A 28-year-old female is brought to the emergency department after a near-drowning incident at the beach. She is alert but experiencing respiratory distress with bilateral crackles on auscultation. Her oxygen saturation is 88% on room air. Which of the following is the most likely diagnosis?
Noncardiac pulmonary edema
Pneumonia
Cardiogenic pulmonary edema
Pneumothorax
The correct answer is noncardiac pulmonary edema. In near-drowning incidents, aspiration of water can lead to acute lung injury and subsequent noncardiac pulmonary edema. This condition is characterized by fluid accumulation in the lungs due to increased capillary permeability, rather than from cardiac dysfunction. The bilateral crackles and low oxygen saturation support this diagnosis.
Cardiogenic pulmonary edema is less likely in this scenario, given the patient's young age and the absence of cardiac history. Pneumonia typically develops over a longer period and would not present immediately after a near-drowning event. While pneumothorax can occur in diving accidents, it typically presents with unilateral decreased breath sounds rather than bilateral crackles.
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