Jun 16, 2017

Interview Transcript

Interviewer: You may have heard or seen the alarming headlines about dry drowning, but does it really happen? The short answer, not exactly the way the media has been portraying it. We'll talk about that next on The Scope.

Announcer: This is From the Frontlines with emergency room physician, Dr. Troy Madsen, on The Scope.

Interviewer: It's a scary scenario if you think about it. The fact that you could be or your child could be swimming, you inhale some water. Everything seems to be fine. But then, a few days later, you die as a result of swallowing that water. It's a term that the media has been using to describe this is dry drowning, and that's not exactly accurate. And also, I think, a little clarification needs to happen around the term and actually how this manifests itself in somebody, because otherwise it could be a very scary prospect.

Dr. Troy Madsen's an emergency room physician. And hopefully, we're going to shed a little light on these two terms and maybe bring a little calm to the conversation. So help me understand the difference between dry drowning and secondary drowning, and if I should be concerned.

Dr. Madsen: Well, it's probably important just to understand how this term has come up in the media. It sounds like there was a case of a preschooler who was playing in the water, knee-deep water, was hit by a wave, seemed like he was fine. A week later, stopped breathing, went to the ER, and died. So this term has come up where the parents reported that they were told the child had suffered from dry drowning. So I think there's been just a little bit of confusion here in terms of the terms.

From the ER, dry drowning is if someone actually drowned. They go in the water. They do not breathe. They're pulled out. They're not breathing. And then, when you examine their lungs, there is no water in the lungs. All that's happened is they've had laryngeal spasm, meaning their vocal cords have shut off. It's a natural response. None of the water got in their lungs, but they still drowned because they got no oxygen to their brain. That's what we call dry drowning.

What's happening here is more what is better termed secondary drowning. Another term for it would be aspiration. It's the same process that would happen if, you know, you or I, or just say passed out on the ground for some reason, and we vomited, and we breathed that in to our lungs, and we didn't cough it out. I would get all that stuff in my lungs.

Probably, I'd be breathing okay at first. But then, say 24 hours or several days later, all that stuff in my lungs is going to cause a whole lot of inflammation. The body is going to respond to that. It's going to try and attack all this foreign material. It's going to cause swelling in the lungs, cause this inflammation that's going to make it really hard for me to breathe. And I'm not going to feel that effects of that for several days.

That's what we're seeing here. This is a case where, I think, this child, probably when that big wave hit him, he breathed a lot of that water in his lungs and he coughed, then I feel fine. And then, over several days, the body had an inflammatory response where it's responding to this water that got in his lungs. He seems to be breathing okay.

My suspicion is that, you know, before he had this episode where he just stopped breathing, he was probably having some trouble breathing. By not knowing all the details of the story though, I would expect that would happen. Maybe fevers, maybe coughing, all these sorts of things that then progressed to where a person or a child really can't breathe.

So that's the difference, I think, between this term we're seeing a lot in the media called dry drowning and what's more of what we would call secondary drowning or aspiration, which is the same process that would happen to any of us if we breathe a whole lot of water in our lungs, or someone's passed out, they vomited, and it gets in their lungs, any time you get that stuff in there, it's going to cause this kind of response. It's going to get worse over time.

Interviewer: And it takes time. It's not like it's all of a sudden going to happen. So, if a parent has their child out of the pool and they do swallow some water, but otherwise seem okay, is that a reason at that point to maybe run off to your doctor or to the ER?

Dr. Madsen: It's not. Because if you came to the ER, they would look at you, they would take the child's vital signs. They'd say, "Hey, he's breathing fine. His vital signs look great. Keep an eye on him." It's the same thing you do in any situation. You'd watch him. If he started to be coughing more, he started having trouble breathing, then that would be a reason to go the ER.

Interviewer: Right. And probably, part of this is connecting the dots that this might not just be another sickness. If those additional symptoms come on, it could have been caused by the swallowing of the water.

Dr. Madsen: Exactly. And you just look back. If I saw a child in the ER then who was having trouble breathing, that has had an inflammation in their lungs, they've been swimming recently, breathed some water in, I'd say, "Hey, this maybe what we call secondary drowning or aspiration. They breathe a lot in their lungs. We're seeing inflammation as a result of that."

Interviewer: Got it. So there is time to react to it. It's not something that's going to strike out of the middle of nowhere. And just really, you just have to be patient and see if something comes of it. And it nothing does, great. No problem.

Dr. Madsen: That's exactly right. I can't imagine this sort of thing just coming completely out of the blue. And I think this whole dry drowning term has probably created a lot of fear where people imagine someone on dry land and suddenly being overwhelmed, essentially drowning, just as if you'd fallen in a lake or something. It's not going to happen like that.

I'd expect over some time a child's going to be coughing more. They may develop a fever. Things are going to progress to where they would eventually get to a point where someone just couldn't breathe.

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