## Immediate Management of Drowning Victim **Key Point:** A drowning victim who is unconscious with inadequate spontaneous breathing requires immediate cardiopulmonary resuscitation (CPR) and rapid transport to hospital, regardless of the duration of submersion. ### Rationale for Correct Answer This child meets criteria for **active resuscitation**: - Unconscious state - Weak/inadequate gasping (not effective breathing) - Cyanosis indicating hypoxia - Recent submersion (8 minutes) The immediate sequence is: 1. **Airway cleared** (already done by rescuers) 2. **Initiate chest compressions and rescue breathing** (100–120 compressions/min, 30:2 ratio in children) 3. **Arrange emergency transport** to a facility capable of advanced life support and extracorporeal rewarming if needed **High-Yield:** Even in cold-water drowning, do NOT assume the victim is dead until they are "warm and dead." Prolonged resuscitation (>1 hour) has resulted in full neurological recovery in some cases, particularly in children and cold-water immersion. ### Why Immediate CPR Is Critical **Clinical Pearl:** Drowning causes hypoxic cardiac arrest. The victim's weak gasping is **agonal respiration**, not effective ventilation. Oxygen saturation is critically low, and without immediate oxygenation and perfusion, irreversible brain damage occurs within minutes. **Mnemonic: DROWN** — **D**on't delay CPR, **R**esuscitate immediately, **O**xygen and ventilation, **W**arm gradually (if hypothermic), **N**ever assume death until warm. ### Transport Consideration Rapid transport to an **ECMO-capable centre** is ideal if the victim is in cardiac arrest or severely hypothermic, as extracorporeal rewarming can improve outcomes in cold-water drowning. [cite:Park 26e Ch 13]
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