A 10-year-old child is brought to the emergency department after being pulled from a swimming pool. The child is unconscious and not breathing. What is the BEST initial intervention?
Perform abdominal thrusts to expel water
Begin active rewarming measures
Initiate chest compressions
Start rescue breathing
The correct answer is to initiate chest compressions. In a submersion injury, the primary concern is hypoxia. The 2020 American Heart Association guidelines emphasize starting with chest compressions in cardiac arrest situations, even in drowning victims. This approach ensures immediate blood flow to vital organs, particularly the brain. While rescue breaths are important in drowning cases, chest compressions take precedence to quickly restore circulation. Warming the patient is important but secondary to initiating CPR. Attempting to remove water from the lungs through abdominal thrusts (Heimlich maneuver) is no longer recommended as it delays CPR and may increase the risk of aspiration.
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