Komplikasi dan Prognosis

Complications

Neurologic injury
Pulmonary edema and ARDS
Secondary pulmonary infection
Multiple organ system failure
Acute tubular necrosis (secondary to hypoxemia)
Myoglobinuria
Hemoglobinuria

Prognosis

Patients who are alert or mildly obtunded at presentation have an excellent

chance for full recovery.
Patients who are comatose, those receiving CPR at presentation to the ED, or
those who have fixed and dilated pupils and no spontaneous respirations have a
poor prognosis. In a number of studies, 35-60% of individuals needing continued
CPR on arrival to the ED die, and 60-100% of survivors in this group experience
long-term neurologic sequelae. Pediatric studies indicate that children who
require specialized treatment for drowning in the pediatric intensive care unit
(PICU) experience at least a 30% mortality rate and an additional 10-30%
experience severe brain damage.

What are the complications of drowning?

Hypoxemia causing brain damage is the major complication in drowning victims

who do not die.

Direct lung tissue damage because of water aspirated into the lung can also occur
and lead to pneumonia and acute respiratory distress syndrome (ARDS).

If the drowning occurs in colder water risks include hypothermia or a drop in body
temperature. (If the body temperature drops below 95F (35C) get medical
attention immediately.)

Cervical spine fractures may occur in diving injuries associated with drowning.

Does the type of drowning matter?

There have been a variety of theories reported regarding the potential responses
of the body to different drowning situations. Most discuss dry vs. wet drowning
and salt vs. fresh water drowning.
Wet vs. Dry Drowning

Most drownings are unwitnessed, and the victim is found floating. While only a
small amount of aspirated water is required to cause significant problems with
lung function, it is the prolonged submersion time and lack of breathing that
causes morbidity due to hypoxemia.

Approximately 10%-20% of drowning victims have dry drowning, but even most
wet drowning victims have less than 4cc/kg of water found in their lungs. For a 50
pound child, this amounts to less than 3 ounces.

Salt vs. Fresh Water Drowning

In the lung, the breathing tubes (trachea, bronchi, bronchioles) branch into
smaller and smaller segments until they end in an air pocket called an alveolus
(plural alveoli). This is the part of the lung where air and red blood cells in
capillary blood vessels come near enough to allow the transfer of oxygen and
carbon dioxide between the two. Alveoli are covered with a chemical called
surfactant that allows the air pocket to open and close easily when breathing
occurs.

When fresh water enters an alveolus, it destroys the surfactant and causes the
alveoli to collapse, unable to open with breathing. A ventilation-perfusion
mismatch occurs in which the body sends blood to parts of the lung that lack
oxygen, resulting in a decrease in the concentration of oxygen in the blood.

Salt water doesn't destroy surfactant, rather it washes it away and damages the
membrane between the alveolus and the capillary blood vessel. One again, the
body sends blood flow to areas of the lung that aren't able to provide it oxygen,
and hypoxemia occurs.