Learning Points:

1. Drowning is a spectrum of injury ranging from no harm to fatality. We define injuries only as either “non-fatal drowning” or “fatal drowning”. 

2. Time submerged is the most important predictor of survival, with greatest prognosis in <5 minutes submerged and poorest prognosis >10 minutes submerged. 

3. Aspiration of liquid causes washout of surfactant leading to atelectasis as well as pulmonary edema due to increased alveolar permeability. 

4. PEEP either via BiPAP/CPAP or mechanical ventilation is critical to reopen collapsed alveoli and improve oxygenation. 

5. Consider hypothermia even in warm-water submersion, and remember that your patient ‘is not dead until they are warm and dead’. 

6. Patients with normal mentation, O2 sat >95%, normal CXR and ABG can be discharged from the ED after a 6-hour observation period from the event.