FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- CPAP requires its own inclusion/exclusion criteria and ongoing reassessment.
- Children have a separate drowning order and destination rule.
First assessment
- Use spinal motion restriction for a diving or shore-break accident. Assess consciousness, airway patency, breathing, perfusion, and oxygen saturation.
- For SpO₂ below 95%, provide high-flow mask oxygen or nasal cannula at 6 L/min as tolerated. Treat arrest using the adult arrest pathway.
Ventilation and wheeze
- Monitor and document rhythm. For bradycardia, clear the airway and assist ventilation with BVM and high-flow oxygen.
- For wheezing, albuterol is 5 mg in 6 mL by continuous nebulization as tolerated. Reassess effort and air movement; inadequate ventilation needs ventilatory support.
Persistent respiratory distress
- A conscious patient with persistent distress after suctioning/coughing to clear the airway may receive CPAP under its separate criteria. Guard against vomiting and reassess continuously.
- If unconscious or unable to protect the airway, follow the advanced-airway pathway and confirm placement. Do not use the conscious-patient CPAP step in someone who cannot protect the airway.
Transport
- Provide ALS escort to the nearest appropriate ERC. Contact base for suspected spinal injury, other trauma, or additional direction as needed.
- Report mechanism, submersion history if known, respiratory/neurologic findings, oxygen and ventilation support, response, and any vomiting or associated trauma.
UNDERSTAND THE CARE
Why repeated respiratory assessment remains central
The drowning pathway begins with the airway, breathing and circulation rather than the apparent success of rescue. Obtain the submersion history when available and assess for associated trauma from diving or shore break. Describe consciousness, oxygenation, air movement and the support required so deterioration can be recognized against a recorded baseline.
Applying the guidance
The choice between oxygen, assisted ventilation and CPAP depends on the current clinical findings. CPAP is not a substitute for a protected airway in an unconscious patient. After suctioning or other support, repeat the breathing assessment and watch for vomiting. Handoff should explain the mechanism, respiratory course and any suspected trauma.
Putting it together
Teaching example: a rescued patient initially coughs and answers questions but then becomes drowsy with inadequate breathing. Reassess and escalate ventilatory support; the earlier level of consciousness no longer determines the next step.
Diagram text & teaching checkpoints
- Rescue history
- Submersion and associated trauma.
- Airway and breathing
- Assess the need for assisted ventilation.
- Treatment fit
- CPAP has separate conscious-patient criteria.
- Transport trend
- Report respiratory and neurologic changes.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.