Red flag to remember
Worsening cough, dyspnea, or hypoxia hours later signals delayed pulmonary edema - escalate immediately.
What is drowning?
Hypoxia is the central problem, so restoring oxygenation and ventilation is the immediate priority. Even patients who initially appear well can deteriorate from delayed pulmonary edema.
Key points to remember
- Hypoxia is the primary injury, and rescue breathing/oxygenation is the most urgent intervention.
- Rescue breaths are prioritized and may begin in the water by trained rescuers before compressions.
- Cervical spine precautions are used if a diving or trauma mechanism is suspected.
- Delayed pulmonary edema (secondary drowning) can develop hours after the event, so observation is required.
- Cold-water submersion can be protective for the brain and warrants prolonged resuscitation.
- The distinction between fresh and salt water is clinically minor compared with the universal threat of hypoxia.
Signs & symptoms
- Hypoxia, ↓LOC, cyanosis
- Pulmonary edema, crackles
Nursing priorities
- Ensure scene safety, then open the airway and begin ventilation/oxygenation immediately.
- Start CPR with rescue breaths if the patient is unresponsive and not breathing.
- Maintain cervical spine immobilization when trauma is suspected.
- Provide high-flow oxygen and monitor respiratory status and oxygen saturation closely.
- Observe the patient for at least several hours for delayed respiratory deterioration.
Labs & values
Oxygen saturation goal greater than94%
ABG to assess oxygenation and acid-base status
Core temperature if cold-water submersion
Chest X-ray for pulmonary edema/aspiration
Patient teaching
- Supervise children near water at all times and use four-sided pool fencing with self-latching gates.
- Use Coast Guard-approved life jackets and learn to swim and perform CPR.
- Seek medical evaluation after any submersion event even if the person seems fine.
- Never swim alone or under the influence of alcohol.
Red flags: report now
- Worsening cough, dyspnea, or hypoxia hours later signals delayed pulmonary edema - escalate immediately.
- Do not stop resuscitation early in cold-water drowning until the patient is rewarmed.
- Never enter unsafe water to rescue someone; throw or reach instead.
- Report any altered mental status or persistent respiratory symptoms after rescue.
References
Clinical references for this topic
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