Drowning:

Drowning is a cause of accidental death  in children Accidental drowning may occur because children  do not  have adequate protective supervision.  It may be defined as submersign incident leading to death within  the first 24 hours. 

Near-Drowning: is a submersion incident in which the  individual survives for more  than 24  hours, irrespective of the eventual outcome. 

Causes:

These fatalities occur  between  the age of 1 and 4  years and during 15-17 years especially in  boys. Most childhood drowning occur  in  fresh water, bathtubs, swimming pools, ponds, large buckets, washing machine, toilets and tanks.  In  adolescents drowning occurs  lake and  rivers. 

Reaction  to Submersion:

The first reaction of child  is panic, frantic, struggling and an attempt to hold  the breath. Latter on  gasping occurs and water  is swallowed, child may  vomit and aspirate vomitus. Laryngospasm may occur,  leading to unconsciousness. 

Pathophysiology:

Pathophysiological effects occur as a consequence of hypoxemia, aspiration and failure of other organs. Death  is either due to immediate asphyxia following laryngealspasm, aspiration of fluid or due to late complication. The clinical changes and complication  are also influenced by  the fact whether submersion occurred  in  fresh water or seawater.

Causes of Hypoxemia  in Drowning

a)  Laryngeal  spasm 

b)  Pulmonary shunting  through non-ventilated alveoli 

c)  Collapse of alveoli 

d)  Fluid  in alveoli and pulmonary edema (with sea-water) 

e)  Decreased  lung compliance (with fresh and  sea-water) 

f)  Complications  like aspiration pneumonitis, altered alveolar capillary membrane, formation of protein-rich exudates and  infection. 

Nursing Management 

a)  Emergency Care: Mouth  to mouth  ventilation should be started immediately. Half of  the submersion victims vomit during ventilation. Oxygen should be given as soon  as possible. 

b)  Cardiac Massage: Effective external cardiac massage 80-100 compression/minute  in  children and 100-  120 compression.minute in  infant should be instituted if no pulse is felt. Maximum ventilatory and circulatory support should be continued Transport the victim  to the hospital if required. Obtain  information' about incident such  as  the type of water, length of submersion, time of initiation of CPR and duration of unconsciousness.