title: Submersion and early-onset acute respiratory distress syndrome: a case report.
abstract: Drowning is a common cause of accidental death, particularly in younger people, and acute respiratory failure is common in these patients. This case report describes a healthy 18-year-old man who suffered a cardiorespiratory arrest due to submersion while swimming in a freshwater lake. First-responder cardiopulmonary resuscitation and defibrillation using an automated external defibrillator resulted in a return of spontaneous circulation. The patient was evacuated to a tertiary care center by a rotor-wing air medical crew. The crew experienced difficulties in oxygenating and ventilating the patient because of early-onset acute respiratory distress syndrome (ARDS). This case report describes the pathophysiology and prehospital management of a patient with suspected early-onset ARDS secondary to drowning. This case report is unique because it describes the oxygenation and ventilation difficulties encountered in managing this patient in the transport setting, and possible strategies to deal with these difficulties. Finally, this case report highlights the prehospital bypass decision-making process for patients requiring specialized medical care.
authors.affiliation: Academy of TransportMedicine and the Research, Ornge Transport Medicine, Toronto, Ontario, Canada.
authors.forename: Wayde
authors.initials: W
authors.lastname: Diamond
authors.forename: Russell D
authors.initials: RD
authors.lastname: MacDonald
mesh_terms: D000293:Adolescent; D017732:Air Ambulances; D002315:Cardiopulmonary Bypass; D047548:Defibrillators; D017809:Fatal Outcome; D006801:Humans; D007101:Immersion / Q000009:adverse effects*; D008297:Male; D015701:Near Drowning / Q000150:complications*; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D013550:Swimming; D013997:Time Factors