A patent airway must be maintained and ventilation assisted as needed; patients should receive supplemental oxygen. CPR should be started on any arrested patient with even a remote possibility of success. Sodium bicarbonate may be considered in hemodynamically unstable patients. Any patient with a significant episode, including those asymptomatic at the scene, should be transported to the hospital for evaluation.
In-water CPR is generally ineffective and dangerous for the rescuer and should not be attempted unless a firm, stable surface is available. Human near-drowning victims aspirate small quantities of water; postural drainage or the abdominal thrust (Heimlich maneuver) is of unproven efficacy in removing water from the lungs or improving oxygenation. No drainage procedure appears to significantly affect oxygenation in experimental preparations. Field limitations to postural drainage include the danger of aspiration from an uncontrolled airway, interruption of ventilation or CPR, the danger of spinal injury, and the possibility of aggravating other undiagnosed injuries. An appropriate maneuver for airway obstruction should be used only if ventilation is obstructed.
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