute Respiratory Distress Syndrome (ARDS). ARDS causes the lungs to fill with fluid (pulmonary oedema) and prevents proper gas exchange in the lungs. ARDS is the most serious form of an acute lung injury and is often fatal. This process starts immediately from the time of aspirating the water and not days later.
When to act
The easiest thing to remember is to observe the coughing. If the submerged person came out of the water coughing and continues to cough increasing badly over the next few hours to days, bring him to the emergency room for attention. Wheezing and chest pain are also worrisome symptoms. The patient may need a chest x-ray with oxygen saturation monitored. Emergency treatment with medications and oxygen may be required as well.
If a cough develops days after the swimming, it’s just a cough.
Always keep a constant eye on kids near water. Even a moment’s distraction could cause you to miss catching the child aspirate. If there is no aspiration, there is no risk of drowning or ‘dry drowning’ a few days later.
Dr Ho has been with IMC for over 9 years and is the Senior Doctor based in our Camden Clinic. A graduate of the Royal College of Surgeons, Dublin in 1994, he also has a Bachelor of Science degree from Baylor University in Waco, Texas. To book an appointment please call: 6733 4440.
