DROWNING

suffocation by immersion in a liquid, usually water. Water closing over the victim's mouth and nose cuts off the body's supply of oxygen. Deprived of oxygen the victim stops struggling, loses consciousness, and gives up the remaining tidal air in his lungs. There the heart may continue to beat feebly for a brief interval, but eventually it ceases. Until recently, the oxygen deprivation that occurs with immersion in water was believed to lead to irreversible brain damage if it lasted beyond three to seven minutes. It is now known that victims immersed for an hour or longer may be totally salvageable, physically and intellectually, although they lack evidence of life, having no measurable vital signsheartbeat, pulse, or breathingat the time of rescue. A fuller appreciation of the body's physiological defenses against drowning has prompted modification of traditional therapies and intensification of resuscitative efforts, so that many people who once would have been given up for dead are being saved. Although asphyxiation (lack of oxygen that causes unconsciousness) is common to all immersion incidents, actual aspiration of water into the lungs may or may not occur. Up to 15 percent of fatal drownings are dry, presumably because the breath is held or because a reflex spasm of the larynx seals off the airway inlet at the throat. When aspiration does occur, the volume of fluid entering the lungs rarely exceeds a glassful; the lungs fill with water chiefly because of an abnormal accumulation of body fluids (pulmonary edema) that is a secondary complication of oxygen deprivation. Commonly, also, quantities of water are swallowed and later vomited spontaneously or during resuscitative procedures; vomiting after the protective laryngeal spasm has subsided can lead to aspiration of stomach contents. A natural biological mechanism that is triggered by contact with extremely cold water, known as the mammalian diving reflex, enhances survival during submersion, thus permitting seagoing mammals to hunt for long periods underwater. Scientists have recently determined that vestiges of the reflex persist in humans. The mechanism is powerful in children. It diverts blood from the limbs, abdomen, and surface areas of the body to the heart and the brain. It also causes an interruption of respiratory efforts and reduces the rate of the heartbeat. Even though the heart functions at a slower rate, in other respects it performs normally; actual arrest of circulatory processes is a relatively late development in the drowning sequence. In this suspended state, intracranial blood retains sufficient oxygen to meet the brain's reduced metabolic needs, despite a total absence of respiratory gas exchange. In warm water the body's need for oxygen is increased; therefore, the oxygen deprivation caused by immersion is rapidly lethal or permanently damaging to the brain. Such warm-water drownings occur commonly in domestic bathtubs. Immersion in icy water causes body temperature and metabolism to fall rapidly (the thermal conductivity of water is 32 times greater than that of air). Immersion hypothermiabelow normal body temperaturereduces cellular activity of tissues, slows the heart rate, and promotes unconsciousness. None of these effects is imminently life-threatening; survival following hypothermic coma is almost 75 percent. Rescue teams now continue the benefits of cold-water protection with therapeutic hypothermia. Lifeless immersion victims with core temperatures as low as 62.6 F (17 C) have survived. See also lifesaving.