Intended for healthcare professionals

Clinical Review ABC of resuscitation

Near drowning

BMJ 2003; 327 doi: (Published 04 December 2003) Cite this as: BMJ 2003;327:1336
  1. Mark Harries


    At times, cold can protect life as well as endanger it. There have been extraordinary examples of survival after long periods of submersion in ice cold water. Such cases highlight the differences in the approach to resuscitation that sets the management of people who nearly drown apart from all other circumstances in which cardiopulmonary arrest has occurred.

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    Essential factors concerning immersion incidents

    Management at the scene


    Attempts to rewarm patients with deep hypothermia outside hospital are inappropriate, but measures to prevent further heat loss are important. Good evidence suggests that when cardiac arrest has occurred, chest compression alone is as effective as chest compression with expired air resuscitation. Extracorporeal rewarming plays such an important part that unconscious patients with deep hypothermia should not be transported to a hospital that lacks these facilities.

    To prevent further heat loss in conscious patients with hypothermia, wet clothing should be removed before they are wrapped in thick blankets. Hot drinks do not help and should be avoided. Shivering is a good prognostic sign. Attempts to measure core temperature at the scene are pointless.

    Collapse after removal from water

    It requires at least two adults to lift a person from the water into a boat. Head-out upright immersion in water at body temperature results in a 32-66% increase in cardiac output because of the pressure of the surrounding water. Resistance to circulation is suddenly removed as the person leaves the water, which, when added to venous pooling, can cause circulatory collapse. This is believed to be the cause of death in many individuals found conscious in cold water but who perish within minutes of rescue. To counter this effect, patients should be lifted out of the water in the prone position.

    Associated injuries

    Patients recovered from shallow water, particularly those with head injuries, often …

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