A 20-year-old male pulled from cold water is apneic with a slow, weak pulse. Which actions should you perform first?

• A. provide rescue breathing, remove wet clothing, immobilize his spine, keep him warm, and transport carefully
• B. perform CPR, check pulse, and give aspirin
• C. raise his legs and provide a blanket only
• D. administer activated charcoal

Answer: (A)

When a drowning patient is apneic but still has a pulse, the immediate focus is on airway and breathing while preventing further heat loss. Begin rescue ventilations right away to oxygenate the blood and support breathing. Using a bag-valve-mask if possible, deliver gentle breaths at a steady rate until you see signs of spontaneous breathing or the pulse becomes a reliable indicator of perfusion.

Exposure management is next. Remove wet clothing and cover the patient with dry, warm blankets or a insulating layer to reduce heat loss. Hypothermia is a major concern after cold-water immersion, and keeping the patient warm helps improve overall outcomes.

Assess for trauma and spinal injury. If there’s any mechanism suggesting potential spinal injury (for example, a difficult extraction from water, diving injury, or significant mechanism of injury), immobilize the spine during handling and transport to prevent secondary injury.

After airway, breathing, and temperature considerations are addressed, transport promptly to advanced care while continuing to monitor and provide ventilations as needed. Aspirin and activated charcoal aren’t indicated in this drowning scenario, and CPR isn’t indicated while a pulse is present.