Pulmonary oedema with SIPE is caused by a combination of increased bloodflow into the lungs due to immersion, combined with increased pressure in the pulmonary arteries and veins (because of exercise), which causes a leak of fluid out of the bloodstream and into the lung tissue. The alveoli become filled with water, making it difficult to breathe. This can occur in fit, healthy individuals whilst swimming, and can also occur shortly after finishing a swim. The patient does not have to have swallowed lots of, or any water for this to occur.

Initially, the swimmer may feel a shortness of breath that is over and above their perceived exertion levels. This often brings on a feeling of unease. In other words, although you may be swimming slowly, you would feel as though you were sprinting.


  • Sudden onset whilst swimming
  • Immediately after finishing a swim

Initial Signs and Symptoms:

  • Shortness of breath (more than is usual for the patient during a swim)
  • Persistent cough
  • A feeling of unease

Later Symptoms:

  • Taste of blood
  • Haemoptysis or bloody phlegm
  • Feeling of heaviness in limbs
  • Utter exhaustion (above and beyond that of doing a long distance swim)
  • Potential chest tightness (not to be confused with an MI. Important to get a clear history of the preceding symptoms)
  • Potential respiratory rale/crackles and/or wheeze (not to be confused with asthma, unless patient is asthmatic)
  • A sense of restriction to their breathing and irritability of wearing a tight race suit
  • Reduced saturations
  • Tachycardia
  • Lower than normal oxygen saturation reading (<95%)


  • Immediate removal from the water
  • Removal of restrictive race suits
  • Dry patient and wrap up to start the warming process
  • Sit upright or semi-recumbent (the patient may want to lie down due to exhaustion. Do not let them.)
  • Oxygen therapy as per Medication Guideline – Medical Oxygen
  • Treat audible wheeze as necessary per Medication Guideline – Salbutamol
  • Transport to hospital with a level of urgency

Most patients who are correctly diagnosed and treated with SIPE make a full recovery within 48 hours.


Page contributors:

Rachel Born, AP22374
Clinical Support Paramedic, Clinical Services

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