Show Summary Details
Page of




Peter J. Fenner

Page of

PRINTED FROM OXFORD MEDICINE ONLINE ( © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy).

date: 27 April 2017

Drowning is a major preventable cause of death, most frequently in children and in developing countries. Aspiration (whether of salt or fresh water) is usual in drowning and near-drowning (known as non-fatal, or submersion injury) and leads to cardiac arrest within a few minutes. Death or severe neurological impairment occurs after submersion for more than 5 to 10 min, but much longer durations may be tolerated in hypothermic conditions.


Precautions include proper supervision of children in recreation areas such as swimming pools, beaches, and river banks, and of young children and epileptics in baths. Personal flotation devices (life jackets) are the best preventive strategy in boating activities. Prevention and rescue efforts of life-savers are effective in swimming pools and on patrolled beaches.

Clinical features

Prognosis cannot reliably be predicted, but cardiovascular status is a better prognostic indicator than neurological presentation. Patients who are neurologically responsive at the scene of immersion, in sinus rhythm and with reactive pupils, have good outcomes. Those who are asystolic on arrival at hospital and remain comatose for more than 3 h have a poor prognosis unless they are hypothermic. Patients with a normal chest radiograph on admission usually survive.


The factors that influence outcome are (1) immediate management—including rapid rescue; laying the victim on their side for assessment of the airway and breathing to assist drainage of any excess water from the airways and lungs; prompt and effective bystander cardiopulmonary resuscitation, using supplemental oxygen if available, preferably with oxygen of highest concentration possible (e.g. bag–valve–mask) and an oropharyngeal airway, endotracheal tube, or laryngeal mask airway in comatose victims (if suitably skilled personnel are present). (2) Hospital management—important elements are (a) ventilatory support to maintain adequate arterial oxygenation, which may involve the use of extracorporeal membrane oxygenation and/or cardiopulmonary bypass in refractory cases; (b) colloid resuscitation, (c) recognition and treatment of complications, e.g. secondary pneumonia.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.