Submersion/Drowning

Tom RaderStaff - June 1, 2021

Submersion injuries/drowning can occur when the patient replaces the air in their lungs with water. This can happen when they go underwater in a strea
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In an austere setting is it worth giving an individual who recovered from a submersion injury prophylactic antibiotics to prevent pneumonia instead of just waiting for signs to develop? Asking as someone who has studied multiple water borne bacterial pathogens and would never want what lives in fresh or salt water to have a chance to establish a foothold in my lungs.

 

This is a good example of a realistic austere/SHTF scenario that just isn’t covered in typical medical advice. Which means the answer is “it depends.” This would be my line of thinking:

1. How dirty is the water?
2. How able am I to get the patient to professional help?
3. If no pro help, what are my antibiotic supplies like, how strongly do I feel I need to ration those supplies (eg. it’s a major SHTF event), how likely is this person to survive at all, etc?

Say SHTF big time a month ago, so no expectation of expert help. Someone drowns in a backyard pool. The pool looks clean and probably has treatment chemicals in it — and since SHTF recently, the chemicals are probably still effective, meaning the likelihood of microorganism nasties is low. If the patient is generally healthy / not someone who’s already elderly or sick, then I’d probably feel fine not giving an antibiotic and holding onto that for the future.

If that scenario was different, where the water was iffy + the person has a history of respiratory infections + I have enough supplies + I think the SHTF event will be over sooner than later, then yeah I might preemptively use antibiotics. 

 

If you are administering CPR to a victim of drowning, would you want to continue with CPR without rescue breathing or administer two rescue breaths every 30 compressions or so? I know that the recommendation in the CPR section is to just do compressions because of the air in the lungs that will make it into the bloodstream, but what if the lungs are full of fluid and unable to benefit from the residual oxygen in the lungs? Before CPR, would it be worth it to put the person on his/her side to try to get some of the water out of the lungs? Thanks!

 

You’re thinking about it the right way, and this actually gets into the nuance between “CPR” and “rescue breathing” — which as you know the trend is to de-couple those two in teaching/advice.

Drowning = rescue breathing with a possible side of CPR. Starting at 1:34 in the video, Tom says “People that have inhaled water into their lungs need rescue breathing.” The variable is whether or not they have a pulse. No pulse = “classic” CPR where you do breaths and compressions. Pulse = just breathing.

You don’t need to immediately tilt the patient — many will often naturally react by coughing out the liquid as acted in the video, since coughing is the lungs natural defense mechanism for “I don’t like what’s in here!” If you start by rolling them over, it’s unlikely that gravity alone is enough to ‘drain’ the lungs without assistance from the patient’s body.

So the official advice is to tilt them once they start coughing it up, that way it doesn’t rebound back down where it just came from due to gravity.

This also makes it easier in practice… say you’re 100 lbs and the victim is 300 lbs. You’d have a hard time repeatedly going back and forth between rolling them on their side vs. onto their back for breathing/compressions. Better to focus on triggering the body to cough it out, then help that process by rolling them into the recovery position.