Last reviewed: 20 Sep 2020
Last updated: 21 Mar 2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • respiratory impairment
  • evidence of submersion or immersion

Risk factors

  • age (0-4 years)
  • male sex
  • alcohol or drug intake
  • swimming alone/diving
  • lack of awareness of water hazard risks
  • lack of swimming ability
  • cardiac disease
  • seizure disorder

Diagnostic investigations

1st investigations to order

  • pulse oximetry/arterial blood gases
  • chest x-ray
  • basic metabolic panel
More 1st investigations to order

Investigations to consider

  • cervical spine CT
  • creatine kinase
  • serum alcohol and urine drugs of abuse
  • ECG
  • serum cardiac biomarkers
  • anticonvulsant medication levels
More investigations to consider

Treatment algorithm


Diretor Médico da Sobrasa

Ten Cel BM Médico RR - Corpo de Bombeiros Militar do Rio de Janeiro

Defesa Civil Municipal do Rio de Janeiro

Membro Fundador - International Drowning Research Alliance - IDRA

Rio de Janeiro



DS is an author of several references cited in this topic.

Executive Director: Lifeguards Without Borders

Medical Director: International Surf Lifesaving Association

Medical Director: Starfish Aquatics Institute

Medical Director: Innovative Attraction Management Starguard Elite

Board of Directors: Safer 3 Water Safety Foundation

Staff: Global Outreach Doctors

Jacksonville Beach



JS has acted as a paid medical expert for cases related to emergency medicine and drowning. JS has accepted honoraria of up $1000 to speak at aquatics or EMS conferences on the topic of drowning resuscitation; however, he has engaged in no product endorsement and received no honoraria from device/pharma makers.

Assistant Professor

Department of Emergency Medicine

University of Florida College of Medicine - Jacksonville

Medical Director

Jacksonville Beach Ocean Rescue

Deputy Medical Director

Trauma One




AS declares that he has no competing interests.

Dr David Szpilman, Dr Justin Sempsrott, and Dr Andrew Schmidt would like to gratefully acknowledge Dr Bhakti K. Patel and Dr D. Kyle Hogarth, previous contributors to this topic. BKP and DKL declare that they have no competing interests.

Peer reviewersVIEW ALL

Assistant Professor of Internal Medicine

Department of Medicine

Division of Pulmonary and Critical Care Medicine




AGV declares that he has no competing interests.

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