Chest Pain Following Water Park Incident with Brief Submersion

Case at a Glance

A 38-year-old female presents with left-sided chest pain and mild dyspnea approximately 18 hours after a brief submersion incident at a water park. Patient has concerns about possible water aspiration and secondary drowning.

Patient's Story

The patient experienced an accident while using a water slide at a recreational facility. Her flotation device overturned upon reaching the pool, causing her to become submerged for an estimated 15-30 seconds. She reports initial panic and uncertainty about whether she held her breath or potentially inhaled water. Upon surfacing, she experienced immediate coughing and burning sensations in her throat and nasal passages, attributed to chlorine exposure. The following morning, she developed left-sided chest discomfort and mild shortness of breath, prompting concern about delayed complications from possible water aspiration.

Initial Assessment

38-year-old obese female (BMI 44) with history of hypertension, anxiety, and depression presenting with post-incident respiratory symptoms. Current medications include antihypertensive therapy (losartan-hydrochlorothiazide), antidepressants (trintellix, mirtazapine), anticholinergic (oxybutynin), and antihistamine (Allegra). Patient appears anxious about potential complications but is hemodynamically stable.

The Diagnostic Journey

Patient presents with constellation of symptoms following water submersion incident, requiring evaluation for possible aspiration pneumonitis versus anxiety-related symptoms. Key considerations include distinguishing between actual pulmonary complications and anxiety-driven symptom perception, given patient's psychiatric history and recent traumatic experience.

Final Diagnosis

Post-submersion anxiety with probable minor chlorine irritation. No evidence of significant water aspiration or secondary drowning syndrome based on clinical presentation and timeline.

Treatment Plan

Reassurance and patient education regarding secondary drowning timeline and symptoms. Monitoring for progression of respiratory symptoms. Anxiety management with existing psychiatric medications. Instructions for immediate medical evaluation if symptoms worsen, including increased dyspnea, persistent cough, fever, or chest pain progression.

Outcome and Follow-up

Patient advised that symptoms are likely related to anxiety and minor chemical irritation rather than significant pulmonary complications. Given the brief duration of submersion and ability to cough immediately upon surfacing, risk of serious aspiration is low. Recommended follow-up with primary care provider for ongoing anxiety management and routine care of comorbid conditions.