A patient who has been submerged in water may be at risk for pulmonary edema if water has been aspirated.
Clinical findings associated with pulmonary edema:
(1) evidence of aspiration at the time of recovery, especially if from fresh water
(2) hemoptysis
(3) lung crackles on auscultation
(4) chest X-ray showing fluffy shadows
(5) low arterial oxygen pressure while breathing room air, especially if it starts to fall
A person with one or more of these findings should be admitted to the hospital for at least 4 hours (some would hold for 24 hours).
A falling arterial oxygen pressure indicates impending respiratory distress syndrome and is an indicated for assisted ventilation with positive end expiratory pressure (PEEP).
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