Submersion Injuries

What are submersion injuries?

Submersion (sub-MER-zhun) injuries are conditions caused by not being able to breathe under any liquid substance, such as water. Liquids entering the lungs may prevent the victim from getting enough air and the brain from getting enough oxygen. Submersion injuries may lead to a water rescue, near-drowning, or drowning. Water rescue is when the victim remains alert after a submersion or immersion injury. The victim may have temporary (short-term) symptoms like coughing that clears up quickly. Near-drowning is when the victim survives but has more serious symptoms after an immersion or submersion injury. Drowning is caused by a long period of immersion or submersion that leads to death of the victim. It is one of the leading causes of accidental deaths among all age groups.

What causes submersion injuries?

Submersion injuries usually happen while swimming or being around pools or bodies of water. The following factors or conditions may increase risk of having a submersion injury:

  • Accidents when boating or swimming.

  • Alcohol and drug use when boating or swimming.

  • Heart attacks, seizures (convulsions), muscle cramps, and hypoglycemia (low blood sugar).

  • Homicide (murder) or suicide (killing oneself).

  • Not knowing how to swim or not being able to swim when needed.

  • Scuba diving and water sport activities.

  • Very cold water temperature.

  • Falling through thin ice.

What are the signs and symptoms of submersion injuries?

The victim may have any of the following:

  • Abdominal (stomach) enlargement, nausea (upset stomach), or vomiting (throwing up).

  • Cold skin that may appear as white to bluish-purple patches.

  • Confusion, trouble thinking or remembering, or loss of consciousness.

  • Coughing, increased breathing, shortness of breath, or wheezing (high-pitched noise heard when breathing out).

  • Increased or decreased heartbeat or low blood pressure.

  • Weak or absent pulse.

What problems can submersion injuries cause?

The victim may have any of the following:

  • Acute respiratory distress syndrome: This is a sudden and very serious condition that occurs when the lungs become swollen and filled with liquids. This condition causes severe shortness of breath and may lead to respiratory failure. Respiratory failure means you cannot breathe well enough to get oxygen to the cells of your body.

  • Brain edema: Brain edema (swelling) may be caused by brain cell damage when no oxygen is present for a long period.

  • Hypothermia: Hypothermia happens when the body temperature drops way below normal causing problems with how things work inside the body. Once the body temperature drops too low for a long period of time, organ failure may develop and cause death.

  • Pneumonia: Pneumonia is the swelling of the lungs that is usually caused by an infection. The liquid in the lungs may make it hard for you to breathe. People with pneumonia can have symptoms that range from mild to very severe (bad).

How are submersion injuries diagnosed?

The caregiver will do a complete physical examination on the victim. He may also need to know what caused the submersion injury. Tests may be done to know the condition of the victim and what other problems may happen. These tests may include any of the following:

  • Blood gases: This test is also called an arterial blood gas or ABG test. Blood is taken from an artery (blood vessel) in the arm or groin. The groin is the area where the abdomen (stomach) meets the upper leg. The blood is tested for the amount of gases in it, such as oxygen, acids, and carbon dioxide.

  • Blood tests: The victim's caregiver may need blood taken for tests. The blood can be taken from a vein in the hand, arm, or the bend in the elbow. It is tested to see how the body is working. It can give caregivers more information about the victim's health condition. Blood may be drawn more than once.

  • Electroencephalogram: This test uses many small pads or metal discs placed on the victim's head. Each has a wire that is hooked to a machine. This machine prints a paper tracing of brain wave activity from different parts of the brain. Caregivers look at the tracing to see how the brain is working.

  • Glucose meter: A glucose meter is a small machine used to test the amount of sugar in the blood. The finger is pricked so caregivers can get a small drop of blood. The blood is put onto a testing strip, and put into the glucose meter. A screen on the glucose meter will show the amount of sugar in the blood. This test may be done several times a day.

  • Magnetic resonance imaging: This is also called an MRI. During the MRI, pictures are taken of the head. An MRI may be used to look at the brain, muscles, joints, bones, or blood vessels. The victim will need to lay still during a MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury.

  • Neurologic signs: Neurologic signs are also called neuro signs, neuro checks, or neuro status. Caregivers check the victim's eyes, memory, and how easily he wakes up. The victim's hand grasp and balance may also be tested. This helps tell caregivers how the victim's brain is working after an injury or illness. The victim may need to have his neuro signs checked often. His caregiver may even have to wake him up to check his neuro signs.

  • X-ray: This is a picture of the bones, lungs and heart. Caregivers use it to see how the lungs and heart are doing, and if bones are broken. Caregivers may use the x-ray to look for signs of infection like pneumonia, or collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.

How are submersion injuries treated?

Victims should be removed from the water quickly and lay person CPR must be done as soon as possible. CPR is also called cardiopulmonary resuscitation. CPR is used when a person stops breathing and his heart has stopped beating. Lay person refers to anyone who is not a trained healthcare worker. If you start CPR early and do it correctly, you may be able to save someone from dying. Ask the caregiver for information about CPR. The victims after initial rescue and CPR must be brought to an emergency facility for further treatment and observation. The victim may also need any of the following:

  • Endotracheal tube (ET) insertion: An endotracheal tube may be put into the victim's mouth or nose. It goes down to his windpipe to help keep his airway open and help the victim breathe. It may be hooked to a ventilator (breathing machine), and the victim may get extra oxygen through the ET tube. The victim will not be able to talk while the ET tube is in place.

  • Medicines: Antibiotics may be given for lung complications. Pain medicines are needed if there are signs of injury or trauma. Medicines for blood sugar may be given if needed.

  • Oxygen: The victim may need extra oxygen to help him breathe easier. It may be given through a plastic mask over the mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside the nose. Tell caregivers if the victim's nose gets dry or if the mask or prongs bother him. Ask caregivers before taking off the oxygen. Never smoke or let anyone else smoke in the same room while the oxygen is on. Doing so may cause a fire.

How can submersion injuries be prevented?

Submersion injuries may be prevented by doing any of the following:

  • Avoid drinking alcohol and having a heavy meal before swimming.

  • Do not dive in shallow water and keep away from marine animals.

  • Do not try to hyperventilate (increase breathing) to increase your submersion time.

  • Learn CPR if you have a pool or usually do recreational water activities.

  • Never try to help rescue someone without knowing how to do it.

  • Swim near a lifeguard, ask for safe places to swim, and read and follow warning signs posted.

Where can I find more information?

For more information regarding submersion injuries and adult drowning, contact the following:

  • Centers for Disease Control and Prevention
    1600 Clifton Road
    Atlanta , GA 30333
    Phone: 1- 800 - 232-4636
    Web Address: http://www.cdc.gov

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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