What oxygen level is indicated during initial management of near-drowning?

• A. 21% oxygen
• B. 15% oxygen
• C. 50% oxygen
• D. 100% oxygen

Answer: (D)

During the initial management of near-drowning, the priority is rapidly correcting hypoxemia to protect the brain and other organs. Submersion often causes significant oxygen deprivation because of airway irritation, possible aspiration, and surfactant dysfunction, which impairs gas exchange. Providing the highest feasible inspired oxygen concentration helps maximize the amount of oxygen entering the blood and increases the diffusion gradient into the alveoli, quickly raising arterial oxygen content. That’s why 100% oxygen is used right away, delivered through a non-rebreather mask or during bag-valve ventilation, so oxygen delivery is maximized as you begin resuscitation. Once oxygenation is stabilized, you then titrate FiO2 down to maintain adequate saturation (typically in the mid-to-high 90s). Lower initial concentrations, like room air or 15%, would not promptly correct the critical hypoxemia, and 50% would not provide the same rapid improvement in oxygen delivery.