Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Drowning

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In one line

·Drowning causes the body to run out of oxygen because water blocks the airways or floods the lungs, and that oxygen loss can damage the brain, heart, and lungs within minutes.

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Normal physiology

·Normally, the airway stays open and dry, the lungs are coated with surfactant (a slippery film that keeps air sacs from collapsing), and oxygen moves easily across the thin walls of the air sacs into the bloodstream to feed every organ.

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What goes wrong

·When someone is submerged, they hold their breath at first because the throat snaps shut (laryngospasm) to keep water out. But if they stay underwater too long, the body is forced to gasp for air, and water rushes into the lungs instead. That water washes away the surfactant and damages the delicate walls of the air sacs, so oxygen can't cross into the blood anymore. The blood oxygen level drops, and without oxygen the brain and heart start to fail within minutes.

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Hallmark signs

·The person was underwater or their face was in the water
·They cough hard and sound wet
·They breathe fast and work hard to breathe
·Crackling or bubbling sounds in the lungs when you listen with a stethoscope
·Low oxygen level on the pulse oximeter (the finger clip)
·Confusion or acting strange
·Blue or gray color to the lips, face, or fingernails (cyanosis)
·Vomiting

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Red flags · escalate now

·Any trouble breathing or fast breathing that does not get better quickly
·Confusion, extreme sleepiness, or not responding normally
·Blue or gray color to the lips or face
·Coughing up pink or frothy spit (a sign of fluid building up in the lungs)
·Chest pain or very low oxygen level on the monitor

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Workup

·Arterial blood gas (ABG)
·Chest X-ray
·Serum lactate
·Basic metabolic panel (BMP, includes electrolytes and creatinine)
·Creatine kinase (CK)
·Electrocardiogram (ECG)

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Treatment

·Five rescue breaths (mouth-to-mouth or bag-mask) before starting chest compressions if the person has no pulse
·High-flow oxygen by mask or nasal cannula, or positive-pressure ventilation (bag-mask, CPAP, BiPAP) if breathing is very weak
·Intubation (breathing tube) and mechanical ventilator with lung-protective settings (tidal volume 6 mL/kg ideal body weight, plateau pressure ≤ 30 cm H₂O, PEEP 5–15 cm H₂O) for severe cases
·Cervical spine (neck) immobilization with a collar or backboard if the person dove, jumped, or fell into the water
·Rewarming (remove wet clothes, cover with blankets, give warm IV fluids, or use a warming blanket) if body temperature is below 95°F (35°C)
·Observation in the hospital for at least 6–8 hours even if the person looks fine; antibiotics only if fever or new white patches on chest X-ray appear later

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NCLEX trap

·Breathing in water damages the lungs but does NOT mean infection. Only give antibiotics if infection actually shows up later — fever, positive culture, or new lung cloudiness days after the drowning. Day one is about oxygen and breathing support, not antibiotics.
·Even if the person feels okay after being pulled from the water, they MUST be watched in the hospital for at least 6 to 8 hours. The lungs can fill with fluid or collapse hours later (called delayed ARDS), so early discharge is dangerous.
·When someone is drowning and still has a pulse, the biggest problem is NOT their heart — it's that they are not getting oxygen. Start rescue breathing (blowing air into their lungs) first to get oxygen in. Only do chest compressions if the heart stops.
·Always fix the lack of oxygen first. Get air moving in and out of the lungs before worrying about body temperature. Cold water can actually protect the brain during drowning, so warming them up too fast can hurt more than help.
·Drowning already floods the lungs with water and damages the tiny air sacs. Pouring in more IV fluid makes the lungs even wetter and harder to breathe through. Use only small amounts of fluid and focus on gentle ventilator settings that protect the lungs.
·Protect the neck any time drowning happens from a fall, a dive, hitting rocks, or a water accident. Even if the story is unclear, assume the spine might be hurt until you can prove it is safe. Move the person carefully and keep the head and neck still.

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