1. Updates provided as the World Health Assembly adopted its first drowning resolution in 2023 with current estimate of over 90% of drowning related deaths are preventable. Updated epidemiology provided.
2. Clarification on automated external defibrillator (AED) use provided. AEDs do have a limited role in the care of drowning patients; however, the application of these devices should not interfere with compressions and ventilation as shockable rhythms are present in less than 6% of patients.
3. Updated ER disposition recommendations based on grade of severity and mortality with associated flow chart (Figure 1). Grades 2 and below may be safely observed and likely discharged within 4-6 hours.
4. Expanded ICU management recommendations.
5. Recommendation for aggressive fever prevention (for neuroprotection) but no recommendation for traditional targeted temperature management in the post-cardiac arrest patient per the recent Targeted Temperature Management 2 trial.
6. Recommendations for the management of shivering.
7. No role for the routine use of prophylactic antibiotics.
8. Updated Swimming Induced Pulmonary Edema (SIPE).
9. Risk factors: Cold water, pre-existing (Cardiovascular) CV disease, overhydration, horizontal positioning during swimming, tight fitting wetsuits, and concurrent respiratory infections.
10. Diagnostic findings typical chest x-ray findings of perifissural and interstitial thickening, widened azygos vein diameter, and enlarged cardiac silhouette.
11. Management: ß2-agonists, Positive Pressure, Positive Expiratory Pressure (PEP) Device.