In adult non-fatal drowning with hypotension and pulmonary edema, which protocol should be followed?

• A. Normal Saline: 1 L Bolus
• B. Cardiogenic Shock protocol
• C. Ventilatory support only
• D. Observation and monitor

Answer: (B)

When a drowning patient is experiencing hypotension with pulmonary edema, the situation is best understood as cardiogenic shock rather than simple fluid loss. The heart is not pumping effectively, so putting more fluid into the system can flood the lungs and worsen edema while failing to correct the low blood pressure.

Following the Cardiogenic Shock protocol focuses on supporting the heart and improving perfusion without overloading the lungs. Start with airway and oxygenation to optimize oxygen delivery. Then prioritize hemodynamic support: use vasopressors to raise blood pressure and maintain adequate perfusion, and add inotropes if the cardiac pump is weak to improve contractility. Because the edema comes from the heart’s poor pumping, avoid large volume IV fluid boluses that can worsen pulmonary edema. If appropriate, use diuretics to reduce fluid overload once the patient is stabilized. Rapid assessment to identify reversible cardiac issues and continuous monitoring are key components.

The other approaches don’t address the underlying pump failure: a normal saline bolus can worsen pulmonary edema and may not correct hypotension; ventilatory support alone doesn’t treat shock; waiting and observing misses the urgent need to restore perfusion.