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Drowning
In drowning the main problem is hypoxia, so in resuscitation ventilation comes first — five initial rescue breaths — together with treatment of hypoxaemia and delayed pulmonary oedema; there is no clinically important difference between fresh and salt water.
Why it matters in the exam
Questions test the order of actions in resuscitating a drowning victim: opening the airway and five rescue breaths before compressions, with no abdominal thrusts to drain water from the lungs. Routine cervical spine immobilisation is not needed, except when injury is suspected — diving into shallow water, surfing or neurological signs.
Observation is also tested: a drowning patient who looks well may develop breathlessness and hypoxaemia over the following hours because of surfactant injury and pulmonary oedema; so observe for several hours (usually 6–8), and if saturation, examination and X-ray are normal — discharge. A hypoxaemic patient receives oxygen and, if needed, CPAP or ventilation with PEEP.
Hypothermia that accompanies drowning in cold water may protect the brain, so in children who drowned in very cold water resuscitation is continued for a long time and the child is rewarmed before deciding to stop. Submersion time is the most important prognostic factor: submersion over 10 minutes predicts a poor outcome, but is not on its own a reason to withhold resuscitation. Prophylactic antibiotics are not routine, and prevention — close supervision of children, pool fencing and life jackets — matters most.
The exam often shows a child found in a pool or bath and asks what is done first at the scene and in hospital. At the scene the answer is always ventilation, and in hospital — oxygen, chest X-ray, blood gas and watching for respiratory deterioration. The cause of the drowning should also be sought: a seizure, an arrhythmia, intoxication or injury, and in a young child also neglect.
Key points
- The main problem is hypoxia — ventilation comes first.
- Five rescue breaths, then standard CPR; no abdominal thrusts.
- Spinal immobilisation only when injury is suspected.
- A patient who looks well — 6–8 hours of observation.
- Cold water — prolonged resuscitation and rewarming.
Summary table
| Stage | Finding | Danger | Action |
|---|---|---|---|
| Rescue and resuscitation | Respiratory or cardiac arrest | Hypoxia | Five rescue breaths, then standard CPR |
| Alert patient with normal saturation | Cough, mild symptoms | Delayed pulmonary oedema | 6–8 hours of observation; discharge if normal |
| Hypoxaemia | Breathlessness, crackles | ARDS | Oxygen, CPAP or ventilation with PEEP |
| Suspected injury | Diving into shallow water, surfing | Cervical spine injury | Spinal immobilisation |
| Cold-water drowning | Hypothermia | Mimics death | Prolonged resuscitation and rewarming |
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Sources
- European Resuscitation Council Guidelines: cardiac arrest in special circumstances, 2021 (with the 2025 update) — Drowning
- Wilderness Medical Society Clinical Practice Guidelines for the treatment and prevention of drowning, 2019 update — Hospital care
- Szpilman D et al., Drowning (New England Journal of Medicine), 2012 — Management
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.