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 environment. Previously, this definition sounded like death from the ingress of water (or other liquids) into the respiratory tract and lungs. But it was not accurate enough.
The modern wording implies that the liquid becomes a barrier to air entering the respiratory tract. But this does not mean that a person must die. In any case, it 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. Usually happens if a person is floundering with all his might.
- False (dry), or asphyxic drowning - happens due to reflex spasm of the glottis. In this case, neitherno air or liquid enters the lungs, and the person suffocates to death.
- Syncope drowning - occurs in cold water. It causes reflex vasospasm and cardiac arrest. Death in the water, in fact, has nothing to do with the liquid that enters the respiratory tract after the victim has sunk to the bottom.
- Mixed type - characterized by the presence of signs of several types of drowning at once.
Causes of 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 behind the buoys”, “do not swim in reservoirs 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 immersion.
Scuba divers and divers often fail to time correctly and drown, or suffer from decompression sickness attacks when ascending too quickly. Of particular importance are factors such as the presence of waterfalls and whirlpools, a strong current or a muddy bottom.
Drowning mechanism
Death in water can be conditionally 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. Consequently, the volume of circulating fluid (BCC) increases rapidly, the load on the heart increases, and all this leads to its stop. ExceptIn addition, because of 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 cannot cope with such a load and may fail.
Drowning in s alt water, on the contrary, leads to thickening of the blood, and as a result - increased thrombosis. Most often, cardiac arrest occurs due to thrombosis of the coronary arteries. 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 the person was in the water (for example, a sharp blow when falling).
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 react inadequately to the situation, his skin and mucous membranes are cyanotic, breathing is frequent, superficial, noisy. There may be a cough. Increased pressure is replaced by hypotension and bradycardia. There may be a significant amount of water in the stomach, which can cause vomiting. A person usually recovers quickly after an accident.
- Agonal period is characterized by the fact that the victim is unconscious. He still has a heartbeat and breathing, but muscle activity is fading. The skin is cyanotic, cold. At this point, pulmonary edema sets in, and dense pink foam comes out of the mouth.
- Clinical death does not outwardly differ from the agonal period. The person is motionless, there is no pulse even on largearteries, cardiac arrest occurs. The pupils are dilated, without reaction to light. If you pull the person out of the water at this point, cardiopulmonary resuscitation is unlikely to be successful.
Symptoms
While a person is still in the water, the following signs of drowning can be recognized:
- characteristic position of the head relative to the body (if the victim lies on his back, then the head is thrown back, and if on the stomach, the head is completely immersed in water);
- eyes closed or hidden under hair;
- possible convulsive sighs;
- man tries to roll over.
Asfective drowning is characterized by alcohol intoxication or head trauma. The pulse is rare, arrhythmic, palpable only on large vessels. The lower airways are usually clear or contain a small amount of fluid. Death occurs in four or five minutes. Resuscitation is hindered by laryngospasm and clenching of the teeth.
Syncope drowning is possible even from a small amount of water. In this case, clinical death occurs quickly. The color of the skin with syncopal drowning is very pale, the pupils do not react to light, "ice shock" develops.
Forensics
Syncope drowning leaves behind characteristic signs that can be seen at autopsy at the medical examiner's office. Among others, signs of a rapidly onset death prevail, such as bright cyanoticspilled cadaveric spots, liquid blood in the cavities of the heart and great vessels, as well as the absence of pink persistent foam at the mouth.
In addition, with true drowning, fluid is found in the terminal sections of the bronchioles and in the sphenoid bone of the skull, the lungs are swollen, ribs are imprinted on them, there are hemorrhages under the pleura. Plankton living in a pond is found not only in the stomach and lungs, but also in other organs, which indicates that it got there with the bloodstream.
You can also determine the signs of a corpse in the water: the skin is pale, wrinkled at the fingertips (the so-called "washerwoman's hands"), and with a long stay in the liquid, it can peel off along 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 fished out of 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 life will quickly get to the corpse and can damage the remains to such an extent that all physical evidence will be destroyed.
Emergency Algorithm
These rules are the same for all types of assistance to victims on the water. Drowning Emergency is a step-by-step algorithm that will help you make a quick decision in a critical situation.
First, you need to make sure that the life of the rescuer is not in danger. This is important because the benefit of salvation must outweigh the potential harm. The victim is removed from the water. It's necessarydo it carefully, as the person may have a fractured spine and therefore need to be transported from the body of water on a plank or shield.
Secondly, lay the victim in such a way that his stomach rests on the knee of the rescuer, but only on condition that no more than three to five minutes have passed from the moment of drowning. If by the time a person is caught from a reservoir, he has long been unconscious, then it is necessary to immediately begin cardiopulmonary resuscitation. Clean your mouth for better airflow. At this stage, be sure to call an ambulance.
From the third step, emergency assistance for drowning begins - you need to check the pupils, pulse, breathing. Then, after making sure that all of the above signs are absent, it is necessary to start CPR. Continue pumping your heart and inhaling air until the ambulance team arrives. If spontaneous breathing does not occur, it could save the victim's life.
Assistance for drowning after the restoration of breathing, heartbeat and consciousness consists in warming the person and controlling vital signs. Until the arrival of doctors for the victim, unfortunately, nothing significant can be done.
Treatment
Properly rendered emergency aid for drowning can help doctors stabilize the condition of the victim in the future. If spontaneous breathing is not restored, then the patient is transferred to artificial ventilation of the lungs, the trachea and bronchi are sanitized. Drug therapy must includeprevention 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 s alt pond, saline and glucose are prescribed. Be sure to correct the acid-base state. After emergency care, a short course of antibiotics is usually given to prevent infection.
