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July 4, 1986, Vol 256, No. 1 >
ARTICLE | July 4, 1986

The Resuscitation of Near-Drowning Victims FREE

Joseph P. Ornato, MD
[+] Author Affiliations

Reprint requests to Medical College of Virginia, Box 525, Richmond, VA 23298 (Dr Ornato).


JAMA. 1986;256(1):75-77. doi:10.1001/jama.1986.03380010079029
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References

DROWNING causes almost 9000 deaths in the United States each year out of an estimated 80 000 near-drowning incidents.1 Males between the ages of 10 and 19 years are the most common victims. Fortunately, only about one of every nine or ten underwater submersion accidents results in death. When death occurs, the term "drowning" is applied. "Near-drowning" is the term used when there is at least temporary survival from suffocation by submersion.2

The usual sequence of events in the animal model of drowning is initial breath holding followed by the swallowing of large amounts of water, vomiting, terminal gasping with flooding of the lungs, and death.3 Animal models of near-drowning in the laboratory do not precisely mimic human drowning in natural waters.4-6 This must be taken into account when extrapolating results of animal research to clinical resuscitation. Less hemodilution is noted in humans than in animals,

REFERENCES

1 +
Baker SP, O'Neill B, Karpf RD: The Injury Fact Book . Lexington, Mass, DC Heath & Co, 1984;, pp 155-164.
2 +
Modell JH:  Drowning versus neardrowning: A discussion of definitions . Crit Care Med 1981;; 9:351-352.
3 +
Redding JS:  Drowning and near-drowning . Postgrad Med 1983;;74:85-97.
4 +
Miles S:  Drowning . Br Med J 1968;;3:597.
5 +
Segarra F, Redding RA:  Modern concepts about drowning . Can Med Assoc J 1974;;110:1057-1062.
6 +
Modell JH, Moya F:  Effects of volume of aspirated fluid during chlorinated fresh water drowning . Anesthesiology 1966;;27:662.
7 +
Moritz AR:  Chemical methods for the determination of death by drowning . Physiol Rev 1944;; 24:70-80.
8 +
Rivers JF:  Drowning: Its clinical sequelae and management . Br Med J 1970;;2:157.
9 +
Heimlich HJ:  Pop goes the cafe coronary . Emerg Med 1974;;6:154.
10 +
Heimlich HJ, Hoffmann KA, Canestri FR:  Food-choking and drowning deaths prevented by external subdiaphragmatic compression . Ann Thoracic Surg 1975;;20:188-195.
11 +
Heimlich HJ:  Subdiaphragmatic pressure to expel water from the lungs of drowning persons . Ann Emerg Med 1981;;10:476-480.
12 +
Patrick EA:  The Heimlich maneuver . Emergency 1981;;13:45-47.
13 +
Modell JH, Davis JH:  Electrolyte changes in human drowning victims . Anesthesiology 1969;; 30:414-420.
14 +
Moser RH:  Drowning: A seasonal disease . JAMA 1974;;229:563-566.
15 +
Pearn J:  Pathophysiology of drowning . Med J Aust 1985;;142:586-588.
16 +
Colebatch HJH, Halmagyi DJF:  Effect of vagotomy and vagal stimulation on lung mechanics and circulation . J Appl Physiol 1963;;18:881-887.
17 +
Colebatch HJH, Halmagyi DFJ:  Reflex pulmonary hypotension of fresh-water aspiration . J Appl Physiol 1963;;18:179-185.
18 +
Nopanitanya W, Gambill TG, Brankhous KM:  Fresh water drowning: Pulmonary ultrastructure and systemic fibrinolysis . Arch Pathol 1974;;98:361-366.
19 +
Halmagyi DFJ, Colebatch HJH:  Ventilation and circulation after fluid aspiration . J Appl Physiol 1961;;16:35-40.
20 +
Bergquist RE, Vogelhut MM, Modell JH, et al:  Comparison of ventilatory patterns in the treatment of freshwater near-drowning in dogs . Anaesthesiology 1980;;52:142-148.
21 +
Heimlich HJH:  The Heimlich maneuver: First treatment for drowning victims . Emerg Med Service 1981;;10:58-61.
22 +
Knopp R:  Near drowning . J Am Coll Emerg Phys 1978;;7:249-254.
23 +
Ruben H:  Emergency resuscitation . Acta Anaesthesiol Scand 1961;;9( (suppl) ):111.
24 +
Ruben A, Ruben H:  Artificial respiration: Flow of water from the lung and the stomach . Lancet 1962;;1:780-781.
25 +
Martin TG:  Neardrowning and cold water immersion . Ann Emerg Med 1984;;13:263-273.
26 +
Conn AW, Barker GA:  Fresh water drowning and near-drowning: An update . Can Anaesth Soc J 1984;;31:s38-s44.
27 +
Gooden BA:  Drowning and the diving reflex in man . Med J Aust 1972;;2:583-587.
28 +
Sims JK:  How much CPR is enough CPR ? J Am Coll Emerg Phys 1978;;7:218-219.
29 +
Siebke H, Rod T, Beeivik H, et al:  Survival after 40 minutes of submersion without cerebral sequela . Lancet 1975;;1:1275-1277.
30 +
Modell JH, Graves SA, Kuck EJ:  Near-drowning: Correlation of level of consciousness and survival . Can Anaesth Soc J 1980;;27:211-215.
31 +
Conn AW, Montes JE, Barker GA, et al:  Cerebral salvage in near-drowning following neurological classification by triage . Can Anaesth Soc J 1980;;27:201-210.
32 +
Kaukinen L:  Clinical course and prognostic signs in near-drowned patients . Ann Chir Gynaecol 1984;;73:34-39.
33 +
Frewen TC, Sumabat WO, Han VK, et al:  Cerebral resuscitation therapy in pediatric near-drowning . J Pediatr 1985;;106:615-617.

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1 +
Baker SP, O'Neill B, Karpf RD: The Injury Fact Book . Lexington, Mass, DC Heath & Co, 1984;, pp 155-164.
2 +
Modell JH:  Drowning versus neardrowning: A discussion of definitions . Crit Care Med 1981;; 9:351-352.
3 +
Redding JS:  Drowning and near-drowning . Postgrad Med 1983;;74:85-97.
4 +
Miles S:  Drowning . Br Med J 1968;;3:597.
5 +
Segarra F, Redding RA:  Modern concepts about drowning . Can Med Assoc J 1974;;110:1057-1062.
6 +
Modell JH, Moya F:  Effects of volume of aspirated fluid during chlorinated fresh water drowning . Anesthesiology 1966;;27:662.
7 +
Moritz AR:  Chemical methods for the determination of death by drowning . Physiol Rev 1944;; 24:70-80.
8 +
Rivers JF:  Drowning: Its clinical sequelae and management . Br Med J 1970;;2:157.
9 +
Heimlich HJ:  Pop goes the cafe coronary . Emerg Med 1974;;6:154.
10 +
Heimlich HJ, Hoffmann KA, Canestri FR:  Food-choking and drowning deaths prevented by external subdiaphragmatic compression . Ann Thoracic Surg 1975;;20:188-195.
11 +
Heimlich HJ:  Subdiaphragmatic pressure to expel water from the lungs of drowning persons . Ann Emerg Med 1981;;10:476-480.
12 +
Patrick EA:  The Heimlich maneuver . Emergency 1981;;13:45-47.
13 +
Modell JH, Davis JH:  Electrolyte changes in human drowning victims . Anesthesiology 1969;; 30:414-420.
14 +
Moser RH:  Drowning: A seasonal disease . JAMA 1974;;229:563-566.
15 +
Pearn J:  Pathophysiology of drowning . Med J Aust 1985;;142:586-588.
16 +
Colebatch HJH, Halmagyi DJF:  Effect of vagotomy and vagal stimulation on lung mechanics and circulation . J Appl Physiol 1963;;18:881-887.
17 +
Colebatch HJH, Halmagyi DFJ:  Reflex pulmonary hypotension of fresh-water aspiration . J Appl Physiol 1963;;18:179-185.
18 +
Nopanitanya W, Gambill TG, Brankhous KM:  Fresh water drowning: Pulmonary ultrastructure and systemic fibrinolysis . Arch Pathol 1974;;98:361-366.
19 +
Halmagyi DFJ, Colebatch HJH:  Ventilation and circulation after fluid aspiration . J Appl Physiol 1961;;16:35-40.
20 +
Bergquist RE, Vogelhut MM, Modell JH, et al:  Comparison of ventilatory patterns in the treatment of freshwater near-drowning in dogs . Anaesthesiology 1980;;52:142-148.
21 +
Heimlich HJH:  The Heimlich maneuver: First treatment for drowning victims . Emerg Med Service 1981;;10:58-61.
22 +
Knopp R:  Near drowning . J Am Coll Emerg Phys 1978;;7:249-254.
23 +
Ruben H:  Emergency resuscitation . Acta Anaesthesiol Scand 1961;;9( (suppl) ):111.
24 +
Ruben A, Ruben H:  Artificial respiration: Flow of water from the lung and the stomach . Lancet 1962;;1:780-781.
25 +
Martin TG:  Neardrowning and cold water immersion . Ann Emerg Med 1984;;13:263-273.
26 +
Conn AW, Barker GA:  Fresh water drowning and near-drowning: An update . Can Anaesth Soc J 1984;;31:s38-s44.
27 +
Gooden BA:  Drowning and the diving reflex in man . Med J Aust 1972;;2:583-587.
28 +
Sims JK:  How much CPR is enough CPR ? J Am Coll Emerg Phys 1978;;7:218-219.
29 +
Siebke H, Rod T, Beeivik H, et al:  Survival after 40 minutes of submersion without cerebral sequela . Lancet 1975;;1:1275-1277.
30 +
Modell JH, Graves SA, Kuck EJ:  Near-drowning: Correlation of level of consciousness and survival . Can Anaesth Soc J 1980;;27:211-215.
31 +
Conn AW, Montes JE, Barker GA, et al:  Cerebral salvage in near-drowning following neurological classification by triage . Can Anaesth Soc J 1980;;27:201-210.
32 +
Kaukinen L:  Clinical course and prognostic signs in near-drowned patients . Ann Chir Gynaecol 1984;;73:34-39.
33 +
Frewen TC, Sumabat WO, Han VK, et al:  Cerebral resuscitation therapy in pediatric near-drowning . J Pediatr 1985;;106:615-617.

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