A 24-year-old man presents to the hospital after a near drowning. He has a history of a seizure disorder and experienced a seizure while swimming in his pool. He is currently alert but having difficulty breathing. His temperature is 37.3°C, blood pressure is 110/72 mmHg, heart rate is 134 beats per minute, and respiratory rate is 32 breaths per minute. He has no jugular venous distention, and other than being tachypneic, he has a normal physical examination. An arterial blood gas shows a PaO2 of 85 mmHg on supplemental oxygen with a face mask set to a fraction of inspired oxygen of 50%. A chest x-ray is ordered and shows bilateral infiltrates.
Which of the following is the correct diagnosis?
A. Heart failureAcute respiratory distress syndrome (ARDS). This patient meets criteria for ARDS: he has bilateral infiltrates on chest x-ray, a PaO2/FiO2 ratio <200, and pulmonary edema that cannot be explained by heart failure (neck veins not distended). (A) Whereas ARDS is a potential complication of near drowning, heart failure is not; in addition, the lack of jugular venous distention argues against heart failure. (B) This patient is tachypneic with positive chest x-ray findings; therefore, his hypoxemia is not from hypoventilation. (D) Aspiration pneumonitis and pneumonia can lead to ARDS; however, this patient currently meets the definition of ARDS, making this the better answer.