Red flags
- Cardiac arrest — prolonged CPR (esp cold water)
- ARDS onset within 24 h
- Cervical spine injury (diving)
First steps
- ABCDE + C-spine precautions if trauma suspected
- High-flow O₂ + early intubation if GCS <8 or resp failure
- Continuous cardiac monitoring
Key investigations
- ABG, CXR, ECG, glucose, U&E, alcohol/tox screen
- CT head/C-spine if trauma
Differentials
- Cardiac cause of drowning (arrhythmia, MI)
Initial management
- ARDS-net ventilation strategy
- ECMO if refractory ARDS
- Observe ≥6 h even if asymptomatic (secondary drowning)
- Hypothermic drowning arrest — extended CPR + ECMO rewarming (up to 100% neurologically intact survival if K+ <10)
Referral
- ICU
AI clinical assessment
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This tool is for educational and clinical support only. It does not replace professional medical judgment or institutional protocols.
