August 4, 2014

Know the symptoms of 'secondary drowning'

The phenomenon commonly known as secondary drowning is rare, but awareness is the key to survival - particularly in children. Secondary drowning can occur hours after a person survives an underwater drowning experience.

A phenomenon commonly known as secondary drowning, though extremely rare, has been getting more attention this summer thanks to cases publicized nationally and shared on social media.

Secondary drowning – sometimes called “delayed” or “dry” drowning – can occur hours after a person survives an underwater drowning experience. The individual may appear to be recovered, but the inhaled water is absorbed into the lungs and can damage the membranes necessary to exchange oxygen and carbon dioxide.

Symptoms – which are more difficult to detect in young children – include bouts of coughing, wheezing, gasping for air or lethargy.

If it is not treated in time, secondary drowning can be fatal.

How it happens

The cause of secondary drowning is injury to the lungs from debris in the water: salt, dirt, bacteria and chemicals in chlorine, said Dr. Graham Snyder, an emergency physician at WakeMed Hospital. These injuries cause the lung to leak fluid and fill the lung’s alveoli.

In addition, water that comes into the lungs can wash away surfactant, a chemical that helps the alveoli expand.

Untreated, the fluids cause acute respiratory distress syndrome (ARDS) and eventually brain hypoxia and cardiac arrest.

Sometimes, after recovering from secondary drowning, patients may suffer permanent damage with symptoms similar to emphysema.

Children more at risk

The few fatal cases are more likely to involve children.

“Adults are probably less at risk for dying from it because they know something is wrong,” said Snyder, although that does not mean that they are not at risk.

Fatal scenarios most often occur when a young child or infant is put to bed after a near-drowning experience and never wakes up.

Lindsay Kujawa, a California mother and blogger whose toddler survived a secondary drowning scare in June, gained national attention for her efforts to spread awareness about the condition.

“If I had heard of (secondary drowning) before, I would have done things differently. I would have brought him in the moment I noticed a change in his behavior,” she wrote on her blog. “I want to make sure this never happens to another child.”

After a near-drowning

Doctors insist that after any near-drowning experience, victims should visit the emergency room to ensure that they are okay.

Often, hospital staff will monitor a near-drowning survivor for four to six hours to make sure that he or she has not incurred damage to the lungs.

Dr. Stephen Colucciello, an emergency physician at Carolinas Healthcare System in Charlotte, said he has encountered secondary drowning at least once previously, although he has treated many drowning victims. Emergency physicians treat the patient with supportive care, he said, often by monitoring oxygen levels. The patient should receive serial lung exams, especially around the four-hour mark. Extreme cases can be treated with escalated oxygen, a ventilator or a bronchoscopy to clear debris.

Accidental drowning

While doctors acknowledge that awareness of secondary drowning symptoms is important, they stress that preventing all drownings should be the top priority.

Accidental drowning is the leading cause of death for children ages 1 through 4, according to Debra Petrarca, manager of WakeMed’s Trauma Program and a Safe Kids Wake County representative. She says parents should never overestimate a child’s ability to swim. “Knowing how to swim doesn’t prevent drowning,” Petrarca said.

In 2011, 23 children accidentally drowned in North Carolina, the majority of them under the age of 4, according to the 2013 Annual Report of the North Carolina Child Fatality Task Force. Since Memorial Day weekend this year, WakeMed Hospitals have treated 12 near-drowning patients. Eleven of them were children under the age of 9.

No separate statistics are kept distinguishing cases of wet drownings versus secondary drownings.

Snyder estimates that he has treated about 50,000 patients in his career and only witnessed one victim of secondary drowning. However, his passion for preventing drowning has driven him to learn “everything about drowning and resuscitation.”

Recently, Snyder developed a wearable monitoring device that will be available in early 2015 called SEAL SwimSafe. Worn by swimming children, the device sets off an alarm if they are submerged for too long.

Keep kids safe

Snyder recommends teaching children how to swim at a young age, and says if a child cannot swim, his or her caretaker should know how to swim and vigilantly stay within reach.

Colucciello advocates that one adult be assigned the task of watching a child who is in the water. “When lots of people are watching (a child), none are watching,” he added. “I see drowning when lots of people are watching the kid. Of all the dangerous situations, parties are high on the list.”

Janice Williams, Coalition Coordinator at Safe Kids Charlotte Mecklenburg and Director of Carolinas Center for Injury Prevention, encourages parents to know a child’s tendencies and personalities. “Some kids might dabble. Boys push the risk-taking envelope,” she said, adding that she watches her boys at the edge of the water because she is aware of their risk-taking traits.

Dr. Damian McHugh, Emergency Physician at Rex Hospital, urges adults to keep a “buddy system” and avoid alcohol when children are around. He encourages parents to always remain within arm’s length, even during bath time.

“An ounce of prevention is worth pounds and pounds of cure,” he said.

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