What parents need to know about dry, secondary drowning

It’s a summer hazard that comes up every year on the local news – and rightfully so – and this past April made national headlines when a family warned other parents about “dry drowning” after their four-year-old daughter was hospitalized.

Dry drowning or secondary drowning, non-medical terms that are often used interchangeably, are rare incidents that can occur up to 24 hours after spending time in the water.

“Dry or secondary drownings pose the greatest danger because both can go unrecognized,” said Thad Golden, MD, director of critical care at Grand Strand Medical Center in Myrtle Beach, S.C. “It can be as innocent as getting knocked over in the waves at the beach. The child may appear to be fine immediately after walking ashore, but symptoms can appear hours later.”

“You’ll never be sorry that you came in to get checked out after any kind of near-miss event in the water. I advocate that seeking medical attention is probably the best idea,” Dr. Golden said.

Dr. Golden provides the facts on these submersion injuries and shares how to keep your kids safe in and out of the water.

What is drowning?

Some of the terminology with drowning has changed over the years. For example, “near drowning” used to be recognized when referring to a victim who did not die; “wet drowning” meant someone who actually ingested a significant amount of water, which isn’t always necessarily important in terms of the danger. Now, drowning is any incident where a person is impaired from being in or under water, whether the person survives or not.

What are other forms of drowning?

There are secondary terms known as “dry drowning” and “secondary drowning”, which are not recognized terms medically, however, they are both commonly used in the public. So, it’s important for people to know what those terms mean and when to seek medical attention.

Dry drowning is when a person gets a little bit of water in their upper airway and then experiences spasms of the airway. The individual is not drowning because there is water overwhelming their lungs, instead, he/she is drowning because of hypoxemia, or a lack of oxygen flow. That is dry drowning.

Secondary drowning is when there is water ingestion. Many times people, most frequently children, appear to be fine and fully recovered and then slowly, over time, as much as 24 or even 48 hours later, begin to exhibit symptoms like shortness of breath, fatigue, fever and serious respiratory ailments. Secondary drowning is sometimes referred to as “parking lot drowning” because people are away from the water.

There are several thoughts behind the reason for the delayed reaction, such as:

• the water is washing out the chemical that keeps an individual’s air sacs open; and
• the water, especially if it’s chlorinated, may cause a chemical injury or pneumonia in the lungs because it’s not sterile. We see that with incidents involving the ocean. That type of water is not meant to be in your lungs.

What is most concerning about dry and/or secondary drowning?

People think more water ingestion makes it more dangerous, but that isn’t always necessarily true. Even though these are relatively rare events, most people will get into a little trouble in the pool or get knocked over by a wave, and just jump right back up. The problem is, if dry or secondary drowning goes unrecognized, it can be deadly. That’s why it’s so important to raise awareness and be vigilant.

What are the warning signs?

We always tell people that if there is any significant incident – a child was in trouble or pulled out of the water, it’s probably best to have them medically evaluated or certainly watched very carefully. I liken it a parent being worried about a child suffering from a concussion. In those cases, the child needs to be checked on frequently; it’s the same concept with an incident in the water. For the first 24 hours after the incident, a parent should look for any signs of:

• shortness of breath,
• lethargy or fatigue, or
• fever.

If a parent notices any of those signs or symptoms, the child should be brought in for evaluation immediately.

How is dry or secondary drowning diagnosed?

It will be diagnosed by the signs and symptoms of the patient, which can be recognized by any healthcare professional. A lot of times patients will have abnormal breath sound that will be heard by a medical professional during a lung exam. Some of the patients will have pulmonary edema, where there is fluid within the air sacs of the lungs and this also can be heard on examination. A patient’s oxygen saturation may be on the lower side, so, during a pulse oximetry – the method used for measuring a patient’s oxygen saturation – the individual’s heart rate may be elevated. Again, the most important thing is to seek medical attention for any significant incidents in the water.

How is it treated?

It depends on the severity of the case. It can be treated with oxygen, antibiotics, or diuretics, a medication that will help get rid of fluid in the lungs. In more severe cases, treatment will require mechanical ventilation where a patient would be placed on a breathing machine.

When should one seek medical attention?

Immediate medical attention is recommended if the individual is not doing well directly after the event, and certainly within 24 hours during the window of time where issues can crop up. Anyone who gets in trouble to the point where assistance is needed or water was ingested should have a healthcare professional evaluate them, listen to their lungs, and decide whether or not the patient will need imaging like a chest X-ray. The greatest danger period is up to 24 hours after the event. There have been some rare cases that occur after that timeframe.

What are some tips to help prevent dry and/or secondary drowning?

The buddy system is a great tool to ensure your child’s safety. All kids, no matter how proficient they are in the water, especially in the ocean where conditions can change, should have someone who is watching. The same goes true for adults. An incident could happen in seconds. Lifeguards can help but they are not an absolute; we have to be responsible for each other and teach children to look after one another as well. Also, for adults, avoid alcohol near the water. The risk of being intoxicated and then entering the pool or the ocean raises the bar a little higher for an incident.

Dr. Thad Golden is a pulmonologist at HCA Healthcare’s Grand Strand Medical Center in Myrtle Beach, S.C. Grand Strand Medical Center is a member of HCA Healthcare’s South Atlantic Division.