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1-6,25 Water in lungs washes out surfactant causing atelectasis (alveolar collapse), diminished gas transfer, ventilation perfusion mismatch, and hypoxia Non-cardiac pulmonary edema, may cause acute respiratory distress syndrome (ARDS) immediately or be delayed (even after normal CXR) necessitating observation for 4-6 hours Initially due to external water insult, then worsened by microvascular damage activating inflammatory cascade, which results in extravasation of fluid into alveoli worsening ventilation / perfusion (V/Q) mismatch Shunting –hypoxic pulmonary vasoconstriction increases pulmonary hypertension driving fluid into alveoli Hypercapnia – increased levels of carbon dioxide in the blood resulting in acidosis most often due to breath holding or apnea Contaminated water (petroleum, sewage, organic, mud, sand, etc.) – may increase lung injury and require bronchoalveolar lavage to cleanse