Up to 15% of drowning patients don't have significant amounts of water in their lungs. They asphyxiate due to laryngeal spasm and are known as "dry drownings". For the rest, ventilation of the lungs is complicated by the presence of water.
However, don't get too clever: the basic rules for drowning or near-drowning are the same as for any other cardio-respiratory arrest: clear the airway and begin CPR. Some studies recommend the use of the Heimlich Maneouvre to remove water from the airways, but I haven't seen that make its way into mainstream practice yet.
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