Section: Veterinary Care In-depth
Diagnosis In-depth
While the diagnosis of near drowning is based on an observation of the event, certain diagnostic tests are necessary to evaluate the extent of lung or brain damage or to monitor the condition of a severely affected pet. If your pet appears normal after submersion, 24-hour hospitalization for observation may be all that is required. However, the following tests are necessary for those pets whose condition is more serious.
Thoracic radiographs (chest X-rays) are taken to look for the presence of pulmonary edema or to see if pneumonia is present. Pulmonary edema due to near drowning may take up to 48 hours to develop so serial X-rays are often necessary.
An arterial blood gas is obtained to assess how well a pet is able to oxygenate. A blood gas also helps the veterinarian to decide whether oxygen therapy is necessary.
A pulse oximeter also assesses how well a pet can oxygenate. The pulse oximeter utilizes a special clip placed on the pet's lip to measure oxygenation.
A transtracheal aspirate (TTA) samples the fluid in the lungs if pneumonia is suspected or if the pet was submerged in contaminated water. The sample is then submitted for microscopic evaluation and culture so appropriate antibiotics can be chosen to treat the pneumonia.
A complete blood count and biochemistry profile evaluate changes in the white blood cell count or damage to internal organs due to loss of oxygen and shock.
Urinalysis detects the presence of hemoglobinuria (hemoglobin in the urine), which may occur as a result of damage to red blood cells from fresh water near-drowning.
Central venous pressures are measured using an intravenous catheter placed in the jugular vein. Serial measurements are taken to determine the proper amount of IV fluids to be administered to near-drowning patients. Not all hospitals have the facilities to do this type of monitoring; however, inability to do such a test does not hinder proper care for your pet.
Treatment In-depth
Hospitalization and observation for the 24-hour period following a near-drowning incident is recommended regardless of how good a pet may appear initially. Difficulty breathing may develop hours after the near drowning incident. Treatment may consist of the following:
Supplemental oxygen for pets that have difficulty breathing.
An IV catheter for administration of IV fluids, which are used to treat shock and dehydration, and for administration of certain drugs.
Diuretics such as furosemide (Lasix) to treat pulmonary edema. Unfortunately, diuretics do not relieve the edema secondary to near-drowning as well as in cases of pulmonary edema due to other causes like heart disease.
Bronchodilators such as aminophylline or terbutaline to dilate the airways and improve breathing. These drugs usually have only a minor effect, as bronchoconstriction is not the main problem in near drowning patients.
Mechanical ventilation (use of a respirator) for patients that do not respond to therapy with oxygen and IV drugs. Your pet will be fully anesthetized while your veterinarian places an endotracheal tube or tracheostomy tube, which is then attached to the ventilator. The machine will breathe for your pet. This is usually a temporary measure (24-72 hours) until your pet can breathe normally on his own.
I.V. drugs such as mannitol or steroids to reduce cerebral edema in those pets that have severe changes in their mental status due to a prolonged period of oxygen deprivation or due to seizures following a near-drowning episode.
Antibiotics are not indicated unless the pet was submerged in contaminated water or pneumonia is present. Antibiotics are initiated only after a culture has been obtained.
Pets that are treated and discharged from the hospital should not exercise for the first one or two weeks, depending on the extent of lung injury. Pets recovering from pulmonary edema or pneumonia are often short of breath and tire easily following exercise.
