Drowning is the condition in which a submersion in a liquid occurs that results in a liquid to air interface at the victims' airway that prevents the victim from breathing air. The primary insult is hypoxia which may result in secondary cardiac rhythm deterioration.

General issues

• Unless there are signs of death, resuscitation should be attempted and transport should occur to the nearest appropriate E.D.
• Unless there is evidence of mechanism of neck or spinal trauma, immobilization is not recommended as it may delay opening of the airway and provision of rescue breaths which are essential to survival
• Hypothermic immersions may result in better potential outcome especially in children
• Have suction available and be prepared to clear airway as majority of victims who require rescue breathing +/- chest compressions will vomit

First Steps ABCD's

• Ventilation must start immediately either on a flotation device or in shallow water (or out of the water).
• Attempts to remove water from the airway are unnecessary, wastes time and may potentially be harmful; Provide rescue breathing identically to that of standard CPR.
• Provide 2 rescue breaths making sure to see chest rise (if patient is not responsive and not breathing)
• Provide standard CPR (lay rescuer gives chest compressions, healthcare provide assesses for pulse × 10 seconds, if no definite pulse then provides chest compressions)
• Standard CPR, 5 cycles of 30:2 compressions to ventilations then reassess
• Assess rhythm (standard monitor/defibrillator or AED) to look for shockable rhythm
• Dry & Warm victim

Additional steps

• Rapid transport to hospital
• Early intubation for drowning victims in cardiac arrest
• All drowning victims, even those with rapid recovery who needed minimal intervention need transport and evaluation (may develop delayed life threatening pulmonary complications due to increased pulmonary capillary permeability, which will not be immediately apparent)

Source: Circulation 2005;112. 2005 AHA Guidelines for CPR and ECC.