Drowning is breathing difficulty from being under or in water, and the main problem is lack of oxygen. Rescue breaths and early oxygen are the priority, and patients who seem well can still develop lung injury over the next hours.
Key symptoms
- Cough, vomiting and shortness of breath
- Confusion or reduced consciousness
- Cold, pale or blue skin
- No breathing or pulse in severe cases
What you find on exam
- Airway, breathing, oxygen saturation and lung crackles
- Pulse and level of consciousness
- Core temperature for hypothermia
- Look for neck injury if diving or shallow water
Tests
- Pulse oximetry and blood gas
- Chest X-ray
- Blood glucose, electrolytes, ECG
- Observe for at least 4 to 6 hours if symptoms
Treatment basics
- Remove from water safely; spinal care only if injury is likely
- Give 5 initial rescue breaths, then CPR with ventilations if no pulse
- High-flow oxygen; CPAP or intubation for low oxygen
- Remove wet clothes and warm the patient
- Do not try to drain water from the lungs
Red flags
- Low oxygen saturation despite oxygen
- Altered mental status
- Hypothermia or a long time underwater
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; AHA Guidelines for CPR and ECC. Written by Making Synapses. Making Synapses is not affiliated with these organizations.