What is the treatment for a patient who has ingested water in a near-drowning episode?

Treatment for Near-Drowning Patients

The most critical treatment for a near-drowning patient is immediate rescue from water followed by cardiopulmonary resuscitation (CPR) with emphasis on rescue breathing to reverse hypoxemia, which is the primary pathophysiological mechanism and determinant of outcome. 1

Initial Management Algorithm

1. Immediate Rescue and Assessment

• Remove victim from water by fastest means available 1
• Do not attempt to drain water from lungs or perform Heimlich maneuver 1
• Quickly assess responsiveness and breathing

2. Resuscitation Based on Patient Status

• For unresponsive victims with abnormal/absent breathing:

  • Begin CPR immediately with emphasis on rescue breathing 1
  • For lone rescuers: provide 5 cycles (about 2 minutes) of CPR before activating EMS 1
  • If two rescuers present, one should activate EMS immediately while the other begins CPR 1
  • Continue resuscitation until EMS arrives

• For responsive victims with respiratory distress:

  • Position for optimal breathing
  • Administer supplemental oxygen if available (target SpO2 >94%) 1
  • Monitor closely for deterioration

3. Special Considerations

• Hypothermia management:

  • Remove wet clothes 1
  • Prevent further heat loss by insulating/shielding from wind/cold 1
  • Do not delay CPR to check temperature or wait for rewarming 1
  • If available, use warm humidified oxygen 1

• Spinal precautions:

  • Consider cervical spine immobilization only for victims with:
    • Clinical signs of injury
    • History of diving into shallow water
    • Signs of alcohol intoxication 1, 2

Hospital Management

• All near-drowning victims should be transported to hospital for evaluation
• Even asymptomatic patients require 4-6 hours of observation 3
• Symptomatic patients typically need at least 24 hours of observation 3
• Severe cases may require:
  • Advanced airway management
  • Positive pressure ventilation (PEEP/CPAP) 4
  • Management of complications (pulmonary edema, ARDS, cerebral edema)

Important Clinical Pearls

• The duration and severity of hypoxia is the single most important determinant of outcome 1
• Water temperature affects survival - cold water drowning may have better outcomes, particularly in children 1, 5
• Avoid rough movement during transport 1
• Foreign body airway obstruction maneuvers are not recommended and may cause harm 1
• Mouth-to-mouth ventilation in water may be helpful if performed by trained rescuers, but should not delay removal from water 1

Common Pitfalls to Avoid

• Attempting to remove water from lungs through postural drainage or abdominal thrusts 1
• Delaying CPR to check for pulse longer than 10 seconds 1
• Assuming victims without obvious water aspiration didn't drown 1
• Premature termination of resuscitation efforts, especially in hypothermic patients 1
• Failing to observe even apparently well patients, as deterioration can occur hours after the event 3

The evidence strongly supports that immediate rescue breathing and oxygenation are the cornerstones of treatment for near-drowning victims, as hypoxemia is the primary pathophysiological mechanism that must be reversed to improve survival and neurological outcomes.