Medical

Drowning / submersion injury

Before / During / After / Pitfalls

Before

• Correct hypoxemia and hypothermia; evaluate trauma if mechanism suggests it.
• Use PEEP/CPAP/NIV when safe; prepare intubation for persistent hypoxemia, AMS, or failing ventilation.
• Suction and aspiration precautions are important.

During

• Preoxygenate with PEEP; avoid derecruitment during transition.
• Confirm tube and start lung-protective, oxygenation-focused ventilation.
• Avoid unnecessary C-spine assumptions unless trauma risk exists.

After

• Treat hypothermia, aspiration/ARDS physiology, and associated trauma.
• Titrate FiO₂/PEEP and reassess gases/imaging.
• ICU pathway for severe hypoxemia or neurologic injury.

Pitfalls

• Assuming all drowning patients need prophylactic antibiotics.
• Dropping PEEP during transport/transition.
• Missing hypothermia or trauma.