When water enters the airway instead of the esophagus, it is called aspiration, which is the mechanism behind choking on water or a non-fatal drowning event. This can happen from drinking too quickly or being submerged, and it causes immediate respiratory distress. The body’s natural response is a forceful cough, which usually clears the liquid, but when this reflex fails, immediate intervention is necessary to prevent oxygen deprivation. Quick action is paramount because the brain is highly susceptible to damage from a lack of oxygen.
Recognizing Severe Aspiration and When to Call Emergency Services
Minor aspiration often results in a brief, sputtering cough that resolves quickly, but severe aspiration or near-drowning presents with clear signs of an ineffective airway clearance. A person choking on water will show an inability to speak, cry, or cough forcefully enough to be heard. This inability to move air is a sign of a partial or complete airway blockage.
Physical symptoms escalate rapidly as oxygen levels drop, including the skin, lips, or nail beds turning blue or grey (cyanosis). The victim may exhibit panic or distress, clutching at their throat, or may have a weak, silent cough that produces no air movement. If you observe any of these severe signs, or if the person becomes limp and unresponsive, you must immediately call emergency services before attempting any physical intervention.
The immediate priority is to summon professional help while initiating first aid, so if another person is present, have them make the emergency call right away. Loss of consciousness or inability to breathe normally signifies a complete respiratory failure that requires the most aggressive form of resuscitation.
Immediate Steps for a Conscious Victim
If the person is conscious but is struggling to clear their airway, the first step is to encourage them to cough forcefully. Coughing is the body’s most effective natural defense mechanism for dislodging foreign material from the trachea. If the victim cannot clear the water with their own cough, you must begin a sequence of back blows and chest thrusts.
Position yourself to the side and slightly behind the victim, supporting their chest with one arm while leaning them forward. Delivering five sharp blows with the heel of your hand between the person’s shoulder blades uses gravity and force to help expel the water. After each blow, check to see if the obstruction has cleared.
If the back blows are unsuccessful, immediately transition to administering five chest thrusts. Stand behind the person and place your arms under their armpits, wrapping them around the chest. Place the thumb-side of your clenched fist on the center of the breastbone, and then grasp that fist with your other hand. Deliver five sharp thrusts straight back into the chest. The cycle of five back blows and five chest thrusts should be repeated until the person breathes normally or becomes unresponsive.
Responding to Unconsciousness and Respiratory Failure
If the person becomes unconscious at any point, carefully lower them to the ground and immediately begin the protocol for respiratory failure. Because a drowning event involves a lack of oxygen, the resuscitation efforts must prioritize ventilation over chest compressions. The rescuer should perform two initial rescue breaths before beginning chest compressions.
To deliver the rescue breaths, open the airway using the head-tilt, chin-lift maneuver. Pinch the nose shut, make a complete seal over the person’s mouth with your mouth, and deliver a breath lasting about one second, ensuring the chest visibly rises. Follow this with a second breath, then begin chest compressions.
The compression-to-breath ratio is 30 compressions followed by two rescue breaths, repeated until emergency help arrives or the person begins to breathe normally. Chest compressions should be delivered at a rate of 100 to 120 per minute, pressing down about two inches on the center of the chest. If the victim vomits during resuscitation, quickly turn them onto their side to clear the airway before immediately resuming the compression-breath cycle.
Monitoring for Delayed Complications
Even after a person who choked on water appears to recover and is breathing normally, a risk of delayed complications remains, often referred to as “dry drowning” or “secondary drowning.” These terms describe respiratory problems that manifest hours after the initial incident, resulting from the water that was inhaled into the lungs. The water can cause irritation and inflammation, potentially leading to pulmonary edema, where fluid builds up and impairs the lungs’ ability to transfer oxygen.
Symptoms to monitor for in the 24 hours following the event include a persistent, worsening cough, noticeable difficulty breathing, or wheezing sounds. Other signs of concern are lethargy, extreme fatigue, sudden changes in behavior, or a fever, which may indicate a developing infection like aspiration pneumonia. Because these complications can be life-threatening, any person who has experienced significant water aspiration requires a professional medical evaluation.