Drowning Resuscitation Medical Slides

Present the key distinction from standard BLS/ALS: drowning is a respiratory arrest that leads to cardiac arrest (hypoxic etiology). Therefore: start with 5 rescue breaths (not compressions first), as restoring oxygenation is the primary intervention. ILCOR 2024 recommends: 5 initial rescue breaths → check for signs of life → if absent, begin CPR at 30:2 ratio (single rescuer) or 15:2 (two rescuers). In-water rescue breathing should be attempted by trained rescuers if possible. Do NOT attempt abdominal thrusts to expel water (ineffective and risks aspiration of stomach contents). C-spine immobilization only if mechanism suggests injury (diving, watercraft).

Present the cold water submersion management: "No one is dead until they are warm and dead" — cases of survival with good neurological outcome exist after >60 minutes of submersion in cold water (<6°C), especially in children. Hypothermia is neuroprotective but complicates resuscitation: VF refractory to defibrillation below 30°C (limit to 3 shocks until rewarmed), cardiac drugs ineffective and accumulate at <30°C (withhold epinephrine until ≥30°C per some guidelines). Rewarming: passive external for mild (32-35°C), active external warming for moderate (28-32°C), extracorporeal rewarming (ECMO) for severe (<28°C) with cardiac arrest. Continue CPR during rewarming to at least 32°C before declaring death.

Present evidence-based prognostic indicators: Good prognosis — submersion <5 minutes, cold water, early bystander CPR, GCS ≥6 on ED arrival. Poor prognosis — submersion >25 minutes in warm water, CPR duration >25 minutes, asystole on arrival, absent pupillary reflexes, pH <6.8, no spontaneous respiratory effort. The Szpilman classification (grades 1-6) stratifies severity by initial presentation. Emphasize: in hypothermic drowning, prolonged resuscitation (until core temperature ≥32-34°C) is warranted regardless of submersion duration — multiple case reports of full recovery after >60 min cold water submersion. In warm water drowning >30 min without ROSC, prognosis is near-universally fatal.