A 36 year old lady is airlifted from the beach having been caught in a rip and taken out to sea. RR 28, SpO2 99% with high flow O2. Initially confused on scene, now alert.
click images to enlarge
Describe and interpret this arrival CXR and repeat after 12 hours
CHEST X-RAY INTERPRETATION
Bilateral predominantly mid-zone airspace shadowing.
Fluid in the horizontal fissure.
Very large gastric bubble.
Multiple monitoring leads including AED pads.
Repeat CXR review:
This CXR was 12 hours after admission.
There is significant improvement in the parenchymal infiltrates, however, they are still prominent.
Fluid remains in the fissure and perhaps the right costophrenic angle.
Pulmonary oedema from inhalation of salt water and resultant hypoxaemia.
With close observation and low flow oxygen she improved without any specific intervention and was discharged 24 hrs after admission!
The fluid in the alveoli is presumably a mix of salt water and interstitial fluid from pulmonary oedema as a result of chemical pneumonitis.
Despite a number of dictionary definitions of drowning suggesting that death is required, the WHO acknowledges that people survive drowning.