The FRS staff place the patient next to you. They are obviously in cardiac arrest and have an airway full of water. What additional measure is required at the start of a drowning cardiac arrest?

You quickly suction the airway and deliver 5 effective BVM ventilations. There is no response in the patient. What do you continue now?

You continue with your ALS management of the patient. Your colleague has already attached defibrillator pads and it is reading asystole. The FRS staff offer to help, and they take control of giving chest compressions. Your colleague is IO trained and offers to gain early IO access. What should you try to gain early where skill set allows?

You gather the intubation equipment while your colleague quickly secures IO access. Your colleague sets up next to you, and you start your intubation attempt. There is some water in the airway, but you successfully intubate the patient. You confirm with auscultation and capnography waveform and reading of 2.2 mmHg. 

With IO access gained, you can start giving cardiac arrest medication. In this scenario, what should you measure prior to administering drugs?

Temperature comes back as 32.2°C, what does this mean for your drug administration?

What is the dosage of Adrenaline 1:10000 given?

You administer the first adrenaline 1:10000 and continue with your ALS management. The Fire staff continue to deliver good chest compression in 2 minute cycles.The friends advise that the patient has no other past medical history, and there were no other factors involved in his drowning. Considering the reversible causes, what factors are present in this case?

You are managing Hypoxia through ETI and ventilation. You break open some heat blankets and start to warm the patient. You’re aware the patient is due another adrenaline 1:10000, what are the intervals between each administration in this scenario?

You continue to manage the arrest with ALS, FRS continue to manage chest compressions, and further Ambulance back up has arrived on scene. The patient has remained in asystole throughout. One of the backing up Paramedics asks if you should stop the arrest as the patient was submerged for more than 50 minutes. Is this correct?

You explain this is incorrect and the patient requires transportation to hospital. You load the patient and make your way to A&E, giving a pre-alert on route. The ALS continues throughout, and you handover to the resus team awaiting at hospital. One of the Doctors asks if the drowning was salt water or fresh water, to which you reply fresh. Are there any different treatment requirements within Ambulance service care to managing salt vs fresh water drowning?