Tenggelam : Pasien meninggal pada saat kejadian atau meninggal dalam 24 jam pertama. Near drowning/ hampir tenggelam: Pasien masih survives dalam 24 jam pertama.

Angka kejadian kematian akibat tenggelam US : 8000/ thn Aus : 500/thn Ind : jarang dipublikasikan

Kejadian pada anak/dewasa Anak dan dewasa yang tidak bisa berenang. Minum alkohol mabuk berenang tenggelam Epilepsiberenangkambuh Trauma kepala Trauma organ tubuh Kecelakaan kapal.

Pathofisiology Submersion Initial priod of panic and voluntary breath holding. Violent srunggling Breaking point resulting in involuntary gasping ( hypoxic and / or hypercapnic ventilatory responsivity determines the breaking point.) Aspiration of water or laryngospasme or both

Secundary apnea Cerebral hypoxia leading to loss of consciousness ( Within 3-4 minutes of submersion)

On going hypoxia leading of cardiac arrest Hypoxia ischemic injury to the brain Cytotoxic cerebral edema Intracranial hypertension and reduced cerebral blood flow Brain Steam herniation and death

Pulmonary Pathology in Drowning and Near Drowning

Submersion

Breath holding ( Apnea)

Upper airway obstruction ( Laryngospasm)

Aspiration of water

Alveolar hypoxia and hypercapnia

Increased left ventricular after load

ARDS

Altered Surfactant function

Pulmonary hypertension

Pulmonary edema formation

Sistemik hypoxemia and hypercapnia

Cardiac depression ASYSTOLE

Factor Asociated with prediction of outcame in near Drowing Factor suggestive of favorable outcame Submersion time 10 minute NO resuscitation the first 10 menutes CPR given >25 menutes Use of cardiotonic medications in the field or ED GCS Score