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.
Onset:
- 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%)
Treatment:
- 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
Clinical Resources Website
St John Ambulance Western Australia Ltd (ABN 55 028 468 715) (St John WA) operates ambulance and other pre-hospital clinical services. St John WA’s Clinical Resources, including its Clinical Practice Guidelines (Clinical Resources), are intended for use by credentialed St John WA staff and volunteers when providing clinical care to patients for or on behalf of St John WA, within the St John WA Clinical Governance Framework, and only to the extent of the clinician’s authority to practice.
Other users – Terms of Use
The content of the St John WA Clinical Resources is provided for information purposes only and is not intended to serve as health, medical or treatment advice. Any user of this website agrees to be bound by these Terms of Use in their use of the Clinical Resources.
St John WA does not represent or warrant (whether express, implied, statutory, or otherwise) that the content of the Clinical Resources is accurate, reliable, up-to-date, complete or that the information contained is suitable for your needs or for any particular purpose. You are responsible for assessing whether the information is accurate, reliable, up-to-date, authentic, relevant, or complete and where appropriate, seek independent professional advice.
St John WA expressly prohibits use of these Clinical Resources to guide clinical care of patients by organisations external to St John WA, except where these organisations have been directly engaged by St John WA to provide services. Any use of the Clinical Resources, with St John WA approval, must attribute St John WA as the creator of the Clinical Resources and include the copyright notice and (where reasonably practicable) provide a URL/hyperlink to the St John WA Clinical Resources website.
No permission or licence is granted to reproduce, make commercial use of, adapt, modify or create derivative works from these Clinical Resources. For permissions beyond the scope of these Terms of Use, including a commercial licence, please contact medservices@stjohnambulance.com.au
Where links are provided to resources on external websites, St John WA:
- Gives no assurances about the quality, accuracy or relevance of material on any linked site;
- Accepts no legal responsibility regarding the accuracy and reliability of external material; and
- Does not endorse any material, associated organisation, product or service on other sites.
Your use of any external website is governed by the terms of that website, including any authorisation, requirement or licence for use of the material on that website.
To the maximum extent permitted by law, St John WA excludes liability (including liability in negligence) for any direct, special, indirect, incidental, consequential, punitive, exemplary or other loss, cost, damage or expense arising out of, or in connection with, use or reliance on the Clinical Resources (including without limitation any interference with or damage to a user’s computer, device, software or data occurring in connection with such use).
Cookies
Please read this cookie policy carefully before using Clinical Resources from St John WA.
The cookies used on this site are small and completely anonymous pieces of information and are stored on your computer or mobile device. The data that the cookies contain identify your user preferences (such as your preferred text size, scope / skill level preference and Colour Assist mode, among other user settings) so that they can be recalled the next time that you visit a page within Clinical Resources. These cookies are necessary to offer you the best and most efficient possible experience when accessing and navigating through our website and using its features. These cookies do not collect or send analytical information back to St John WA.
Clinical Resources does integrate with Google Analytics and any cookies associated with this service enable us (and third-party services) to collect aggregated data for statistical purposes on how our visitors use this website. These cookies do not contain personal information such as names and email addresses and are used to help us improve your user experience of the website.
If you want to restrict or block the cookies that are set by our website, you can do so through your browser setting. Alternatively, you can visit www.internetcookies.com, which contains comprehensive information on how to do this on a wide variety of browsers and devices. You will find general information about cookies and details on how to delete cookies from your device. If you have any questions about this policy or our use of cookies, please contact us.