Nurse’s Toolbox : Dry Drowning
How to Recognize This Scary Condition and Guide Patients
In nurse triage, one of the scariest calls a nurse can get is a near drowning (or dry drowning). Statistically, less than 2% of all drownings are categorized as dry drownings, but the media’s notoriety and some miscommunication have led parents to believe that they are more common events. However, many nurses have difficulties with this type of call, so you can only imagine how panicked a new parent may be after an incident. Typical dry drowning involves a child falling into a bathtub or pool and gasping in water. The lungs then let the water in, causing pulmonary edema. Sometimes the water may not enter the lungs, but laryngospasms cause the airway to shut off. Either way, the symptoms are essentially the same :
- Chest Pain
- Trouble Breathing
- Feeling extremely tired
It is easy to be confused by the coughing that comes with near drowning. It is normal for the child to cough for a few minutes until the airway is cleared. But, if the coughing spasms return within 6 to 24 hours, the child needs to be evaluated for fluid retention in the lungs. The child might also need to be given IV fluids for electrolyte support.
Dry drowning can be subtle and difficult to recognize because the child may have just slipped for a second. However, the water in the airway can still cause laryngospasms up to 24 hours later (although experiencing the spams more than 6 hours later is rare).
Fortunately, triage nurses can more easily recognize the signs of dry drowning because they have the benefits of the protocols. The Schmitt-Thompson Clinical Protocols content use all the latest evidence and practices handed down by the AMA. These protocols help nurses correctly assess patients and guide them to the correct level of care.
The symptoms we watch for and teach callers about are :
- Coughing occurs in the following 6 hours
- Vomiting occurs in the following 6 hours
- Difficulty breathing occurs in the following 24 hours
- Your child’s symptoms become worse
Difficulty breathing can manifest as chest pain, rapid breathing, or shortness of breath (with or without exertion). Retractions or wheezing are not necessarily always noted and if they have a persisting respiratory symptom (cough, difficulty breathing) after the submersion incident, then emergent medical evaluation is recommended.
Finally, when evaluating a possible dry drowning, remember that if a child is unconscious for any length of time he or she needs to have an emergent medical evaluation.