Treatment of near drowning begins at the scene with rapid, cautious removal of the victim from the water (T.a.ble..,..193.-1). Spinal precautions should be observed if the mechanism of injury, such as diving or surfing, raises suspicion of such injury. The vast majority of spinal injuries are to the lower cervical spine after diving. Clues to spinal injury may be paradoxical respiration (abdominal breathing without movement of intercostal muscles), flaccidity, priapism, or unexplained hypotension or bradycardia. Lifeguards and emergency medical technicians should maintain spinal precautions during rescue if possible. Initial history may be unreliable, and the physician should have a low threshold for obtaining cervical spine x-rays.
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