A 25-year-old male presents to the ED after he was found completely submerged in a lake for 2 minutes. He arrives to the Emergency Department awake, alert, and oriented. Vital signs are T 36.5, BP: 140/80, HR 102, RR 35, SpO2 of 91% on a non-rebreather mask. Patient is noted to have increased work of breathing using accessory muscles and only speaking in 1-2 word sentences. Lung exam reveals diffuse rales. Which of the following if the most appropriate treatment? 

A. Intravenous antibiotics

B. Oxygen by positive pressure ventilation 

C. Intravenous fluids

D. Intravenous corticosteroids

E. Intravenous Lasix

B. Oxygen by positive pressure ventilation is the most appropriate treatment. The decision to intubate a submersion victim is based on clinical impression: O2 <90% or PaO2 <50 on high flow or PaCO2 >50 or altered mental status to maintain positive pressure ventilation 

For more information on drowning, please refer to our old post: http://emdaily.cooperhealth.org/content/emconf-drowning