Drowning is a leading cause of accidental death worldwide. It occurs when water enters the lungs, preventing breathing. The process can happen quickly, often in just a few minutes. As the body struggles to breathe, a series of changes take place that affect the lungs, brain, and appearance. Understanding what the drowning process looks like can help identify when someone is in danger in the water.
What happens to the lungs?
The lungs are impacted first during drowning. Here is what happens:
- Water enters the lungs instead of air when submerged. This causes throat spasms and breathing difficulties.
- Water blocks off the airway, preventing oxygen from reaching the lungs and bloodstream. This is known as suffocation.
- The lack of oxygen causes the lungs to spasm and contract irregularly, making breathing progressively more labored.
- Fluid builds up in the lungs, causing pulmonary edema. Foam may begin leaking from the mouth.
- As breathing slows, carbon dioxide builds up in the bloodstream. The lungs try to expel it by gasping and panting.
- Eventually, waterlogged lungs fail, no longer able to transfer oxygen to or remove carbon dioxide from the bloodstream.
The lungs are usually the first system affected in drowning and sustain the most damage initially. As oxygen depletes, other organs begin to be impacted as well.
How does the brain react?
The brain requires constant oxygen to function normally. Within minutes of submersion, the brain starts reacting to the lack of air:
- Brain cells begin dying after around 4-6 minutes without oxygen. The hippocampus, responsible for memory, is especially vulnerable.
- Loss of oxygen to the brain leads to hypoxia, altering brain function. Reflexes may become suppressed.
- Hypoxia rapidly progresses to anoxia, in which the brain is completely deprived of oxygen. This leads to loss of consciousness usually within 1-2 minutes.
- Prolonged oxygen deprivation causes neuronal injury and death. The longer the brain goes without oxygen, the greater the damage.
- After around 10 minutes without oxygen, most experts predict irreversible brain damage or death.
The brain is rapidly affected by drowning and sustains permanent damage after just a few minutes without air. Loss of consciousness usually precedes damage, making rescue efforts very time sensitive.
How does the body appear during drowning?
As the lungs and brain react to oxygen deprivation, several physical signs appear on the outside of the body. Here are some characteristics of what a drowning victim may look like:
- Skin may turn blue around the lips and fingertips, signaling cyanosis from lack of oxygen.
- Eyes may be open, moving side to side. They often have a glazed or vacant look.
- Loss of control over limbs can create a climbing motion with arms and legs.
- Head may be tilted back with face upturned as the victim reflexively tries to keep their mouth above water.
- Coughing or choking as water enters the throat. Foam or froth may discharge from the mouth and nose.
- Gasping as the person tries to breathe. These breaths may happen infrequently just before sinking.
- Awake victims may struggle to keep their mouths above water by climbing on top of rescuers.
- Loss of consciousness causes the body to go limp and sink passively without movement.
Identifying these visual cues quickly is critical for recognizing drowning and beginning rescue efforts before hypoxia and its effects occur.Children in particular may sink quickly and quietly, highlighting the need for constant supervision around water.
Stage 1: Distress
The first stage of drowning is known as aquatic distress. Victims realize they are in trouble and cannot safely exit the water. Some visual signs include:
- Horizontal body position with head tilted back
- Attempting to swim or float, but making little progress
- Struggling to keep the mouth and nose above water
- Hyperventilating with rapid breathing
- Keeping the arms to the side and elbows high while kicking
- Trying to call for help by waving or yelling
At this stage, most victims are still able to keep themselves afloat to some degree and their airway is unobstructed. Rescue is very possible if aid reaches them promptly.
Stage 2: Peril
If distress continues, the victim enters a state of aquatic peril. Signs include:
- Inability to lift the mouth and nose above water to breathe
- Head reclined back and low in the water as hypoxia sets in
- Very little movement from legs; floating vertically without kicking
- Minimal arm and leg motion as muscles begin to weaken
- Sinking under the water and reappearing in cycles as strength fades
- Coughing and gasping more strenuously when surfacing
At the peril stage, water is likely entering the lungs and outcomes become much more dangerous. Rescue requires immediately getting the victim’s mouth and nose clear of the water.
Stage 3: Aquatic Unconsciousness
The final stage occurs when the victim loses consciousness due to hypoxia. Signs include:
- Lack of movement with limbs suspended vertically below the surface
- No reactive coughing, gagging or gasping reflexes
- Sinking and remaining submerged without attempts to surface for air
- Blank stare or closed eyes showing lack of awareness
- Blue-tinged skin and lips
- Foam or vomit leaking from the mouth
Once a victim reaches this stage, irreversible brain damage and death will shortly follow without immediate rescue efforts. The window for successful resuscitation drops rapidly so instant action is critical.
Key Differences by Age
While the basic drowning process is similar across age groups, some differences exist in children versus adults:
Children
- Sink more quickly due to less body fat and muscle mass
- Can submerge in only a few inches of water such as a bathtub
- Slip under quietly, often without splashing or cries for help
- Brain damage occurs sooner – within 2-3 minutes underwater
- Hypoxia leads swiftly to cardiac arrest in children
Adults
- Muscle strength allows treading water initially
- Stronger lung capacity enables more forceful calls for help
- Heavier body means it takes longer to sink once unconscious
- Brain can withstand 4-6 minutes without oxygen before damage
- Drowning delayed by gasping and vertigo when surfacing
Understanding these differences allows rescuers to tailor their reactions based on the victim’s age and associated risks. Kids require hypervigilance, while adults may seem deceptively less urgent at first. But in all cases, each second without air brings the victim closer to death.
What factors influence drowning risk?
Many variables can increase or decrease the chances of drowning when in the water. These include:
Age
- Drowning risk peaks at ages 1-4, when children are mobile but lack safety awareness.
- Risk rises again after age 65 due to health conditions affecting swimming ability.
Swimming skill
- Inability to swim makes drowning more likely by up to 8 times.
- Even weaker swimmers tire quickly, raising their risk.
Health conditions
- Pre-existing conditions like seizures, heart problems, or lung disease.
- Use of alcohol or drugs impacting reflexes and coordination.
Type of water
- Fast-moving water in rivers or oceans makes rescue difficult.
- Cold water can cause hypothermia, weakening muscles.
Knowing these common risk factors helps identify who is most vulnerable and merits preventive measures.
How does the body respond after rescue?
If rescued from drowning, the body goes through additional changes during recovery:
- Fluid continues filling the lungs even after removal from water. Oxygen is administered to help clear it.
- Vomiting is common as the body ejects swallowed water from the stomach.
- Coughing helps expel water from the lungs but may last for days.
- Confusion, agitation, or loss of consciousness are possible depending on hypoxia duration.
- Delayed symptoms like fever, chest pain, or trouble breathing often appear in the hours or days after rescue as the lungs react.
- Secondary drowning can occur if fluid remains in the lungs long after the incident.
Post-drowning efforts focus on supporting breathing, monitoring for secondary complications, and providing neurological care if oxygen loss caused brain injury.
Conclusion
Drowning progresses through distinct stages as water fills the airways and gradually cuts off oxygen. Recognizing the visual signals at each phase allows for faster identification and rescue. While children and adults drown differently, both face irreversible damage within minutes without help. Understanding what to look for when someone is struggling in water can save precious moments before it becomes too late. Being alert around water and knowing what to watch for are critical to preventing tragedy.