What complications must EMS monitor for after rescue from drowning?

• A. Only dehydration.
• B. Skin infections.
• C. Cardiac arrhythmias unrelated to respiratory compromise.
• D. Aspiration pneumonia, pulmonary edema, ARDS, secondary drowning; monitor airway and provide supportive care.

Answer: (D)

After a drowning rescue, the most important concerns are respiratory complications that come from aspirating water and the resulting hypoxia. Water in the lungs can cause chemical injury (pneumonitis), fluid buildup (pulmonary edema), and impaired gas exchange, which can rapidly worsen oxygenation. Because residual water and airway irritation can trigger delayed problems, EMS must monitor for secondary drowning, which can occur hours after the incident as edema and inflammation limit breathing. Aspiration pneumonia is another risk as bacteria or contaminants can irritate the airways and lead to infection if ventilation stays compromised. In practice, this means closely tracking airway patency, providing supplemental oxygen, and using ventilation support as needed, while watching for signs of increasing work of breathing, hypoxia, or changes on capnography and vital signs. While dehydration, skin infections, and unrelated cardiac arrhythmias can occur in the broader course of illness, they do not capture the primary, time-sensitive pulmonary risk profile that demands vigilant airway and breathing monitoring after drowning.