Drowning — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Symptomatic/hypoxic?
   Symptomatic / hypoxic? (Drowning = respiratory impairment from submersion; the core injury is hypoxia (laryngospasm/aspiration → lung injury/ARDS/pulmonary edema). Rescue: do not endanger yourself; the priority is oxygenation and ventilation — open the airway, give rescue breaths first (drowning is a hypoxic arrest, ventilation before standard C-A-B). No need to clear water from the airway; abdominal thrusts/Heimlich are not recommended (ineffective, delay ventilation). Cervical collar not routine (only with trauma/shallow-water diving signs).)
   • Symptomatic / needs oxygen / abnormal consciousness or breathing → Symptomatic/hypoxic → oxygen ± intubation
   • Completely asymptomatic, normal exam and oxygen saturation → Asymptomatic · observe 4–8 h
2. [End] Asymptomatic · observe 4–8 h
   Completely asymptomatic, normal exam, normal SpO2, stable vitals: observe for about 4–8 hours; if they remain asymptomatic with normal oxygen and exam, they may be discharged (delayed deterioration is uncommon but warrants the observation period). Admit if respiratory symptoms/falling oxygen appear during observation.
3. [End] Symptomatic/hypoxic → oxygen ± intubation
   Symptomatic/hypoxic (needs oxygen, respiratory distress, abnormal consciousness): oxygen to keep SpO2 >94%, CPAP/BiPAP for persistent hypoxia/dyspnea, intubation + PEEP if unable to protect the airway or still hypoxic on high-flow oxygen, manage as ARDS/pulmonary edema; arrest → BLS/ACLS (cold-water/pediatric prognosis can be better); rewarm if hypothermic; symptomatic patients needing oxygen go to ICU.

Source guidelines & references

• Drowning (AHA/ILCOR resuscitation guidelines; emergency management)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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