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Key sources
The following summarized guidelines for the evaluation and management of near-drowning are prepared by our editorial team based on guidelines from the American Heart Association (AHA 2020), the Wilderness Medical Society (WMS 2019), and the British Thoracic Society (BTS 2017).


1.Diagnostic investigations

Chest X-ray
Recognize that initial CXR findings do not correlate with arterial blood gas measurements or outcomes.
Consider obtaining CXRs to track changes in patient condition, but not for determining prognosis if obtained at the time of presentation.
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  • Neuroimaging

  • Laboratory tests

2.Respiratory support

Oxygen supplementation: aim at an oxygen saturation of 94-98% once spontaneous circulation is restored in patients after near-drowning.

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  • Noninvasive positive pressure ventilation

  • Mechanical ventilation

3.Medical management

Rescue: attempt rescue from a safe location by reaching, throwing, or rowing to the drowning patient if not formally trained in water rescue.
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  • In-water resuscitation

  • CPR

  • Management of hypothermia

  • Management of VF

  • Indications for evacuation

  • Antibiotic therapy

  • Corticosteroids

4.Therapeutic procedures

Cervical spine immobilization: as per AHA 2020 guidelines, do not perform routine stabilization of the cervical spine in the absence of circumstances suggesting a spinal injury.

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  • Heimlich maneuver

  • Therapeutic hypothermia

5.Specific circumstances

Cold water survival: advise to distance oneself from any immediate life threats (such as fire, sinking vehicle, whitewater, hazardous waves, rocks) upon falling into cold water. Remain calm and focused and control breathing by taking slow deep breaths.
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6.Preventative measures

Participant education and training: counsel patients with coronary artery disease, prolongedQT syndrome or other ion channel disorder, autism, seizure disorders, or other medical and physical impairments about the increased risk of drowning and about steps to mitigate the risk, such as buddy swimming and rescue devices, should they choose to participate in water activities.
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  • Personal flotation device

  • Presence of lifeguards

7.Follow-up and surveillance

Discharge from hospital: consider discharging patients after near-drowning with normal mental status if the respiratory function is normalized and no further deterioration in respiratory function has been observed after an observation period of 4-6 hours.