Diferencia entre revisiones de «Immersion pulmonary edema»
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**Prevalence approx 1.8% in combat swimmers | **Prevalence approx 1.8% in combat swimmers | ||
**Very rare outside these groups | **Very rare outside these groups | ||
**Similar to exertion-related pulmonary edema (best described in racehorses) | |||
*No good evidence-based risk factors identified, but hypertension appears to be associated<ref name="Miller" /> | *No good evidence-based risk factors identified, but hypertension appears to be associated<ref name="Miller" /> | ||
**There may also be some relation to overhydration.<ref name="Yoder">Yoder JA, Viera AJ. Management of swimming-induced pulmonary edema. Am Fam Physician. 2004 Mar 1;69(5):1046, 1048-9.</ref> | |||
*Immersion increases cardiac output and doubles pulmonary artery pressures compared to being out of water<ref name="Miller" /> | *Immersion increases cardiac output and doubles pulmonary artery pressures compared to being out of water<ref name="Miller" /> | ||
**Blood is also redistributed from extremities to the thorax. This effect is greater in cold water.<ref name="Ludwig" /> | |||
==Clinical Features== | ==Clinical Features<ref name="Ludwig">Ludwig BB, Mahon RT, Schwartzman EL. Cardiopulmonary function after recovery from swimming-induced pulmonary edema. Clin J Sport Med. 2006 Jul;16(4):348-51.</ref>== | ||
*Dyspnea and/or hemoptysis immediately after water immersion | |||
*No history of water aspiration or laryngospasm | |||
*Hypoxia (SpO2 <92% or A-a gradient >30) | |||
*CXR opacities consistent with interstitial pulmonary edema or alveolar filling process | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
*Clinical diagnosis, based on history and physical examination | |||
==Management== | ==Management== | ||
*Primarily supportive care, including supplemental oxygen<ref name="Yoder" /><ref name="Lund">Lund KL, Mahon RT, Tanen DA, Bakhda S. Swimming-induced pulmonary edema. Ann Emerg Med. 2003 Feb;41(2):251-6.</ref> | |||
**Remove from water | |||
**Remove cold clothes and place into a warm environment | |||
**[[Albuterol]] may be used for symptomatic relief | |||
*Typically resolves completely within 24-48 hours | |||
==Disposition== | ==Disposition== | ||
*Discharge if asymptomatic or minimal symptoms, normal SpO2 | |||
*Otherwise, admit for observation | |||
==See Also== | ==See Also== | ||
Revisión del 08:38 17 ago 2015
Background
- Also known as Swimming-Induced Pulmonary Edema (SIPE)[1]
- Populations affected: Combat swimmers (e.g. Navy SEALs), triathletes, and submersion divers (aka "breath-hold diving")[2]
- Prevalence approx 1.8% in combat swimmers
- Very rare outside these groups
- Similar to exertion-related pulmonary edema (best described in racehorses)
- No good evidence-based risk factors identified, but hypertension appears to be associated[2]
- There may also be some relation to overhydration.[3]
- Immersion increases cardiac output and doubles pulmonary artery pressures compared to being out of water[2]
- Blood is also redistributed from extremities to the thorax. This effect is greater in cold water.[4]
Clinical Features[4]
- Dyspnea and/or hemoptysis immediately after water immersion
- No history of water aspiration or laryngospasm
- Hypoxia (SpO2 <92% or A-a gradient >30)
- CXR opacities consistent with interstitial pulmonary edema or alveolar filling process
Differential Diagnosis
- Hypothermia
- Immersion pulmonary edema
- Marine toxins, envenomations, and bites
- Scuba diving emergencies
- Submersion injury (drowning and near-drowning)
Diagnosis
- Clinical diagnosis, based on history and physical examination
Management
- Primarily supportive care, including supplemental oxygen[3][5]
- Remove from water
- Remove cold clothes and place into a warm environment
- Albuterol may be used for symptomatic relief
- Typically resolves completely within 24-48 hours
Disposition
- Discharge if asymptomatic or minimal symptoms, normal SpO2
- Otherwise, admit for observation
See Also
References
- ↑ https://clinicaltrials.gov/ct2/show/NCT00815646 (Accessed 08/17/15)
- ↑ 2.0 2.1 2.2 Miller CC 3rd, Calder-Becker K, Modave F. Swimming-induced pulmonary edema in triathletes. Am J Emerg Med. 2010 Oct;28(8):941-6.
- ↑ 3.0 3.1 Yoder JA, Viera AJ. Management of swimming-induced pulmonary edema. Am Fam Physician. 2004 Mar 1;69(5):1046, 1048-9.
- ↑ 4.0 4.1 Ludwig BB, Mahon RT, Schwartzman EL. Cardiopulmonary function after recovery from swimming-induced pulmonary edema. Clin J Sport Med. 2006 Jul;16(4):348-51.
- ↑ Lund KL, Mahon RT, Tanen DA, Bakhda S. Swimming-induced pulmonary edema. Ann Emerg Med. 2003 Feb;41(2):251-6.