# Drowning and Electrical Injury > Drowning and electrical injury for NEET-PG Medicine, covering hypoxic physiology, resuscitation order, fibrillation risk, rhabdomyolysis and late complications. - Canonical URL: https://prepelephant.com/topics/neet-pg/medicine/drowning-and-electrical-injury - Exam / course: NEET-PG · Subject: Medicine - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-08 - Last updated: 2026-10-08 - Reference basis: Harrison's Principles of Internal Medicine; ERC Guidelines for Resuscitation; Oxford Handbook of Emergency Medicine - How to cite: "Drowning and Electrical Injury", PrepElephant, https://prepelephant.com/topics/neet-pg/medicine/drowning-and-electrical-injury ## Direct answer Drowning is respiratory impairment after submersion in liquid, and hypoxaemia, not the volume of water swallowed, is what kills. Resuscitation therefore starts with ventilation: five initial rescue breaths, high-flow oxygen and early airway control, with chest compressions added only when there is no pulse. Electrical injury works differently, because current passing through the heart causes ventricular fibrillation or asystole, while muscle necrosis and myoglobinuria can appear hours later. ## What you must remember - **Pathophysiology:** Laryngospasm can occur early, so the volume of water aspirated is often small; the hypoxia itself drives bradycardia, arrest and acidosis. - **Resuscitation order:** Oxygenation and ventilation come first, since the arrest is usually respiratory in origin; standard CPR follows only if the pulse is absent. - **Abdominal thrusts:** The Heimlich manoeuvre is not recommended, because it does not clear the lungs and adds regurgitation and aspiration risk. - **Fresh versus salt water:** Both cause surfactant loss and pulmonary oedema, so the water type changes textbook physiology more than bedside treatment. - **Cervical spine:** Immobilise when diving, surfing or trauma is suspected, but never let spinal precautions delay airway control. - **Arrhythmia in electrical injury:** Ventricular fibrillation is the usual lethal rhythm, and alternating current at mains frequency is more arrhythmogenic than direct current of the same voltage. - **Hidden damage:** Entry and exit wounds mark the current path, but deep muscle necrosis, rhabdomyolysis and compartment syndrome often exceed what the skin shows. ## Two rescues, two different physiologies A four-year-old is pulled from a village pond after several minutes under water. She is grey, apnoeic and pulseless. 1. **Ventilate first:** give five rescue breaths with oxygen if available, then check the pulse. 2. **Start CPR if pulseless:** if the pulse is absent, standard paediatric CPR begins without delay, and the cervical spine is considered but never allowed to hold up the airway. 3. **Protect the lungs:** once spontaneous breathing returns, high-flow oxygen is given aiming for normal saturations, with a chest radiograph for oedema or aspiration and arterial gas to judge acidosis. 4. **Observe:** many victims who look well still need observation for several hours (many protocols say up to 24 hours), because pulmonary oedema or ARDS can declare itself late. 5. **Avoid routine drugs:** routine steroids and prophylactic antibiotics have no proven role. A labourer touching a 230-volt live wire during monsoon repair work presents differently. He is thrown back and unconscious, with a small burn on the palm, and the rhythm strip shows ventricular fibrillation, so defibrillation and advanced life support follow the usual algorithm. Afterwards the danger is deeper: creatine kinase is measured, urine is tested for blood without red cells (suggesting myoglobinuria), potassium is watched, and intravenous fluid is given to maintain urine output. A tense, painful forearm or calf compartment needs pressure measurement and early fasciotomy, and established necrosis may later demand amputation. ## Where the exam tries to catch you Examiners favour a few recurring traps. - **Trap:** judging an electrical injury by its visible burn. — **Correct:** a small entry wound over a large deep muscle injury is typical, and a normal-looking limb can hide a compartment syndrome. - **Trap:** using the term secondary drowning. — **Correct:** it has no clinical meaning and should be avoided, since a victim who deteriorates within hours has a delayed pulmonary complication. - **Trap:** abandoning a lightning victim in cardiac arrest. — **Correct:** these victims often recover with prompt CPR and should not be abandoned. - **Trap:** treating drowning in isolation after cold-water immersion. — **Correct:** drowning is often paired with hypothermia, so consider both together. ## Frequently asked questions ### What is the first priority in resuscitating a drowning victim? Oxygenation and ventilation come first, because drowning is usually a hypoxic arrest. Give five rescue breaths with supplemental oxygen, check for a pulse, and start CPR only if none is present, followed by early advanced airway management. ### Why is the Heimlich manoeuvre not recommended for drowning? Abdominal thrusts do not clear water from the lungs effectively and raise the risk of regurgitation and aspiration. Current resuscitation guidance advises against routine drainage of water from the stomach or airway in drowning victims. ### What is the commonest lethal rhythm after electrical injury? Ventricular fibrillation is the commonest lethal rhythm after electrical injury, followed by asystole, particularly after high-voltage exposure. Electrical injury arrests are managed with standard advanced life support, with early defibrillation as the decisive step. ### Why is creatine kinase measured after high-voltage electrical injury? Creatine kinase detects rhabdomyolysis from deep muscle damage, which can follow even a brief high-voltage shock. A raised level, myoglobinuria and hyperkalaemia guide fluid resuscitation, potassium monitoring and vigilance for compartment syndrome. ### Does the type of water change drowning management? The difference between fresh and salt water matters little at the bedside, since both impair gas exchange and need oxygen, ventilation and monitoring for pulmonary oedema. Textbooks still describe the physiology, but treatment does not change with the type of water inhaled.