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Drowning is defined as respiratory impairment as a result of being in or under a liquid. Drowning typically occurs silently, with only a few people able to wave their hands or call for help. After rescue symptoms may include breathing problems, vomiting, confusion, or unconsciousness. Occasionally symptoms may not appear until up to six hours afterwards. Drowning may be complicated by low body temperature, aspiration of vomit, or acute respiratory distress syndrome.