Home Removal 3 types of drowning. Providing first aid to a drowning person

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3 types of drowning. Providing first aid to a drowning person

C23.550.260.393 C23.550.260.393

Drowning mechanism

When drowning in fresh water blood thinning occurs. This is explained by the flow of water from the lungs into the bloodstream. Occurs due to the difference in osmotic pressure of fresh water and blood plasma. Due to blood thinning and sharp increase the volume of blood in the body causes cardiac arrest (the heart is not able to pump such a huge volume). Another consequence of blood thinning that can cause complications and death- hemolysis, occurring due to the difference in osmotic pressure of blood plasma and cytoplasm of erythrocytes, their swelling and rupture. As a result, anemia, hyperkalemia develops, and a large amount of cell membranes, cellular contents and hemoglobin enters the bloodstream at a time, which, when excreted through the kidneys, can lead to acute renal failure.

When drowning in salt water, the exact opposite process occurs - blood thickening (hemoconcentration).

Typically, the mechanism of drowning is as follows: a person who cannot swim, caught in the water, takes deep breaths while fighting for his life. As a result, a certain amount of water enters the lungs and loss of consciousness. Since the human body is completely immersed in water and continues breathing movements, then the lungs are gradually completely filled with water. At this time, body muscle spasms may occur. After some time, cardiac arrest occurs. A few minutes after this, irreversible changes begin in the cerebral cortex. When actively fighting for its life, the body requires more oxygen, i.e. hypoxia intensifies and death occurs in a shorter time.

When drowning in cold water, especially in children with low body weight and high regenerative capacity of the body, complete or partial restoration brain functions after 20-30 minutes after drowning.

Causes of drowning

Drowning occurs by various reasons. Often people drown, neglecting basic precautions (do not swim beyond the buoys, do not swim while drunk, do not swim in questionable bodies of water, do not swim in a storm). In drowning, the fear factor plays a big role.

Thus, often those who cannot swim, who accidentally find themselves in water at great depths, begin to row chaotically with their arms and legs, shouting “Help me, I’m drowning!” Thus, they release air from their lungs and inevitably plunge into water.

Drowning can also occur among scuba diving enthusiasts. Sometimes this is even more dangerous than simple drowning, especially if you dive alone. Drowning of scuba divers is often accompanied by the so-called “caisson disease.”

Forensic-medical examination

Forensic medical diagnosis of drowning, as well as other causes of death, is made on the basis of establishing a set of signs detected both during a sectional study and with the help of additional methods research and depending on the type of drowning. The true (“pale”, “wet”) type of drowning is characterized by the presence of persistent whitish finely bubbled foam at the openings of the mouth and nose, acute swelling of the lungs, hemorrhages under the pulmonary pleura, detection of fluid from the drowning environment in the sinus of the sphenoid bone, diatom plankton in internal organs And bone marrow and some other signs.

In the pathogenesis of asphyxial (“blue”, “dry”) type of drowning, the leading link is acute disorder external respiration, in connection with which, when examining a corpse, diffuse, rich cadaveric spots of a bluish-violet color are noted, cyanosis and puffiness of the face and neck, hemorrhages in the conjunctiva, pronounced swelling of the lungs with a significant increase in their volume and airiness.

The reflex type of drowning is characterized by signs of quickly occurring death, the most pronounced of which are diffuse, saturated cadaveric spots of a bluish-violet color, a liquid state of blood in the cavities of the heart and large vessels in the absence of signs of other types of drowning.

In addition to signs that directly or indirectly indicate drowning, there are signs of a corpse being in water: pallor of the skin, the so-called. “goose bumps”, wrinkling of the skin of the scrotum and nipple area, maceration of the skin (the time and extent of which depend on many factors - water temperature, age of the victim, etc.). The final signs of maceration are the spontaneous separation of the epidermis of the hands along with the nails (the so-called “gloves of death”). This may make it difficult to identify the corpse. On the feet, the skin peels off only on the plantar surfaces. In the process of putrefactive changes in the corpse, hair separation occurs. Under the influence of water, hair loses contact with the skin. Wet items of clothing, skin and the hair of the corpse, the presence of sand, silt, and algae on it also indicate that the corpse was in water.

Often death in water occurs not from drowning, but from various diseases(sudden death in water), injuries, etc. The corpse or its parts may be thrown into the water in order to conceal the murder. Establishing the true cause of death, especially when the body remains in water for a long time, is very difficult, and in some cases impossible. It should be noted that the forensic expert establishes, in particular, the cause of death (for example, mechanical asphyxia as a result of closure respiratory tract water in case of drowning). Establishing the type of violent death (murder, suicide, accident) is not within the competence of a forensic expert; This issue is being resolved by law enforcement officials, taking into account, among other things, forensic medical examination data.

Rescue of drowning people

You can save a drowning person in the first 3-6 minutes from the start of drowning. However, when drowning in very cold water, in some cases this period reaches 20-30 minutes.

In the practice of forensic medicine, cases have been recorded when a drowned person was successfully resuscitated after 20-30 minutes in water, while the water could be relatively warm, both fresh and salty, and the lungs were filled with water.

It is advisable to swim up to a drowning person from behind. After this, you need to turn him over on his back so that his face is on the surface of the water and quickly transport him to the shore. It should be remembered that a drowning person has developed the so-called “instinct of self-preservation” and he can cling to his rescuer and pull him to the bottom. If this happens, then under no circumstances should you panic. You need to take a deep breath and dive into the depths. A drowning person will lose support and unclench his hands.

First aid involves removing the victim from the water. Then it is necessary to determine the pulse and type of drowning. Wet drowning is characterized by a bluish appearance of the face and skin.

In case of wet drowning, it is necessary to remove water from the victim’s respiratory tract. To do this, they place him on a bent knee and pat him on the back. Then, if there is no pulse, they immediately begin chest compressions and artificial respiration.

In the case of dry or syncope drowning, resuscitation measures must be started immediately.

If a person was able to be pulled out of the water very quickly and did not lose consciousness, then it is still necessary to call an ambulance, since even in this case there is a risk of complications.

Attention! Every victim must be shown to a doctor, even if they feel excellent after resuscitation! There is a danger of pulmonary edema and other serious consequences (for example, repeated cardiac arrest). Only in one week will it be possible to say with confidence that his life is out of danger!

The proverb “Saving drowning people is the work of the drowning people themselves” is not without meaning. In a critical situation, the most important thing is not to get confused. If you get into the water, you need to soberly assess the situation, calm down and swim to the shore. If after a while you become very tired, relax, lie on your back and breathe calmly. If you get into a whirlpool, you need to dive and at depth try to swim to the side (the speed of the current at depth is always lower). If you can see that a large wave is coming towards you, it is highly advisable to dive to avoid being hit.

Notes

Signs revealed during external examination of the corpse:

1. Persistent fine bubble foam around the openings of the nose and mouth (Kruszewski's sign) in the form of lumps resembling cotton wool (“foam cap”), is the most valuable diagnostic sign of drowning. At first, the foam is snow-white, then it takes on a pinkish tint due to the admixture of blood liquid. Foam is formed during drowning due to the mixing of mucus with water and air. It consists of a framework in the form of mucus, exfoliated epithelial cells and its own foam covering the frame. When the foam dries, traces of it remain around the openings of the nose and mouth. If there is no foam on the corpse removed from the water, then it is recommended to apply pressure on chest, after which it may appear. Usually the foam disappears after 2-3 days, and only sanguineous fluid is released from the openings of the nose and mouth of the corpse due to the development of the processes of imbibition and hemolysis.

2. Due to the increase in lung volume (with the development of hyperhydroaeria), the circumference of the chest increases, as well as the supra- and subclavian fossae and the reliefs of the clavicles are smoothed.

3. Color and expression cadaveric spots may vary depending on the type of drowning. Thus, Bystrov S.S. (1974) with the “true” type of drowning found the cadaveric spots paler, blue-purple in color with a pinkish or reddish tint, and with the asphyxial type they were abundant, dark blue, dark purple in color. Due to the loosening of the epidermis, oxygen penetrates into the blood superficial vessels skin, which leads to the formation of oxyhemoglobin (from reduced hemoglobin), so cadaveric spots quickly take on a pinkish color. When the corpse is partially immersed in water at the level of the boundary line, a bright red stripe with a bluish tint is observed, gradually turning into the color of the upper and lower areas of the corpse spots. Sometimes, during drowning, cadaveric spots appear evenly over the entire surface of the corpse (and not just in the underlying sections as usual) due to the movement (turning over) of corpses by the flow of water.

4. The color of the skin of the face, neck and upper chest also changes depending on the type of drowning (S.S. Bystraya). With the “true” type, the skin of the named areas is pale blue or pinkish-blue in color, and with the asphyxial type, it is blue or dark blue.

5. Hemorrhages in the conjunctiva and sclera can be detected, as well as gelatinous swollen folds of the conjunctiva due to their edema.

6. Puffiness of the face is sometimes noted.

7. It is less common to see traces of defecation. Certain external signs: the nature and color of cadaveric spots, coloring of the skin of the face, neck, upper chest, hemorrhages (in the conjunctiva and sclera, puffiness of the face and traces of defecation - are not signs characteristic only of drowning, they are equally found in other types of mechanical asphyxia.

Signs revealed during internal examination (autopsy) of a corpse

1. In the lumen of the trachea and bronchi, fine-bubble persistent foam is found, which in the “true” type of drowning has a pinkish color, sometimes mixed with blood and water; priasphyktic type - this foam appears white (S. S., Bystrov).

2. When opening the chest cavity, one notices the sharply increased volume of the lungs. They fully comply pleural cavities . Their anterior sections cover the cardiac shirt. Their edges are rounded, the surface has a variegated “marble” appearance: light gray areas alternate with light pink ones. Stripe-like imprints of ribs may be visible on the surfaces of the lungs. When discharged from the chest cavity, the lungs do not collapse. Lungs don't always look the same. In some cases (with the asphyxial type of drowning) we are dealing with the so-called “dry swelling of the lungs” (hyperaeria) - this is a condition of the lungs when they are sharply swollen, but on the cut they are dry or a small amount of liquid flows from the surfaces. Hyperaeria depends on the penetration of air into the tissue under the pressure of liquid. There is a strong degree of swelling of the alveoli. This is accompanied by stretching and rupture of the alveolar walls and elastic fibers, often expansion of the lumens of the small bronchi and, in some cases, the entry of air into the interstitial tissue. There are a small number of areas of tissue edema. The surface of the lungs is uneven and mottled. The fabric feels spongy to the touch. It is dominated by small limited hemorrhages. The weight of the lungs is not increased compared to the norm. In other cases (with the “true” type of drowning), “wet swelling of the lungs” (hyperhydria) occurs - this is the name of the condition of the lungs of a drowned person, when a large amount of watery liquid flows from the surface of the cuts, the lungs are heavier than usual, but are airy everywhere. There is an average degree of swelling of the alveoli, the presence of a large number of foci of edema and large diffuse hemorrhages. The surface of the lungs is smoother, the tissue is less variegated, and has a doughy consistency to the touch. The weight of the lungs exceeds normal by 400 - 800 g. Hyperhydria is less common than hyperairia; It is believed that it occurs when a person falls under water after a deep exhalation. Depending on the state of the foci of bloating and edema, a third form of acute pulmonary bloating is distinguished - intermediate, which is also characterized by an increase in lung volume. When palpating, there is a feeling of crepitation in some places, and in some places the consistency of the lungs is doughy. Foci of swelling and edema alternate more evenly. The weight of the lungs increased slightly, by 200-400g. Microscopic examination of the lungs during drowning should look for areas of acute swelling and areas of edema. Acute bloating is recognized by a sharp expansion of the lumen of the alveoli; the interalveolar septa are torn, and “spurs” protrude into the lumen of the alveoli. Foci of edema are determined by the presence in the lumen of the alveoli and small bronchi of a homogeneous pale pink mass, sometimes with an admixture of a certain amount of red blood cells. Next, when studying the lungs, you need to pay attention to the blood filling of the vessels. When drowning, it is expressed unevenly. According to the air areas, the capillaries of the interalveolar septa are collapsed, the tissue appears anemic, in areas of edema, on the contrary, the capillaries are dilated and full of blood. Microscopic picture lung tissue in case of drowning, it is supplemented by the presence of foci of atelectasis and the presence of hemorrhages in the interstitial tissue; the latter are limited and diffuse. In addition, plankton elements and mineral particles, particles of plant fiber, etc. can be found in the small bronchi and alveoli.

3. Rasskazov-Lukomsky-Paltauf spots in case of drowning - important diagnostic sign- are large vague hemorrhages in the form of spots or stripes under the pleura of the lungs, having a pale pink, pale red color. However, this sign is not constant.

4. The presence of fluid in the stomach in which drowning occurred (Fegerlund’s sign); with the asphyxial type there is a lot of fluid, with the “true” type there is little. Water may also be present in the initial part of the intestine. Has a certain diagnostic value the presence of an admixture of silt, sand, algae, etc. in the gastric contents. During lifetime ingestion, up to 500 ml of liquid can be found in the stomach. Possibility of post-mortem penetration of fluid into the gastrointestinal tract intestinal tract most authors reject it (S. S. Bystrov, 1975; S. I. Didkovskaya, 1970, etc.).

5. In the sinus of the main bone, liquid (5.0 ml or more) is found, in which drowning occurred (V. A. Sveshnikov, 1961). When laryngospasm occurs (asphyxial type of drowning), the pressure in the nasopharynx cavity decreases, this leads to the entry of the drowning medium (water) into the sinus of the main bone through the pyriform slits. In the left half of the heart, blood is diluted with water and has a cherry-red color (I. L. Kasper, 1873). Hemorrhages in the muscles of the neck, chest and back (hemorrhages in the sternocleidomastoid muscle, Paltauf; hemorrhages in the muscles of the neck and back - Reuters, Wachholz) as a result of severe tension in the muscles of a drowning person while trying to escape.

6. Edema of the liver, bed and wall of the gallbladder and hepatoduodenal fold F. I. Shkaravsky, 1951; A.V. Rusakov, 1949). On microscopic examination, liver edema is expressed by expansion of the pericapillary spaces and the presence of protein masses in them. Swelling may be uneven. In those places where it is significant, intralobular capillaries and central veins are full-blooded. In the crevices and lymphatic vessels of the interlobular connective tissue swelling reveals a homogeneous pale pink mass. Edema of the gallbladder is often diagnosed macroscopically. In some cases, it is found during microscopic examination - in this case, a characteristic state of the connective tissue of the bladder wall is revealed in the form of moving apart, loosening of collagen fibers, and the presence of pink liquid between them.

Signs detected in laboratory tests

These include signs associated with intravital penetration of the drowning environment (water) into the body and changes in the blood and internal organs caused by this environment (water):

Detection of diatom plankton and pseudoplankton in the blood, internal organs (except lungs) and bone marrow.
Positive “oil test” by S. S. Bystrov - identifying traces of technical fluids (petroleum products).
Identification of quartz-containing mineral particles (B. S. Kasatkin, I. K. Klepche).
Difference between blood freezing points in the left and right heart (cryoscopy).
Establishing the fact and degree of blood dilution in arterial system and in the left heart (electrical conductivity study and refractometry).

Signs characteristic of drowning:

fine-bubble persistent foam at the openings of the mouth and nose (Krushevsky’s sign);
increase in chest circumference;
smoothing of the supra- and subclavian fossae;
the presence of pinkish persistent fine bubble foam in the lumen of the trachea and bronchi;
“wet swelling of the lungs” (hyperhydria) with rib marks;
fluid in the stomach and upper small intestine mixed with silt, sand, algae (Fegerlund's sign);
in the left half of the heart, blood diluted with water is cherry-red in color (I. L. Kasper);
Rasskazov-Lukomsoky-Paltauf spots;
fluid in the sinus of the main bone (V. A. Sveshnikov);
swelling of the bed and wall of the gallbladder and hepatoduodenal fold (A. V. Rusakov and P. I. Shkaravsky);
hemorrhages in the muscles of the neck, chest and back as a result of severe muscle tension (Paltauf, Reiter, Wahgolp);
the visceral pleura is somewhat cloudy;
air embolism of the left heart (V.A. Sveshnikov, Yu.S. Isaev);
lymphohemia (V.A. Sveshnikov, Yu.S. Isaev);
liver swelling;
compression fracture of the cervical spine;
ruptures of the gastric mucosa;
detection of diatom plankton and pseudoplankton in the blood, internal organs (except lungs) and bone marrow;
identification of traces of technical fluids - a positive “oil test” (S. S. Bystrov);
identification of quartz-containing mineral particles (B. S. Kasatkin, I. K. Klepche);
difference in blood freezing points in the left and right heart (cryoscopy);
statement of the fact and degree of blood dilution in the arterial system, left heart (refractometry, electrical conductivity study).

Signs characteristic of a corpse being in water:

"goose pimples";
pale skin;
nipples and scrotum wrinkled;
hair loss;
maceration of the skin (wrinkling, pallor, “washerwoman’s hand”, “gloves of death”);
rapid cooling of the corpse;
signs of rotting;
presence of signs of fat wax;
presence of signs of peat tanning;
detection of traces of technical fluids (oil, fuel oil) on the clothing and skin of a corpse.

Common (“similar”) signs - general asphyxia and drowning:

hemorrhage in the conjunctiva and white membrane of the eyes;
cadaveric spots of dark blue or blue-purple color with a violet tint;
the skin of the face, neck, upper chest is pale blue or dark blue in color with a pinkish tint;
puffiness of the face;
traces of defecation; “dry swelling of the lungs” (hyperaeria), subpleural ecchymosis (Tardier spots);
liquid blood in the vessels and heart;
overflow of blood in the right half of the heart;
plethora of internal organs;
congestion of the brain and its membranes;
anemia of the spleen;
emptying the bladder.

General (“similar”) signs of a corpse being in water and drowning:

cadaveric spots are pale, blue-purple with a pinkish or reddish tint;
swelling and swelling of the folds of the conjunctiva;
swelling and maceration of the mucous membrane of the larynx and trachea;
fluid in the middle ear cavity with a perforated eardrum;
the presence of silt, sand, and algae in the upper respiratory tract;
fluid in the abdominal (Moro sign) and pleural cavities.

There are three types of drowning. Drowning can be primary wet, dry or secondary. In addition to drowning, death in water sometimes occurs due to various injuries, heart disease, brain disorders and so on.

Drowning is possible under a variety of circumstances:

1. From an injury received in water.
2. In case of sudden cardiac arrest.
3. In case of violation cerebral circulation.
4. Spasm of the larynx and inability to inhale and exhale:
- because of fear;
- sharp when suddenly hitting a very cold water.

Types of drowning.

Primary (true) drowning.

This is the most common type of drowning. A drowning person does not immediately plunge into the water, but tries to stay on the surface; in panic, he begins to make feverish and erratic movements with his arms and legs. It is the most common type of water accident.

With it, fluid enters the respiratory tract and lungs, and then enters the blood. When a drowning person inhales, he swallows a large amount of water, which fills the stomach and enters the lungs. The man loses consciousness and sinks to the bottom. Oxygen starvation- hypoxia - gives the skin a bluish color, which is why this type of drowning is also called “blue”.

When victims drown in fresh water, the blood quickly becomes diluted with water, the total volume of circulating blood increases, red blood cells are destroyed, and the balance of salts in the body is disrupted. As a result, the oxygen content in the blood sharply decreases. After rescuing a drowning person and providing him with first aid, the phenomenon of pulmonary edema is often noted, in which mouth goes bloody foam.

Drowning in sea water the impact on the victim’s body is very different from drowning in fresh water. Sea water has a higher salt concentration than human blood plasma. As a result of sea water entering the human body, the amount of salts in the blood increases and its thickening develops. At true drowning in sea water, pulmonary edema quickly develops, and white “fluffy” foam is released from the mouth.

"Dry" drowning.

Also quite common. With this type of drowning, a reflex spasm of the glottis occurs. Water does not enter the lower respiratory tract, but suffocation occurs. This usually occurs in children and women, and also when the victim gets into dirty or chlorinated water. With such drowning, water enters the stomach in large quantities.

Secondary or “pale” drowning.

Occurs due to cardiac arrest when the victim falls into cold water, which is called ice cold. This is based on the body’s reflex reaction to water entering the windpipe or in the ear when there is damage eardrum. Secondary drowning is characterized by pronounced spasm of peripheral blood vessels. Pulmonary edema, as a rule, does not develop. Such drownings occur when a person does not try or cannot fight for his life and quickly goes to the bottom.

This often happens during shipwrecks at sea, capsizes of boats, rafts, when a person is immersed in water in a state of panic fear. If the water is also cold, this can lead to irritation of the pharynx and larynx, which in turn often leads to sudden cardiac and respiratory arrest. This type of drowning can also occur if a person in the water has a head injury or has already fallen into the water with one. In this case it happens quick loss consciousness. The skin is characterized by increased pallor, hence the name of the type.

Rescue of drowning people.

When rescuing a drowning person, you should not grab him by the hair or head. The most reliable and safest way is to grab him under the arms, turn his back to you and swim to the shore, trying to keep the victim’s head above the water.

Condition of drowning victims.

It is associated with the duration of being under water, the type of drowning and the degree of cooling of the body. In mild cases, consciousness is preserved, but agitation, trembling, and repeated vomiting are noted. With a prolonged stay in water, with true or “dry” drowning, consciousness is impaired or completely absent, the victims are very excited, there may be convulsions, and the skin is bluish. In case of secondary drowning, pronounced pallor of the skin is noted, the pupils are dilated. The victims have bubbling, rapid breathing.

When drowning in sea water, pulmonary edema quickly develops and the heart rate increases. When drowning is prolonged and secondary, the victim can be removed from the water in a state of clinical or biological death. True drowning in fresh water can be complicated by impaired kidney function in the form of blood in the urine. During the first 24 hours, pneumonia may occur. With pronounced breakdown of red blood cells in the body, acute renal failure.

Emergency assistance for drowning.

Regardless of the type of drowning, help must be provided immediately, otherwise irreversible brain changes will occur. In case of true drowning, this occurs within 4-5 minutes, in other cases after 10-12 minutes. First aid on shore will be different for blue and pale drowning. In the first case, it is necessary first of all to quickly remove water from the respiratory tract. To do this, standing on one knee, place the victim on the bent second leg so that he rests on it. Bottom part chest, and top part the torso and head hung down.

After this, you need to open the victim’s mouth with one hand, and with the other pat him on the back or gently press on the ribs from the back. These steps must be repeated until the rapid flow of water stops. Then perform artificial respiration and closed heart massage. In case of pale type of drowning, artificial respiration is needed immediately, and in case of cardiac arrest - closed massage. Sometimes large particles end up in the respiratory tract of a drowned person. foreign bodies, which get stuck in the larynx, as a result of which the airways become obstructed or a persistent spasm of the glottis develops. In this case, a tracheostomy is performed.

In any type of drowning, it is strictly forbidden to turn the victim’s head, as this can cause additional injury and a possible spinal fracture. To prevent the head from moving, place cushions of tightly twisted clothing on both sides, and if necessary, turn the victim over, while one of those providing assistance should support the head, preventing it from moving on its own.

Resuscitation, in particular artificial respiration, must be continued even if the victim begins to breathe spontaneously, but there are signs of pulmonary edema. Artificial respiration is also carried out when the victim has a breathing disorder (i.e., its frequency is more than 40 per minute, irregular breathing and a sharp blue discoloration of the skin). If breathing is maintained, then the patient should be allowed to breathe in vapors. ammonia. If the rescue of the victim was successful, but he is feeling chills, you need to rub his skin and wrap him in warm, dry blankets. Do not use heating pads in the absence or impairment of consciousness.

In severe types of drowning, the victim must be taken to the intensive care unit. During transportation, artificial ventilation should be continued. Emergency physician or intensive care unit In case of impaired breathing and pulmonary edema in the victim, the hospital inserts a breathing tube into the trachea and connects it to a device or ventilator.

First, a probe is inserted into the victim's stomach. This will prevent stomach contents from entering the respiratory tract. The patient must be transported in a position lying on his side, with the headrest of the stretcher lowered. It's dangerous to stop prematurely artificial ventilation lungs. Even if a person begins to breathe independently, this does not mean that normal breathing has been restored, especially with pulmonary edema.

When drowning in fresh water, a victim in a hospital with sudden blueness and swelling of the neck veins is sometimes bled. In case of pronounced breakdown of red blood cells, sodium bicarbonate solution, red blood cell mass, and blood plasma are transfused intravenously. To reduce swelling, diuretics, such as furosemide, are administered. A decrease in protein levels in the body is an indication for transfusion of concentrated albumin.

With the development of pulmonary edema against the background arterial hypertension 2.5% benzohexonium solution or 5% pentamine solution, glucose solutions are administered intravenously. Large doses of hormones are used: hydrocortisone or prednisolone. Antibiotics are prescribed to prevent pneumonia. To calm motor agitation, 20% sodium hydroxybutyrate solutions, 0.005% fentanyl solution or 0.25% droperidol solution are administered intravenously.

Based on materials from the book “Quick Help in Emergency Situations.”
Kashin S.P.

Remember! If there are no signs of life, it is unacceptable to waste time on complete removal water from the respiratory tract and stomach.

But since resuscitation of a drowned person is impossible without periodically removing water, foam and mucus from the upper respiratory tract, every 3-4 minutes you will have to interrupt artificial ventilation and chest compressions, quickly turn the victim onto his stomach and remove the contents using a napkin oral and nasal cavity. (This task will be greatly simplified by using a rubber balloon, which can be used to quickly suction out secretions from the upper respiratory tract.)

Remember! In case of drowning, resuscitation is carried out for 30-40 minutes, even in the absence of signs of its effectiveness.

Even when the drowned person has a heartbeat and spontaneous breathing, his consciousness has returned, do not fall into the euphoria that so quickly covers those around you. Only the first step was taken in a whole complex of measures necessary to preserve his life. To prevent most complications, it is necessary immediately after recovery spontaneous breathing and heartbeat, turn the rescued person onto his stomach again and try to remove the water more thoroughly.

First aid for pale drowning

SIGNS OF "PALE" DROWNING

This type of drowning occurs when water does not reach the lungs and stomach. This happens when drowning in very cold or chlorinated water. In these cases, the irritating effect of ice water in an ice hole or highly chlorinated water in a pool causes a reflex spasm of the glottis, which prevents its penetration into the lungs. In addition, unexpected contact with cold water often leads to reflex cardiac arrest. In each of these cases a condition develops clinical death. The skin becomes pale gray in color, without pronounced cyanosis (blue discoloration). Hence the name of this type of drowning. The nature of foamy secretions from the respiratory tract will also differ markedly from the abundant discharge during true “blue” drowning. “Pale” drowning is very rarely accompanied by the release of foam. Even if a small amount of “fluffy” foam appears, after removing it there are no wet marks left on the skin or napkin. This type of foam is called “dry”.

The appearance of such foam is explained by the fact that the small amount of water that enters oral cavity and the larynx to the level of the glottis, upon contact with saliva mucin, forms a fluffy air mass. These secretions are easily removed with a napkin and do not interfere with the passage of air. Therefore, there is no need to worry about their complete removal.

In case of “pale” drowning, there is no need to remove water from the respiratory tract and stomach. Moreover, it is unacceptable to waste time on this. Immediately after removing the body from the water and establishing signs of clinical death, begin cardiopulmonary resuscitation. Decisive factor

rescue in the cold season will be not so much the time spent under water, but the delay in the start of assistance on the shore. The paradox of revival after drowning in cold water is explained by the fact that a person in a state of clinical death finds himself in such a deep hypothermia (lower temperature), which only science fiction writers in novels about “frozen” can dream of. In the brain, as indeed in the entire body, immersed in ice water

, metabolic processes almost completely stop. Low environmental temperatures significantly delay the onset of biological death. If you read in the newspaper that they managed to save a boy who fell into an ice hole and was under the ice for more than an hour, this is not a journalist’s invention.

Remember! If you drown in cold water, there is every reason to expect salvation even if you stay under water for a long time. Moreover, with successful resuscitation, one can hope for favorable course

post-resuscitation period, which, as a rule, is not accompanied by such serious complications as pulmonary and cerebral edema, renal failure and repeated cardiac arrest, characteristic of true drowning. After removing a drowned person from an ice hole, it is unacceptable to waste time transferring him to a warm room in order to begin rendering services there.. The absurdity of such an act is more than obvious: after all, it is first necessary to revive the person, and only then take care of the prevention of colds.

When you need to free your chest to perform chest compressions, don’t even let the severe frost and icy clothes stop you. This is especially true for children: their sternum, which has a cartilaginous base, is easily injured during resuscitation even by ordinary buttons.

Only after signs of life appear, the victim should be transferred to a warm place and there general warming and rubbing should be carried out. Then he should be changed into dry clothes or wrapped in a warm blanket. The rescued person will need plenty of warm drinks and drip injections of heated plasma-substituting fluids.

Remember! After any case of drowning, the victim must be hospitalized, regardless of his condition and well-being.

PROVIDING HELP WITH PULMONARY EDEMA

If signs of pulmonary edema appear, the victim must immediately sit down or put his body in a position with the head end raised, apply tourniquets to the hips, and then inhale oxygen from an oxygen bag through alcohol vapor.

These quite accessible manipulations can have an effect in relieving pulmonary edema. By elevating the head end or sitting the patient down, you will ensure that most of the blood is deposited in the lower extremities, intestines, and pelvis. This simplest measure alone can not only alleviate his condition, but also completely eliminate pulmonary edema.

Remember! The first thing to do when bubbling breathing and the appearance of foamy secretions from the respiratory tract is to sit the patient down as quickly as possible or raise his head end.

Tourniquets on the thighs will allow for so-called “bloodless bloodletting.” To make this method more effective, it is advisable to apply a warm heating pad to the feet or immerse them in warm water and only then apply tourniquets to the upper third of the thighs. Under the influence hot water the blood will rush to the lower extremities, and the applied tourniquets will prevent its return. (Tourniquets on the thighs will not compress the arteries, but will impede venous outflow: the blood will be trapped.)

Remember! The tourniquets are applied for no more than 40 minutes and removed from the right and left legs alternately with an interval of 15-20 minutes.

Inhaling oxygen through alcohol vapor (to do this, just put a piece of cotton wool with alcohol in the mask at the level of the lower lip) is one of the most effective means of combating foaming during pulmonary edema. Alcohol vapor significantly reduces the surface tension of the shell of microscopic bubbles that make up the foam formed in the alveoli.

Destroying the membranes of the bubbles and preventing the formation of new ones will turn the entire volume of the foamed mass into a small amount of sputum, which can easily be removed with a cough, a rubber balloon or a special device for sucking fluid from the respiratory tract - a vacuum extractor.

In the absence of an oxygen cylinder, while breathing is preserved, you can bring a piece of cotton wool or a bandage moistened with alcohol to the nasal passages or mouth.

Remember! In no case should defoaming be considered the only and main method in the fight against pulmonary edema. Although it is very effective, it inherently eliminates only the consequences, and not the cause of a life-threatening condition.

What you need to know about drowning?

Three quarters of partial drowning victims recover without sequelae if they receive basic care immediately after being removed from the water.

The duration of the dive reduces the likelihood of survival. Immersion for a period exceeding 8 minutes is most often fatal.

The rapid restoration of spontaneous breathing (several minutes) after the start of first aid for drowning is a good prognostic sign.

Deep hypothermia (following cold water immersion) may protect vital functions but predisposes to ventricular fibrillation, which may remain refractory to treatment until the temperature rises above 32°C.

The myocardium does not respond to drugs at temperatures below 30°C, so if the temperature is below 30°C, administration of epinephrine and other drugs should be discontinued. When drugs are administered at standard intervals for advanced resuscitation, they accumulate in the periphery, and therefore, at 30 ° C, the lowest recommended doses should be used with doubling the interval between administrations.

Drowning initially causes apnea and bradycardia due to stimulation of the vagus (diving reflex). Continued apnea leads to hypoxia and reflex tachycardia. Continued hypoxia produces severe acidosis. Eventually breathing resumes (tipping point) and the fluid is inhaled, immediately causing laryngospasm. This spasm weakens with increasing hypoxia; the water and whatever is in it rush into the lungs. An increase in hypoxia and acidosis leads to bradycardia and arrhythmia, resulting in cardiac arrest.

In the practice of forensic medicine, cases have been recorded when a drowned man was successfully revived after 20-30 minutes in water, while the water could be relatively warm, both fresh and salty, and the lungs were filled with water. It is assumed that for some short time the alveoli of the human lungs are able to absorb oxygen from water when it is sufficiently saturated.

For the period of clinical death in any type of drowning, it is important to start CPR earlier. The first two stages of the ABC scheme in the form of periodic exhalations into the nose of the drowned person begin immediately after his face is raised above the water by the rescuer, while he is being towed to the shore or to the rescue boat. In a rescue boat (boat) or on the shore, artificial expiratory breathing “from mouth to nose” is immediately continued and closed heart massage is started. Sometimes, as “stage C” of CPR performed in case of drowning, the rescuer uses walking-related pushes with his shoulder on the chest of the drowned person when carrying him ashore in a shallow part of the reservoir (the so-called Norman revival method) for which he lifts the drowned person’s body face down onto his shoulder. When performing CPR of a drowning person, time should not be wasted on ineffective attempts to remove aspirated water from the low airways.

After providing first aid for drowning, the victim must be hospitalized, since even after restoration of vital functions there remains a risk of developing secondary drowning and pulmonary edema.

Utoplenie.txt Last changes: 2014/12/07 09:54 (external change)

Drowning is a type of mechanical suffocation or death that occurs as a result of the lungs and airways filling with water or other liquids.

Types of drowning

Depending on the external factors, conditions and reactions of the body, there are several main types of drowning:

True (aspiration, “wet”) drowning is characterized by the entry of a large amount of fluid into the lungs and respiratory tract. Accounts for about 20% of the total number of drowning cases.
False (asphyxial, “dry”) drowning – a spasm of the respiratory tract occurs, which results in a lack of oxygen. On late stages In dry drowning, the airways relax and fluid fills the lungs. This type of drowning is considered the most common and occurs in approximately 35% of cases.
Syncopal (reflex) drowning is characterized by vascular spasm, which leads to cardiac and respiratory arrest. On average, this type of drowning occurs in 10% of cases.
Mixed type of drowning - combines the signs of true and false drowning. Occurs in approximately 20% of cases.

Causes of drowning and risk factors

Most common cause Drowning is a failure to take basic precautions. People drown because of swimming in questionable waters and places where entry into the water is prohibited, as well as because of swimming during a storm. Quite common causes of drowning are swimming behind buoys and swimming while intoxicated.

The so-called fear factor also plays a significant role. A person who is a poor swimmer or does not know how to swim may accidentally fall into deep water and panic. As a rule, this is accompanied by chaotic movements and screams, as a result of which the air leaves the lungs, and the person actually begins to drown.

Other risk factors include high current speed, whirlpools, and the presence of cardiovascular disease. Drowning can also be caused by fatigue, injuries sustained during diving, and sudden changes in temperature.

Mechanism of drowning and signs of drowning

It is believed that a drowning person always screams and waves his arms, so it is very easy to identify such a critical situation. In fact, much more often there are cases when a drowning person does not look like a drowning person at all, and the signs of drowning are invisible even from a fairly close distance.

A person actively waving his arms and calling for help is most likely under the influence of panic, when real signs of drowning do not appear. He is able to provide assistance to his rescuers, such as grasping rescue equipment.

Unlike cases of sudden panic on the water, a truly drowning person may appear as if he is floating normally. He is unable to call for help because his breathing is impaired. When surfacing, he only has time to quickly exhale and inhale, after which the drowning person goes under the water again and does not have enough time to call for help.

Before completely immersing yourself in water, a drowning person can stay at the surface of the water for 20 to 60 seconds. At the same time, his body is positioned vertically, his legs are motionless, and his arm movements are instinctively aimed at pushing off from the water.

Other signs of drowning include:

the characteristic position of the head, when it is thrown back, and the mouth is open, or completely immersed in water, and the mouth is located directly at the surface;
the person's eyes are closed or not visible under the hair;
“glassy” look;
a person takes frequent breaths, capturing air with his mouth;
the victim tries to roll over on its back or swim, but to no avail.

How to help in case of drowning

First aid for drowning involves removing the victim from the water. It is best to swim up to a drowning person from behind, after which you need to turn him over on his back so that his face is on the surface of the water. The victim must then be transported to shore as quickly as possible.

You should know that when providing assistance in case of drowning, you can often encounter the manifestation of an instinctive reaction in a drowning person, when he can grab onto the rescuer and drag him into the water. In such cases, it is important not to panic, try to breathe in as much air as possible and dive deeply. A drowning person will lose support and instinctively unclench his hands.

Immediately after transporting the victim to shore, it is necessary to check the pulse and determine the type of drowning. With true (“wet”) drowning, the skin and mucous membranes of the victim have a bluish tint, and the veins in the neck and limbs swell. With false drowning, the skin does not have such a bluish color, and with syncope, the skin has a pronounced pale color.

In the case of wet drowning, the first step is to remove fluid from the victim’s respiratory tract. It must be placed on a bent knee and patted on the back. If there is no pulse, you need to start artificial respiration And indirect massage hearts.

First aid for dry or syncopal drowning does not require removing water from the lungs and airways. In this case, it is necessary to immediately begin the above resuscitation measures.

It is very important to remember that assistance for drowning should in no case be limited to these measures. After resuscitation, complications are possible in the form of repeated cardiac arrest or pulmonary edema, so the victim in any case must be shown to a doctor as soon as possible. Even in cases where a drowning person was pulled out of the water very quickly, and he did not lose consciousness, you need to call an ambulance - this will help to avoid possible complications.