By Dr. Nina Radcliff
Know the Signs of Dry Drowning, Secondary Drowning
As temperatures rise, millions upon millions throughout our nation respond to the call of sparkling bodies of water in our backyard or community swimming pools, lakes, beaches, ponds and waterparks, “to hop in, get wet, enjoy and cool down!”
It is so true, water can be refreshing and fun – but we must be prepared for serious fun as it can also be deadly – in less than a minute, without even a sound or a splash. Drowning, near-drowning and water submersion injuries are highly prevalent, yet preventable causes of death and injury for all ages. This week and next I am providing vital information on water safety.
You may have heard the tragic news that almost a week after playing in the water on a family vacation, a 4-year old boy from Texas took his last breath from what has been reported as a “Dry Drowning.” Reportedly, the young boy was playing in knee-deep water during a weekend trip in the waters of the Galveston Bay when he was knocked down by a wave from a distant ship. The young child’s head went under water but he was quickly picked-up by an accompanying family friend and “seemed okay.”
In fact, it was reported that the child had fun the rest of the day and it was not until the next day that the child began vomiting and having diarrhea. His parents had in the past taken him to the doctors for similar symptoms and they were advised it was the stomach bug, so they decided to treat him at home–the thought of a submersion injury did not cross their mind.
Nearly a week later, the boy complained of shoulder pain and later during a nap, took his last breath. Rushed to the hospital, medical staff spent over an hour trying to resuscitate him before pronouncing him dead. Doctors said they found fluid in his lungs and around his heart, and they told his parents that he died of “dry drowning,” according to reports. However, the official cause of his death has not been released by the county coroner.
Throughout our nation as our hearts go out to the family – people are asking, “What is Dry Drowning?” Dry drowning on dry land, while rare—is thought to account for a small (1-2%) of drowning incidents but facts are, that is 1-2% too many!! It can be prevented …knowledge and understanding is life-saving!!
Dr. Nina’s What You Need To Know: About Dry Drowning and Secondary Drowning
Our Lungs: The primary responsibility of our lungs is taking in oxygen and getting rid of carbon dioxide (a waste gas). And in order to function efficiently and effectively, they must be “sterile,” meaning that only air is supposed to enter. No other elements are welcome—this means no food, no saliva, no fluids including pool, ocean, or lake water should be present.
And while we know that our vocal cords help us phonate (talk, whisper, sing, yell), they also serve a very important purpose of protecting our lungs from unwelcome elements. They are located just south of the base of our tongue in our voice box, or larynx, and are comprised of “twin” infoldings of membranous tissue that are able to meet in the middle and block passage of air, fluid, or food. In essence, they function as a gate.
What is Drowning?
According to the World Health Organization (WHO), it is defined as “the process of experiencing respiratory impairment from submersion/immersion in liquid.” And, outcomes should be classified as death, morbidity, or no morbidity (morbidity is defined as having a disease or a symptom of disease).
However, there are a number of terms used—and sometimes used interchangeably—such as wet, dry, active, silent, near and secondary drowning. While the WHO agreed that these terms would no longer be used, we continue to see them in reports and when discussing cases. And for this reason, within are understandings of each in order to provide clarity, as an important reference.
What is Dry Drowning?
After being submerged, water that enters the nose or mouth can cause our vocal cords to spasm (contract). And while the water may not actually enter the lungs — because our vocal cords serve as a gate–if they are partially closed, breathing can become difficult and takes considerable work, but air can still pass. If our cords are completely closed, breathing becomes impossible and air ceases to enter our lungs, which can happen even after leaving the water.
Add to that, during vocal cord spasm, our body will continue to make tremendous efforts to inhale (draw air into the lungs). This generates pressure within the chest, like a vacuum, but against closed or partially closed vocal cords. Since it cannot pull in air, the suction effect pulls in fluid from the surrounding tissues and blood vessels. In medical literature, we call this pulmonary edema. What’s important to understand is that the buildup of lung fluid further impairs oxygen and carbon dioxide exchange.
Dry drowning typically occurs more immediately —soon after exiting the water —and as a result has been also referred to by lifeguards as “parking lot drowning.”
Know that there are signs and dry drowning can happen to anyone at any age. If you or a loved one has a near-drowning experience and notice shortness of breath, increased work of breathing (use of neck muscles, visible movement of rib cage), coughing, stridor (a harsh vibrating or grating sound when breathing), or extreme fatigue, call 911 immediately. Minutes, even seconds, count.
What is Secondary Drowning?
Unlike dry drowning, water passes through the vocal cords and enters the lungs. As discussed earlier, our lungs are meant to be sterile. The presence of a foreigner causes an inflammatory reaction with resultant swelling and fluid buildup in the lung sacs—also known as pulmonary edema, but via a different mechanism than dry drowning. However, the pulmonary edema similarly impairs the lung’s ability to effectively transfer oxygen into the body or carbon dioxide out.
Add to this, if pool water is inhaled, there are a number of chemicals in it that can cause a chemical pneumonitis—inflammation of the lungs due to harmful chemicals.
Signs and symptoms of secondary drowning are more delayed compared to dry drowning (generally 1-24 hours or more). They can include a persistent cough, increased work of breathing, shortness of breath, chest pain, lethargy, fever, unusual mood changes, vomiting (a sign of stress such as a lack of oxygen), or pink frothy discharge from the nose or mouth.
How to Spot?
While the science can be confusing, the vital message is that submersion in a body of water can result in drowning on dry land—minutes, hours, even days later. And while this may sound terrifying, this does not occur without warning signs. Early diagnosis and treatment can be life-saving.
I encourage everyone who has a near-drowning event or gets submersed in a body of water to seek medical assistance. At the very least, call your doctor or child’s pediatrician to inform them of what happened and determine if further evaluation is warranted, even if there are no symptoms. And if you do notice symptoms—shortness of breath, persistent coughing, fever, sleepiness, vomiting, altered mental state along with any listed within—get medical attention immediately, or call 911.
As more people turn to the joys of being in the water (wading, knee-deep or fully submerged) it is important to understand Dry Drownings, Near Drowning and Secondary Drownings. Facts are that there is a false sense of security as most folks think once they (or our loved ones) are finished in the water, the risk of drowning is over. But “dry” and “secondary” drowning can happen just hours after being out of the water and on to other activities. Remember that symptoms of dry drowning usually happen right after any incident in the water while secondary drowning generally starts later, within 1-24 hours of the incident. Please review (and pass along) these vital understandings — they can help keep you and your loved ones safe.
Dr. Nina Radcliff is dedicated to her profession, her patients and her community, at large. She is passionate about sharing truths for healthy, balanced living as well as wise preventive health measures.
She completed medical school and residency training at UCLA and has served on the medical faculty at The University of Pennsylvania. She is a Board Certified Anesthesiologist and a member of the American Society of Anesthesiologists where she serves on committees for Young Physicians and Communications. Author of more than 200 textbook chapters, research articles, medical opinions and reviews; she is often called upon by media to speak on medical, fitness, nutrition, and healthy lifestyle topics impacting our lives, today.