I have resigned myself to the fact that I will never be a world-famous blogger. This is not due to a lack of the ability to write (well, ‘document’, perhaps, as true writing implies artistry) nor a dearth of material (the world around us is just full of quirky stuff) but rather my utter laziness. It takes a serious effort and some time out of the day to place posterior on pew and pen to paper… metaphorically speaking. In any case, with that admission out of the way, I have decided that for as long as the gumption lasts I will try to post a very brief blurb on whatever wilderness medicine literature or related information I happen to be reading. Even if it’s just a link or two, this will hopefully be a small contribution to the field, rather than just my meandering musings.
Hence, here is ‘What I’m Reading in Wilderness Medicine Today’: Salt-Water Aspiration Syndrome.
SWAS (I’ve just decided that is the acronym from now on) is reasonably well documented in the literature and should be familiar from any talk or chapter on drowning/near-drowning. You will likely recall that two different clinical pictures emerge dependant on whether a patient has aspirated fresh or salt water; major concern in the former is the loss of surfactant and resultant atelectasis and lung damage, while the latter is characterised by pulmonary oedema, fluid shifts, metabolic acidosis and later hypoxia, depending on the inhaled volumes. The original paper describing the phenomenon is attributed to a Dr Edmonds in 1970 (see Edmonds C, A salt water aspiration syndrome, Mil Med 1970 Sep;135(9):779-850; I have not yet been able to acquire the article).
Why am I suddenly interested in this? Well, yesterday we were geocaching out along the coast. There was a big sea running, and the onshore wind had piled sea foam in great masses along the shore. We suddenly realised that the Labrador had gone missing, and after 15 minutes of running around calling (there were ostriches nearby, and I thought he might be chasing them) we realised that he had possible tried to run ‘over’ the foam and was now ‘submerged’ amongst the rocks… or had gone into the wild sea and was almost certainly already dead.
We both plunged into the foam, wading and feeling with our feet. The foam was discoloured from particulate matter and very salty, and new ‘waves’ threatened to swamp us as the wind brought more from the adjacent sea. You will imagine my relief when I felt a furry body beneath foam which was up to my neck, and the furry body turned out to be a live but very sick dog. He had been trapped under the surface for 20 minutes.
Initial symptoms were bloodshot eyes, coughing, tachypnoeic with a very wet chest with ronchi/rales and hypersecretion. He was still able to ambulate, however, and so we hoofed it to the car and sped off back to Cape Town and the veterinary hospital where we had booked an appointment via telemed vet clinic software. By the time we arrived an hour later the cough had settled but he had developed a harsh wheeze throughout the respiratory cycle. He was admitted on IV fluids and prophylactic antibiotics for monitoring, and 24 hours later is gradually improving.
Mild cases of SWAS (not uncommon in divers) generally resolve with rest within a few days, while more severe cases require positive pressure ventilation (a very good response to CPAP/PEEP has been observed). Expert opinion and the literature I’ve been able to track down concur that there is no role in for corticosteroids.
Resources to have a look at:
- The SWAS info page on Scuba-Doc’s website is very informative, especially for divers
- A case description article regarding a diver with SWAS – Lehman 2008 – SWAS Flight Surgeon
- Another case description from near-drowning who needed ventilation and PEEP – Pace 1975 – PEEP in Salt-water Near Drowning
- Review (albeit old) on the use of steroids in acute lung injury – Robertson 1985 – Corticosteroids in lung injury
This is by no means an exhaustive review, but please drop me feedback if you find it informative and/or useful. I have not yet been able to find a case report of aspiration/pneumonitis from sea foam in either human or canine in the literature yet, so if you are familiar with such a case please let me know.
Last (happier) picture – the dog and I after we found him.