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cardiac investigation, not only for possible therapy but also to avoid further SDPE
episodes.
It seems reasonable that unless the cause can be identified, verified and corrected,
divers with SDPE should be advised of the possible risks of continuing with the
activity which provoked it, and should be advised against further diving, snorkeling
or energetic swimming.
Differential Diagnosis
Other diseases that can produce pulmonary oedema and cause diagnostic confusion are the
salt water aspiration syndrome, drowning, respiratory oxygen toxicity, gas contaminations,
cold urticaria, the Irukandji syndrome (jellyfish envenomation) and diving induced asthma.
Pulmonary decompression sickness, pulmonary barotrauma and the so-called ‘deep diving
dyspnoea’ are diving disorders that may cause diagnostic confusion with SDPE. Anxiety
produced hyperventilation may also cause some diagnostic confusion, but this has none of the
other respiratory manifestations.
Immersion Pulmonary Oedema (IPE)
There are three forms of acute pulmonary oedema associated with immersion. It may be
induced by swimming/snorkeling, free diving (“lung squeeze” at end of Chapter 11) or scuba
diving. They have some features in common, but there are significant differences in their
demographics, causation and therapeutic implications.
The swimming induced cases tend to be young and fit, but exposed to excessive exertion.
Most of the swimmers affected were otherwise healthy. In special forces combat swimmers,
extreme exertion was incriminated. It was observed in both cold
and warm waters,
sometimes over 20
0
C. Over-hydration may have contributed to some of these
Explanations for IPE include; increased cardiac output due to physical exertion, pulmonary
vascular blood pooling due to immersion, increase in pulmonary vascular resistance due to
cold exposure, hydrostatic pressure effects and increased perfusion in the dependent lung
with side-stroke swimming.
DIVING MEDICAL ADAGE
If a diving accident occurs and you are not sure of the cause, and do not take precautionary
action, it will re-occur but with more serious consequences