Drowning: Terminology, Pathophysiology, Rescue, Resuscitation, and Delayed Deterioration Practice Questions

25 multiple-choice questions on Drowning: terminology, pathophysiology, rescue, resuscitation, and delayed deterioration for paramedic and EMT students, from Chapter 39 (Environmental Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. The WHO defines drowning as:

   1. A. Death within 24 hours of being found underwater in a pool
   2. B. Water entering the stomach during a swimming accident
   3. C. Cardiac arrest that follows the aspiration of salt water
   4. D. Respiratory impairment from submersion or immersion in liquid
   Show answer

   Answer: D. Respiratory impairment from submersion or immersion in liquid

   Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid, and its outcome is classified as death, morbidity, or no morbidity. Survival does not change the term.

2. Under current terminology, which term should no longer be used?

   1. A. Fatal drowning
   2. B. Drowning with morbidity
   3. C. Near-drowning
   4. D. Nonfatal drowning
   Show answer

   Answer: C. Near-drowning

   Terms such as near-drowning, dry drowning, wet drowning, and secondary drowning were abandoned because they caused confusion. Drowning is described as fatal or nonfatal, with or without morbidity.

3. Submersion differs from immersion in that during submersion the:

   1. A. Airway is below the surface
   2. B. Victim inhales water into the lungs
   3. C. Victim is unconscious
   4. D. Water is colder than 20°C (68°F)
   Show answer

   Answer: A. Airway is below the surface

   In submersion the whole body, including the airway, is under the liquid; in immersion the body is covered but the airway is above the surface. Aspiration and unconsciousness can occur in either situation, and water temperature does not define the terms. Immersion can still lead to drowning from waves, exhaustion, or cold.

4. The primary cause of injury and death in drowning is:

   1. A. Hypothermia
   2. B. Hypoxia
   3. C. Electrolyte shift
   4. D. Cervical injury
   Show answer

   Answer: B. Hypoxia

   Breath-holding, laryngospasm, and aspiration cause hypoxemia that leads to loss of consciousness and cardiac arrest, so restoring oxygenation is the central treatment. Hypothermia and spinal injury occur in some cases but are not the main mechanism.

5. Aspiration of even small amounts of water damages the lungs mainly by:

   1. A. Washing out surfactant and causing alveolar collapse
   2. B. Shifting the serum sodium up to life-threatening levels
   3. C. Increasing blood volume until the heart fails
   4. D. Forming clots inside the pulmonary arteries
   Show answer

   Answer: A. Washing out surfactant and causing alveolar collapse

   Both fresh and salt water disrupt surfactant, cause atelectasis, and produce noncardiogenic pulmonary edema and shunting. Clinically significant electrolyte or volume shifts are rare because victims aspirate relatively small volumes.

6. For prehospital care, the difference between fresh water and salt water drowning:

   1. A. Determines which IV fluid is given
   2. B. Decides whether to start CPR
   3. C. Does not change the treatment
   4. D. Changes the compression depth
   Show answer

   Answer: C. Does not change the treatment

   Fluid type matters little clinically; care focuses on oxygenation, ventilation, and support of circulation in both. The older teaching about different electrolyte effects is not useful in the field.

7. The order of preference for rescuing a conscious swimmer in trouble near a dock is:

   1. A. Go, row, throw, then reach
   2. B. Reach, throw, row, then go
   3. C. Throw, go, reach, then row
   4. D. Row, reach, go, then throw
   Show answer

   Answer: B. Reach, throw, row, then go

   Reaching with a pole or throwing a flotation device keeps the rescuer out of the water; swimming to the victim is the last and most dangerous option. Panicked victims can drown untrained rescuers.

8. A 6-year-old is pulled from a pool, unresponsive and not breathing, with a pulse. Your first action is to:

   1. A. Perform abdominal thrusts
   2. B. Start chest compressions
   3. C. Apply the AED pads
   4. D. Begin rescue breaths
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   Answer: D. Begin rescue breaths

   Because drowning arrest is hypoxic, opening the airway and ventilating is the priority, and a child with a pulse needs ventilation alone. Abdominal thrusts delay ventilation and cause vomiting.

9. When CPR is needed for a drowning victim, it should include:

   1. A. Compressions only, without breaths
   2. B. Rescue breaths without compressions
   3. C. Abdominal thrusts before each cycle
   4. D. Compressions with rescue breaths
   Show answer

   Answer: D. Compressions with rescue breaths

   Compression-only CPR is not appropriate for asphyxial arrest because the patient lacks oxygen to circulate. Guidance emphasizes early ventilation, often starting with initial rescue breaths.

10. Attempting to drain water from the lungs of a drowning victim with abdominal thrusts is:

    1. A. Not recommended; it delays ventilation
    2. B. Recommended before the rescue breaths
    3. C. Required after saltwater drownings
    4. D. Useful if the patient is still breathing
    Show answer

    Answer: A. Not recommended; it delays ventilation

    Little water is usually aspirated and it is quickly absorbed, while abdominal thrusts delay ventilation and cause vomiting and aspiration. Suction only if material obstructs the airway.

11. During resuscitation of a drowning victim, vomiting is common. You should:

    1. A. Stop ventilations until it settles down
    2. B. Give abdominal thrusts to clear the stomach
    3. C. Turn the patient to the side and suction
    4. D. Sit the patient up and continue CPR
    Show answer

    Answer: C. Turn the patient to the side and suction

    Swallowed water and gastric distension from ventilation make regurgitation frequent, so log-roll the patient, suction, and resume. Advanced airway placement may be needed.

12. Routine spinal motion restriction for a drowning victim is:

    1. A. Required for every single patient pulled from the water
    2. B. Indicated only with a mechanism or signs of injury
    3. C. Never used, even after diving into shallow water
    4. D. Performed before any rescue breaths are given
    Show answer

    Answer: B. Indicated only with a mechanism or signs of injury

    Spinal injury is rare in drowning unless there is a mechanism such as diving into shallow water, a fall, a watercraft crash, or alcohol use. Unnecessary immobilization delays airway management and ventilation.

13. A 22-year-old dove off a pier into shallow water and was pulled out unresponsive and breathing. You should:

    1. A. Withhold spinal care until he is awake and talking
    2. B. Sit him up to drain water from his airway
    3. C. Give abdominal thrusts before moving him
    4. D. Restrict spinal motion while supporting the airway
    Show answer

    Answer: D. Restrict spinal motion while supporting the airway

    Diving into shallow water is a classic mechanism for cervical spine injury, so manual stabilization with airway support is appropriate. Sitting him up risks worsening an unstable cord injury.

14. A swimmer rescued from a lake is awake but coughing, with a respiratory rate of 28/min and crackles. She feels better and wants to go home. You should tell her that:

    1. A. She is fine because she is now awake
    2. B. Crackles after a rescue clear once she warms up
    3. C. Her lungs can worsen over the next hours
    4. D. Symptoms this mild need no transport
    Show answer

    Answer: C. Her lungs can worsen over the next hours

    A symptomatic drowning patient (cough, tachypnea, crackles) can develop worsening pulmonary edema and hypoxemia over several hours, so she needs transport and observation, commonly at least 4 to 6 hours. Being awake says nothing about her lungs. Crackles after a drowning reflect fluid in the alveoli and do not clear with warming, and even mild symptoms need monitored observation. The old idea of "secondary drowning" is no longer used, but delayed deterioration is real. (WMS 2019 drowning update.)

15. A drowning patient is awake but hypoxic with an SpO2 of 86% on a nonrebreathing mask and has frothy sputum. If protocol allows, the most helpful next step is:

    1. A. CPAP to recruit collapsed alveoli
    2. B. A rapid 2 L normal saline bolus
    3. C. Nebulized albuterol every 5 minutes
    4. D. A nasal cannula at 2 L/min
    Show answer

    Answer: A. CPAP to recruit collapsed alveoli

    CPAP or PEEP opens alveoli collapsed by surfactant loss and improves oxygenation in drowning pulmonary edema. Large fluid boluses can worsen the edema.

16. The best predictor of outcome in drowning is:

    1. A. Fresh versus salt water
    2. B. Duration of submersion
    3. C. Age of the rescuer
    4. D. Color of the water
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    Answer: B. Duration of submersion

    Survival with good neurologic function falls sharply as submersion time increases, especially beyond about 10 minutes. Water type has little effect on outcome.

17. A child submerged in icy water for 20 minutes is in cardiac arrest. You should:

    1. A. Resuscitate and transport while rewarming
    2. B. Declare death because of the time involved
    3. C. Wait for a pulse before starting CPR
    4. D. Rewarm on scene for 1 hour before moving
    Show answer

    Answer: A. Resuscitate and transport while rewarming

    Cold water can protect the brain through rapid cooling and the diving reflex, and children have survived long icy submersions. Prolonged resuscitation with rewarming is indicated.

18. The mammalian diving reflex in cold-water submersion causes:

    1. A. Tachycardia and an increase in brain metabolism
    2. B. Vasodilation of the skin and extremities
    3. C. Rapid breathing that worsens aspiration
    4. D. Bradycardia and shunting of blood to the core
    Show answer

    Answer: D. Bradycardia and shunting of blood to the core

    Cold water on the face triggers apnea, bradycardia, and peripheral vasoconstriction that preserve oxygen for the heart and brain. It is strongest in young children.

19. A competitive swimmer hyperventilated before attempting a long underwater swim and lost consciousness underwater. This is called:

    1. A. Nitrogen narcosis
    2. B. Shallow water blackout
    3. C. Decompression illness
    4. D. Immersion pulmonary edema
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    Answer: B. Shallow water blackout

    Hyperventilation lowers carbon dioxide, delaying the urge to breathe until oxygen falls low enough to cause unconsciousness without warning. Nitrogen narcosis occurs only when breathing compressed gas at depth.

20. Before using an AED on a drowning victim, you should:

    1. A. Leave the patient lying in shallow water to stay cool
    2. B. Apply the pads over the wet clothing
    3. C. Remove the patient from water and dry the chest
    4. D. Wait for 5 minutes of CPR before shocking
    Show answer

    Answer: C. Remove the patient from water and dry the chest

    Water conducts current between the pads and to rescuers, so move the patient to a dry surface and wipe the chest before applying the pads. Shock delivery should not be delayed once the rhythm is shockable.

21. A parent says she was watching the pool and would have heard her child struggling. You should explain that drowning usually:

    1. A. Involves loud shouting for help
    2. B. Takes many minutes of splashing
    3. C. Happens only in deep water
    4. D. Is quick and nearly silent
    Show answer

    Answer: D. Is quick and nearly silent

    A drowning person typically cannot call out or wave because the mouth is at the water surface and breathing takes priority, so drowning is often brief and silent. Constant, close supervision is needed. It can occur in shallow water, including bathtubs and buckets.

22. A 20-year-old with poorly controlled epilepsy asks how to lower his risk of drowning at home. The best advice is to:

    1. A. Take shallow baths instead of showers
    2. B. Swim alone if he wears a life jacket
    3. C. Shower rather than take baths
    4. D. Shower with the door locked for privacy
    Show answer

    Answer: C. Shower rather than take baths

    People with epilepsy have a much higher drowning risk, often in bathtubs, because a seizure in the water can be fatal within minutes. Showering, keeping the bathroom door unlocked, and swimming only with direct supervision lower the risk. A shallow bath is still a drowning risk, a life jacket does not replace a supervising swimmer, and a locked door delays rescue even in the shower.

23. A drowning victim regains a pulse after CPR but remains unresponsive. The rhythm is sinus at 96/min and the temperature is 33°C (91.4°F). Post-resuscitation priorities include:

    1. A. Oxygenation, ventilation, and preventing more heat loss
    2. B. Aggressive rewarming to above 38°C (100.4°F) in the field
    3. C. Removing the advanced airway if SpO2 is above 94%
    4. D. Restricting IV fluids even if the blood pressure falls
    Show answer

    Answer: A. Oxygenation, ventilation, and preventing more heat loss

    After ROSC, support oxygenation and ventilation, treat hypotension, and prevent further cooling, avoiding hyperthermia. Removing a needed airway in an unresponsive patient is dangerous.

24. Cold-water immersion causes sudden gasping and hyperventilation within the first minute, which can lead to aspiration. This is the:

    1. A. Diving reflex
    2. B. Cold shock response
    3. C. Afterdrop phenomenon
    4. D. Bends reaction
    Show answer

    Answer: B. Cold shock response

    Sudden immersion in cold water triggers involuntary gasping, hyperventilation, tachycardia, and hypertension, and the gasp can cause aspiration if the head is under. The diving reflex causes bradycardia and apnea instead.

25. An adult falls overboard into 8°C (46°F) water. After about 10 to 30 minutes, the main threat to self-rescue is:

    1. A. Afterdrop from rewarming of the body core
    2. B. Cold shock gasping and panic
    3. C. Loss of consciousness from hypothermia
    4. D. Loss of muscle function in the limbs
    Show answer

    Answer: D. Loss of muscle function in the limbs

    Cooling of the muscles and nerves of the arms and legs causes swim failure well before profound hypothermia develops, which is why life jackets matter. Afterdrop occurs after rescue, not during immersion. Cold shock gasping is the threat in the first minute, and hypothermic unconsciousness usually takes an hour or more in water of this temperature.