The most common cause of death in nature is drowning. At risk are not only those who cannot swim, but also people who are in a state of altered consciousness, as well as children and cores.
Terminology
According to the latest amendments, drowning is a process that leads to damage to the respiratory tract due to being in a liquid medium. Previously, this definition sounded like death from water (or other fluids) entering the airways and lungs. But it was not accurate enough.
The modern formulation implies that the liquid becomes a barrier to air in the respiratory tract. But this does not mean that a person must die. In any case, this will be considered drowning.
Types of Drowning
There are several types of drowning, depending on the mechanism of the process:
- True (wet), also called aspiration - occurs if the lungs or airways are filled with a large amount of fluid. It usually happens if a person flounders with all his might.
- False (dry), or asphyxial drowning - occurs due to reflex spasm of the glottis. In this case, neither air nor liquid enters the lungs, and a person dies from suffocation.
- Syncopal drowning - occurs in cold water. It causes reflex vasospasm and cardiac arrest. Death in water, in fact, has nothing to do with the liquid that enters the respiratory tract after the victim sinks to the bottom.
- Mixed type - characterized by the presence of signs of several types of drowning at once.
Reasons for drowning
First of all, drowning occurs due to the fact that swimmers neglect the rules of behavior on the water, such as: "do not swim for buoys", "do not swim in ponds with an unknown bottom", "do not swim in a storm." In addition, people who do not know how to swim and suddenly fall into the water at a considerable depth, begin to flounder, quickly spend their strength and air, and thereby accelerate their dive.
Scuba divers and diving enthusiasts often can’t correctly calculate the time and drown, or they begin an attack of decompression sickness when they ascend too quickly. Of particular importance are factors such as the presence of waterfalls and whirlpools, strong currents or muddy bottoms.
Drowning mechanism
Death in water can be divided into two types: freshwater and marine, because the chain of pathological reactions will be different. Fresh water through the wall of the alveoli enters the bloodstream and dilutes it. Therefore, the volume of circulating fluid (BCC) increases rapidly, the load on the heart increases, and all this leads to its stop. In addition, due to fresh water, hemolysis (destruction) of red blood cells occurs. At the same time, the amount of free bilirubin, hemoglobin and potassium increases in the body. The kidneys can not cope with such a load and may fail.
Drowning in salt water, on the contrary, leads to a thickening of the blood, and as a result - increased thrombosis. Most often, cardiac arrest occurs due to coronary artery thrombosis. Syncopal drowning has a reflex mechanism and is not related to the mineral composition of the liquid, but directly depends on its temperature and the conditions under which a person was in the water (for example, a sharp blow when dropped).
Critical periods
With true drowning in water, three clinical periods are distinguished:
- Initial, during which the victim can still hold his breath. If a person is saved at this moment, then he will inadequately react to the situation, his skin and mucous membranes are cyanotic, his breathing is frequent, superficial, noisy. Could be a cough. High blood pressure is replaced by hypotension and bradycardia. There may be a significant amount of water in the stomach, which may cause vomiting. A person, as a rule, quickly recovers after an incident.
- The agonal period is characterized by the fact that the victim is unconscious. He still has a heartbeat and breathing, but muscle activity fades. The skin is cyanotic, cold. At this point, pulmonary edema occurs, and a dense pink foam protrudes from the mouth.
- Clinical death does not seem to differ from the agonal period. The person is motionless, there is no pulse even on large arteries, cardiac arrest is observed. The pupils are dilated, without reaction to light. If you pull a person out of the water at this moment, then cardiopulmonary resuscitation is unlikely to be successful.
Symptoms
While a person is still in the water, the following signs of drowning can be distinguished:
- the characteristic position of the head relative to the body (if the victim is lying on his back, then the head is thrown back, and if on the stomach - the head is completely immersed in water);
- eyes are closed or hidden under the hair;
- convulsive sighs are possible;
- man makes an attempt to roll over.
Aspectic drowning is characterized by alcohol intoxication or head injuries. The pulse is rare, arrhythmic, palpable only on large vessels. The lower respiratory tract is usually clean, or there is a small amount of fluid in them. Death occurs in four to five minutes. Resuscitation is prevented by laryngospasm and tooth compression.
Syncopal drowning is possible even from a small amount of water. In this case, clinical death occurs quickly. The color of the skin during syncopal drowning is very pale, the pupils do not respond to light, and an “ice shock” develops.
Forensic-medical examination
Syncopal drowning leaves behind the characteristic signs that can be seen at the autopsy in the forensic examination bureau. Among others, signs of fast-onset death prevail, such as bright cyanotic spilled
cadaveric spots, liquid blood in the cavities of the heart and great vessels, as well as the absence of pink resistant foam at the mouth.
In addition, with true drowning, fluid is found in the terminal parts of the bronchioles and in the sphenoid bone of the skull, lungs are swollen, ribs are imprinted on them, there are hemorrhages under the pleura. Plankton, which lives in a reservoir, is found not only in the stomach and lungs, but also in other organs, which suggests that it got there with a blood stream.
You can also determine the signs of a corpse being in the water: the skin is pale, wrinkled at the tips of the fingers (the so-called “laundress hands”), and if it stays in the liquid for a long time, it can come off with the nails like gloves. The presence of sand, silt and algae on the clothes and hair of the victim also indicates that the corpse was caught from the water.
The longer the body is in the water, the more difficult it is to determine the cause of death, and if it has any injuries, the marine fauna will quickly get to the corpse and can damage the remains to such an extent that all material evidence will be destroyed.
Emergency algorithm
These rules are the same for all types of assistance to water casualties.
Emergency assistance during drowning is a sequential algorithm of actions that will help you quickly make a decision in a critical situation.
First, you need to make sure that the lifeguard’s life is not in danger. This is important because the benefits of salvation must exceed the potential for harm. The victim is removed from the water. This must be done carefully, as a person may have a fracture of the spine, and therefore, it must be transported from a reservoir on a board or shield.
Secondly, lay the victim so that his stomach rests on the rescuer's knee, but only on condition that no more than three to five minutes have passed from the moment of drowning. If at the time of catching a person from a reservoir he was already unconscious for a long time, then it is necessary to immediately begin cardiopulmonary resuscitation. Clean your mouth for better airflow. At this point, be sure to call the ambulance team.
With the third step, emergency care for drowning begins - you need to check the pupils, pulse, breathing. Then, making sure that all of the above symptoms are absent, it is necessary to start CPR techniques. Continue pumping your heart and breathing in air until an emergency team arrives. If spontaneous breathing does not appear, this can save the victim's life.
Help with drowning after restoring breathing, palpitations and consciousness consists in warming a person and monitoring vital signs. Unfortunately, before the doctors arrived, nothing substantial can be done.
Treatment
Properly provided emergency care during drowning can help doctors stabilize the condition of the victim in the future. If spontaneous breathing has not recovered, then the patient is transferred to mechanical ventilation, sanitize the trachea and bronchi. Drug therapy necessarily includes the prevention of pulmonary edema and acute cardiovascular failure. If drowning was in fresh water, then diuretics and blood components are prescribed, and when drowning in a salt reservoir, saline and glucose are prescribed. Be sure to carry out the correction of the acid-base state. After urgent measures, as a rule, a short course of antibiotics is prescribed to prevent infection.