You are at the patients’ side and quickly assess airway, breathing, and pulse. You confirm the patient has a slow carotid pulse and is breathing at a rate of 4 per minute with lots of secretions and water in his airway. What is your first management

You take over BVM ventilations while your colleague sets up airway equipment. There are no c-spine or trauma concerns, what action can you do to help clear the airway 

You turn the patient on their side and fluid drains from the airway. You continue to ventilate with the BVM but still find it difficult. With multiple people available, what technique can you utilize for a better BVM mask seal

You attempt the two-person ventilation technique, this helps maintain a good mask seal but little air is entering the lungs. Although you investigate the airway and it visually is clear, it feels like there is an obstruction. What can you do to further investigate the airway 

You investigate the airway and see there is seaweed and debris in the trachea. You utilize forceps and remove the obstructions. You repeat BVM ventilations and now have better chest rise and fall. As you manage ventilations and airway, your colleague sets about preparing the patient for extrication.  

The patient suddenly starts to regurgitate a lot of water and you use suction to clear it. You go back to ventilate with the BVM, but now find it difficult again to get good rise and fall of the chest. You attempt airway manoeuvres, two-person BVM, but still no good. In the stepwise airway approach, what is the next step 

You insert an OPA and NPA, and this helps you get good ventilation again. Your colleague and the Lifeboat crew get the patient on the stretcher and into the ambulance. You continue to manage the airway and breathing while your colleague conducts observations and keeps the patient warm. Observations are: HR 52, RR ventilated 10, SPO2 96% on O2, BP 96/49, Temp 35.4°C. As this is a near drowning episode in the ocean, does it change your immediate treatment compared to a near drowning in a river 

In the Ambulance, control informs you that back up is only 5 minutes away. You start to notice the airway filling with water again and attempt to suction it clear. You are having difficulty now with the airway and decide to move up a step on the airway management approach. What adjunct do you use next

You insert an SGA airway in place but struggle to get a good seal and find it difficult to suction the fluids collecting. Are you able to move down the stepwise airway approach 

You decide to revert to the OPA again and get your colleague to assist with suctioning. You manage to clear the airway and now continue to maintain good BVM mask seal and ventilations. Do you now have to step up the stepwise airway approach again to SGA

Paramedic back up arrives, and you give a handover of the events. Which of the following do you handover