Fast Five Quiz: Drowning

Richard H. Sinert, DO


June 25, 2020

The most critical role in management is prompt correction of hypoxemia and acidosis. The degree of hypoxemia is often underrecognized. Patients should receive 100% oxygen and be monitored closely via pulse oximetry, blood gas analysis, or both. Consider intubation and positive end-expiratory pressure (PEEP) with mechanical ventilation support in any patient with poor respiratory effort, altered sensorium, severe hypoxemia, severe acidosis, or significant respiratory distress.

Supplemental oxygen at a fraction of inspired oxygen of 100% should be administered as soon as it is available. The degree of hypoxemia of a patient may be difficult to determine on clinical observation. If available, it is optimal to use of continuous noninvasive pulse oximetry. If the patient remains dyspneic when receiving 100% oxygen or has a low oxygen saturation, use CPAP if it is available. If it is not available, consider early intubation with appropriate use of PEEP. Early use of intubation and PEEP, or CPAP/BiPAP in the awake, cooperative, and less hypoxic patient, is warranted if hypoxia or dyspnea persists despite the patient receiving 100% oxygen.

Ascertaining whether the drowning occurred in warm or cold water is essential. This depends on the temperature of the water and not the temperature of the patient. Maintaining mild hypothermia (core temperature, 89.6°F-93.2°F [32°C-34°C]) may be indicated for 12-24 hours in patients who remain comatose after a drowning episode.

ECMO may be considered in patients after a drowning episode in these circumstances:

  • Respiratory compromise resulting from lack of response to conventional mechanical ventilation or high-frequency ventilation

  • A reasonable probability of the patient recovering neurologic function

  • Persistent hypothermia from cold-water drowning

Efficacy of surfactant therapy has been reported; however, the routine administration of surfactant is not supported by present evidence. Use should be reserved for those with severe hypoxemic respiratory failure.

Read more about the treatment of drowning.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases article Drowning.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.