MBBS OSCE · Emergency & Toxicology
OSCE — Drowning
Eight-minute OSCE station on Drowning: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Drowning.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Drowning is defined by the WHO as the process of experiencing respiratory impairment from submersion or immersion in liquid; outcomes are fatal drowning, non-fatal drowning with morbidity, or non-fatal drowning without morbidity (a rescue). The old terms 'near-drowning', 'dry drowning', 'wet drowning', 'active drowning' and 'secondary drowning' are obsolete. The primary injury is hypoxia produced by laryngospasm and/or aspiration of liquid into the alveoli, which washes out surfactant, collapses alveoli, causes non-cardiogenic pulmonary oedema and ventilation-perfusion mismatch, and may evolve over hours into acute respiratory distress syndrome (ARDS). The downstream killer is hypoxic cardia
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Person submerged and pulled out in respiratory distress or unconscious - drownin |
| Safety | Cardiac arrest after drowning - hypoxic (asphyxial) arrest: give 5 rescue breath |
| Safety | Respiratory deterioration, cough, frothy sputum or hypoxia hours after rescue - |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.