What is the initial management for near-drowning?

• A. 100% oxygen therapy
• B. Warming only
• C. ECMO as first-line
• D. Diuretics and antihypertensives

Answer: (A)

Restoring oxygenation as quickly as possible is the most important first step in near-drowning. Submersion can cause significant hypoxemia from airway injury, aspiration, and lung edema, so delivering 100% oxygen promptly improves arterial oxygen tension and tissue oxygen delivery while you assess the airway and plan ventilation. Use high-flow oxygen via a bag-valve mask or non-rebreather and be prepared to secure the airway if ventilation is inadequate, with continuous monitoring of SpO2 and, if available, arterial blood gases.

Warming the patient may be important if hypothermia is present, but warming alone does not correct the dangerous lack of oxygen. ECMO is not the initial treatment; it’s considered only after conventional airway and ventilation strategies have been optimized and the patient remains severely hypoxic or in cardiopulmonary failure. Diuretics and antihypertensives are not part of the immediate management of near-drowning, as they do not address the acute hypoxemia or airway/injury concerns.