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Pathogenesis of drowning in salt and fresh water. Standards of medical care in disasters

Drowning is death from suffocation as a result of a person falling into water.

A distinction is made between drowning in fresh and salt water, as well as true drowning (when death occurs from aspiration of water) and syncope drowning (death as a result of laryngospasm or reflex cardiac arrest).

In case of drowning V fresh water rapid absorption of large amounts of fluid occurs through the surface of the alveoli into the vascular bed with the development of hypervolemia and hemodynamic overload of the heart. This leads to pulmonary edema. Washing off surfactant from the surface of the alveoli increases the risk of atelectasis. In addition, a decrease in plasma osmolarity leads to the development of hemolysis of erythrocytes with possible violation kidney function.

In case of drowning in salt water water from the bloodstream enters the lungs, leading to pulmonary edema, accompanied by hypovolemia. As a result of hypoxemia and hypoxia, cerebral edema often develops. Obstruction of the respiratory tract by foreign bodies and the development of severe infectious complications from the respiratory system, especially when drowning in open water, are also dangerous.

At clinical death probability favorable outcome increases if drowning is accompanied by general hypothermia (a decrease in body temperature below 35 o C).

When providing assistance to a victim at the scene of an incident, it is necessary to assess appearance the victim. In the presence of total cyanosis, fluid pouring out of the mouth when changing body position, water probably entered the respiratory tract. You should try to remove it: throw the victim’s stomach over the doctor’s knee, or rhythmically bring the drowned person’s legs bent at the knees to his stomach 4-6 times, or by 4-6 rhythmic hand pressure on the victim’s stomach (the hand is placed on 1 transverse palm below the costal angle) . After the water is poured out of the lungs, resuscitation measures are carried out.

If the skin is pale and there is no fluid coming out of the mouth when changing body position, resuscitation measures immediately begin according to standard methods.

If there are no signs of clinical death, the victim is warmed up and, accompanied by a medical worker, is sent to the nearest hospital. Upon admission to the hospital, it is necessary to assess the function of vital organs (adequacy of breathing, hemodynamic stability, nature of consciousness), the presence of clinical signs of hemolysis (gross hematuria). With stable hemodynamics, absence respiratory failure, absence of signs of hemolysis and clear consciousness, the patient is hospitalized in the somatic department for observation for 2-3 days in order to exclude infectious complications. In all other cases, the patient should be hospitalized in the intensive care unit.

When assessing the condition, the presence and degree of hypothermia should be determined. When the body temperature drops to 35 o C, the victim is covered with warm heating pads or warmed with a source of radiant heat. When the body temperature decreases to 34 o C or less, solutions of glucose and rheopolyglucin, 10 ml/kg, heated to 36-37 o C, are additionally administered intravenously until the body temperature rises to 35-36 o C.

If there are signs of respiratory failure, its degree and cause should be determined (bronchospasm, foreign body obstruction, etc.), and treatment should be prescribed depending on the cause that caused DN. In any case, the supply of 40-60% oxygen is mandatory.

Research: general analysis blood, hematocrit determination, plain radiography chest, ECG. If possible, blood CBS or SaO 2 is determined.

Drowning in fresh water. In case of true drowning and existing stage II-III respiratory failure due to pulmonary edema, the issue is resolved in favor of early intubation and transfer to mechanical ventilation with PEEP up to 4-6 cm of water column in hyperventilation mode (tidal volume up to 15-20 cm 3 and respiratory rate at 15-20 % exceeding the average age norms).

The victim is provided with a restriction of intravenously administered fluid to 25-30% of the daily requirement. Inhalation of antifoam agents (30% alcohol, antifomsilan) is indicated. Sedatives are prescribed: GHB 50-70 mg/kg, Relanium 0.3-0.5 mg/kg.

With increasing pressure in pulmonary artery(high central venous pressure) drugs are prescribed that reduce venous return to the heart (only in the absence of hypotension): droperidol 0.25% - 0.1 ml/kg, aminophylline 2.4% - 3 mg/kg, antispasmodics, ganglion blockers short acting(pentamine, benzohexonium) IV or IM (doses of drugs are given in Table 20).

Table 20.Doses of pentamine and benzohexonium used in the treatment of drowning

In order to stabilize the membranes, glucocorticoids are prescribed: doses of prednisolone 10-15 mg/kg/day. To reduce blood volume, Lasix is indicated at a dose of 2-3 mg/kg 3-4 times a day.

After relief of pulmonary edema during drowning in fresh water, 24-48 hours later, repeated pulmonary edema may develop with low venous pressure. Therefore, glucocorticoids, diuretics and PEEP breathing are used for 2-3 days.

In case of development of severe hemolysis, as well as in case of acidosis, it is necessary to prescribe a 4% soda solution (preferably in terms of CBS). If it is not possible to determine them, then soda is administered empirically, based on the calculation of 2 ml/kg of a 4% solution.

If there is a pronounced decrease in osmolarity, a hypertonic sodium chloride solution is administered intravenously in an age-specific dosage.

To prevent the development of infection, an antibiotic is prescribed immediately after the patient is admitted to the hospital.

Drowning in salt water rheopolyglucin is administered intravenously at 10 ml/kg. The total volume of infusion is not less than the daily fluid requirement, 3/4 of this volume must be replenished with electrolyte-free solutions. Glucocorticoids are used at a dose of 5 mg/kg/day, Lasix in the usual dosage, antibiotics only in the presence of infection.

When identifying signs of cardiovascular failure, the degree and cause should be determined (hypervolemia, hypovolemia, electrolyte disturbances, hypoxia), prescribe cardiotrophics: Riboxin 3-5 mg/kg, ATP 0.5-2.0 ml IV or IM, short-acting cardiac glycosides. In case of hemodynamic overload - diuretics, in case of hypovolemia - correction of fluid deficiency. For cerebral edema, therapy is carried out according to known principles (see “cerebral edema”).

Content

Relaxing by a pond is not always pleasant. Improper behavior in water or emergency situations can lead to drowning. Young children are especially susceptible to this risk, but even adults who know how to swim well can become victims of strong currents, convulsions, and whirlpools. The sooner the victim is removed from the water, and he is given first aid for drowning (removing fluid from respiratory tract), the higher the chance of saving a person’s life.

What is drowning

The World Health Organization (WHO) defines drowning as respiratory distress caused by immersion or prolonged exposure to water. As a result, breathing problems and asphyxia may occur. If first aid to a drowning person is not provided on time, death occurs. How long can a person go without air? The brain can function for only 5-6 minutes during hypoxia, so it is necessary to act very quickly, without waiting for the ambulance team.

There are several reasons for this situation, but not all of them are accidental. Sometimes incorrect behavior of a person on the surface of the water leads to undesirable consequences. Key factors include:

injuries from diving in shallow water, in unexplored places;
alcohol intoxication;
emergency situations (seizures, heart attack, diabetic or hypoglycemic coma, stroke);
inability to swim;
neglect of a child (when children drown);
getting into whirlpools, storm.

Signs of drowning

The symptoms of drowning are easy to spot. The victim begins to flounder or gasps for air like a fish. Often a person uses all his energy to keep his head above water and breathe, so he cannot scream for help. Spasm of the vocal cords may also occur. A drowning man panics and gets lost, which reduces his chances of self-rescue. When the victim has already been pulled out of the water, the fact that he was drowning can be determined by the following symptoms:

bloating;
chest pain;
blue or bluish tint to the skin;
cough;
shortness of breath or shortness of breath;
vomiting.

Types of drownings

There are several types of drowning, each with its own characteristics. These include:

“Dry” (asphyxial) drowning. A person dives under water and loses orientation. Often a spasm of the larynx occurs, and water fills the stomach. The upper respiratory tract becomes blocked, and the drowning person begins to suffocate. Asphyxia sets in.
"Wet" (true). When immersed in water, a person does not lose his breathing instinct. The lungs and bronchi fill with fluid, foam may be released from the mouth, and cyanosis of the skin appears.
Fainting (syncope). Another name is pale drowning. The skin acquires a characteristic white, white-gray, bluish color. Death occurs as a result of a reflex cessation of the work of the lungs and heart. This often happens due to a temperature difference (when a drowning person is immersed in ice water) or a blow to the surface. Fainting, loss of consciousness, arrhythmia, epilepsy, heart attack, and clinical death occur.

Rescue of a drowning man

Anyone can notice the victim, but it is important to provide first aid in a short time, because someone’s life depends on it. When on the shore, the first thing to do is call a lifeguard for help. The specialist knows exactly how to act. If he is not nearby, you can try to pull the person out yourself, but you need to remember the danger. The drowning person is in a stressful state, his coordination is impaired, so he can involuntarily cling to the rescuer, not allowing him to grab him. There is a high probability of drowning together (if they behave incorrectly in the water).

Emergency aid for drowning

When an accident occurs, you need to act quickly. If there is no professional rescuer nearby or medical worker, then first aid in case of drowning should be provided by others. The following steps should be followed:

Wrap your finger soft cloth, clean them oral cavity saved.
If there is fluid in the lungs, you need to put the person on his knee with his stomach down, lower his head, and make several blows between the shoulder blades.
If necessary, do artificial respiration, heart massage. It is very important not to put too much pressure on your chest to avoid breaking your ribs.
When a person wakes up, you should free him from wet clothes, wrap him in a towel, and let him warm up.

Difference between sea and fresh water for drowning

An accident can occur in various water sources (sea, river, swimming pool), but drowning in fresh water is different from immersion in a salty environment. What is the difference? Inhalation marine fluid not as dangerous and has a more favorable prognosis. High salt concentration prevents water from entering lung tissue. However, the blood thickens, causing pressure on the circulatory system. Complete cardiac arrest occurs within 8-10 minutes, but during this time it is possible to resuscitate a drowning person.

As for drowning in fresh water, the process is more complicated. When fluid enters the cells of the lungs, they swell and some cells burst. Fresh water can be absorbed into the blood, making it thinner. Capillaries rupture, which impairs cardiac function. Ventricular fibrillation and cardiac arrest occur. This whole process takes a few minutes, so death occurs much faster in fresh water.

First aid on the water

A specially trained person must be involved in rescuing a drowning person. However, it is not always nearby, or several people may drown in the water. Any vacationer who knows how to swim well can provide first aid. To save someone's life, you should use the following algorithm:

You need to gradually approach the victim from behind, dive and cover the solar plexus, taking the drowning person by the right hand.
Swim to the shore on your back, row with your right hand.
It is important to ensure that the victim's head is above the water and that he does not swallow any liquid.
On the shore, you should put the person on his stomach and provide first aid.

First aid rules

The desire to help a drowning person does not always bring benefits. Misbehavior by a third party often only makes the problem worse. For this reason, first aid for drowning must be competent. What is the mechanism of PMP:

After the person is removed from the water and covered with a blanket, symptoms of hypothermia (hypothermia) need to be checked.
Call ambulance.
Avoid deformation of the spine or neck, do not cause damage.
Commit cervical region, placing a folded towel.
If the victim is not breathing, artificial respiration and cardiac massage should be started.

In case of true drowning

In approximately 70 percent of cases, water enters directly into the lungs, causing true or “wet” drowning. This can happen to a child or a person who cannot swim. First health care in case of drowning includes the following steps:

palpation of the pulse, examination of the pupils;
warming the victim;
maintaining blood circulation (raising legs, bending the body);
ventilation of the lungs using breathing apparatus;
if the person is not breathing, artificial respiration must be performed.

With asphyxial drowning

Dry drowning is somewhat atypical. The water never reaches the lungs, but instead the vocal cords spasm. Death can occur due to hypoxia. How to provide first aid to a person in this case:

carry out immediately cardiopulmonary resuscitation;
call an ambulance;
when the victim came to his senses, warm him up.

Artificial respiration and cardiac massage

In most cases of drowning, a person stops breathing. To bring him back to life, you should immediately begin active steps: perform a heart massage, perform artificial respiration. A clear sequence of actions must be followed. How to do mouth-to-mouth breathing:

The victim’s lips should be parted, mucus and algae should be removed using a finger wrapped in a cloth. Allow fluid to drain from the mouth.
Grasp your cheeks so that your mouth does not close, tilt your head back, lift your chin.
Pinch the rescued person’s nose and breathe air directly into his mouth. The process takes a split second. Number of repetitions: 12 times per minute.
Check the pulse in the neck.
After some time, the chest will rise (the lungs will begin to function).

Mouth-to-mouth breathing is often accompanied by cardiac massage. This procedure should be performed very carefully to avoid damaging the ribs. How to proceed:

Place the patient on a flat surface (floor, sand, ground).
Place one hand on the chest, cover with the other hand at an angle of approximately 90 degrees.
Apply rhythmic pressure on the body (approximately one pressure per second).
To start the baby’s heart, you should press on the chest with 2 fingers (due to the baby’s small height and weight).
If there are two rescuers, artificial respiration and cardiac massage are performed simultaneously. If there is only one rescuer, then every 30 seconds you need to alternate these two processes.

Actions after first aid

Even if a person has regained consciousness, this does not mean that he does not need medical care. You should stay with the victim, call an ambulance or seek help from a doctor. It is worth knowing that when drowning in fresh water, death can occur even after a few hours (secondary drowning), so you should keep the situation under control. If you remain unconscious and without oxygen for a long time, the following problems may occur:

brain disorders internal organs;
neuralgia;
pneumonia;
chemical imbalance in the body;
permanent vegetative state.

To avoid complications, you should take care of your health as quickly as possible. A person rescued from drowning should take the following precautions:

learn to swim;
avoid swimming while intoxicated;
do not go into too cold water;

Discuss

Rules for rescue and emergency assistance before medical care for a drowning person - an algorithm for resuscitation actions

Drowning- a type of mechanical asphyxia (suffocation) as a result of water entering the respiratory tract.

The changes that occur in the body during drowning, in particular, the timing of death under water, depend on a number of factors: on the nature of the water (fresh, salty, chlorinated fresh water in swimming pools), on its temperature (ice, cold, warm), on the presence of impurities (silt, mud, etc.), on the state of the victim’s body at the time of drowning (overwork, excitement, alcohol intoxication, etc.).

True drowning occurs when water enters the trachea, bronchi and alveoli. Usually a drowning person experiences severe nervous excitement; he expends colossal energy to resist the elements. Taking deep breaths during this struggle, the drowning person swallows a certain amount of water along with the air, which disrupts the rhythm of breathing and increases body weight. When an exhausted person plunges into water, breathing occurs as a result of a reflex spasm of the larynx (closing of the glottis). At the same time, carbon dioxide quickly accumulates in the blood, which is a specific irritant of the respiratory center. Loss of consciousness occurs, and the drowning person makes deep breathing movements under water for several minutes. As a result, the lungs are filled with water, sand and air is forced out of them. The level of carbon dioxide in the blood increases even more, a repeated breath-hold occurs, and then deep dying breaths occur for 30-40 seconds. Examples of true drowning are drowning in fresh water and sea water.

Drowning in fresh water.

When fresh water enters the lungs, it is quickly absorbed into the blood, since the concentration of salts in fresh water is much lower than in the blood. This leads to blood thinning, increasing its volume and destroying red blood cells. Sometimes pulmonary edema develops. A large amount of persistent pink foam is formed, which further disrupts gas exchange. The circulatory function ceases as a result of impaired contractility of the ventricles of the heart.

Drowning in sea water.

Due to the fact that the concentration of dissolved substances in sea water is higher than in the blood, when sea water enters the lungs, the liquid part of the blood, along with proteins, penetrates from blood vessels into the alveoli. This leads to thickening of the blood, increasing the concentration of potassium, sodium, calcium, magnesium and chlorine ions in it. A large amount of fluid heats up in the alveoli, which leads to their stretching and even rupture. As a rule, when drowning in sea water, pulmonary edema develops. The small amount of air that is in the alveoli helps during breathing movements whipping the liquid to form a stable protein foam. Gas exchange is sharply disrupted and cardiac arrest occurs.

When conducting resuscitation measures extremely important has a time factor. The earlier the revival begins, the greater the chances of success. Based on this, it is advisable to start artificial respiration already on the water. To do this, air is periodically blown into the victim’s mouth or nose while he is being transported to the shore or to the boat. The victim is examined on shore. If the victim has not lost consciousness or is in a state of slight fainting, then to eliminate the consequences of drowning, it is enough to give it a sniff ammonia and warm the victim.

If the circulatory function is preserved (pulsation in the carotid arteries), there is no breathing, the oral cavity is freed from foreign bodies. To do this, clean it with a finger wrapped in a bandage, and remove removable dentures. Often the victim’s mouth cannot be opened due to spasm. masticatory muscles. In these cases, mouth-to-nose artificial respiration is performed; if this method is ineffective, use a mouth dilator, and if it is not available, then use some kind of flat metal object(don't break your teeth!). As for freeing the upper respiratory tract from water and foam, it is best to use suction for these purposes. If it is not there, the victim is placed stomach down on the rescuer’s thigh, bent in knee joint. Then they sharply and energetically squeeze his chest. These manipulations are necessary in cases of resuscitation when artificial ventilation lungs is impossible due to blockage of the airways with water or foam. This procedure must be carried out quickly and energetically. If there is no effect within a few seconds, artificial ventilation of the lungs must be started. If skin pale, then it is necessary to proceed directly to artificial ventilation of the lungs after cleansing the oral cavity.

The victim is laid on his back, freed from restrictive clothing, his head is thrown back, one hand is placed under the neck, and the other is placed on the forehead. Then they push lower jaw the victim forward and upward so that the lower incisors are in front of the upper ones. These techniques are performed to restore the patency of the upper respiratory tract. After this, the rescuer takes a deep breath, holds his breath a little and, pressing his lips tightly to the mouth (or nose) of the victim, exhales. In this case, it is recommended to pinch the nose (when breathing mouth to mouth) or the mouth (when breathing mouth to nose) of the person being revived with your fingers. Exhalation is carried out passively, while the airways must be open.

It is difficult to carry out artificial ventilation of the lungs for a long time using the method described above, since the rescuer may develop undesirable disorders from the of cardio-vascular system. Based on this, when carrying out artificial ventilation, it is better to use mechanical breathing.

If, during artificial ventilation of the lungs, water is released from the victim’s respiratory tract, which makes it difficult to ventilate the lungs, you must turn your head to the side and raise the opposite shoulder; in this case, the mouth of the drowned person will be below the chest and the liquid will pour out. After this, artificial ventilation can be continued. In no case should you stop artificial ventilation of the lungs when independent respiratory movements appear in the victim, if his consciousness has not yet recovered or the breathing rhythm is disrupted or sharply increased, which indicates incomplete restoration of respiratory function.

In the event that there is no effective blood circulation (no pulse in large arteries, heartbeats are not heard, cannot be determined arterial pressure, the skin is pale or bluish), simultaneously with artificial ventilation of the lungs, an indirect cardiac massage is performed. The person providing assistance stands on the side of the victim so that his arms are perpendicular to the surface of the chest of the drowned person. The resuscitator places one hand perpendicular to the sternum in its lower third, and places the other on top of the first hand, parallel to the plane of the sternum. Essence indirect massage the heart consists of a sharp compression between the sternum and the spine; in this case, blood from the ventricles of the heart enters the systemic and pulmonary circulation. The massage should be performed in the form of sharp jolts: there is no need to strain the muscles of the arms, but you should, as it were, “throw” the weight of your body down - this leads to a flexion of the sternum by 3-4 cm and corresponds to the contraction of the heart. In the intervals between pushes, you cannot lift your hands from the sternum, but there should be no pressure - this period corresponds to the relaxation of the heart. The resuscitator's movements should be rhythmic with a frequency of pushes of 60-70 per minute.

Massage is effective if pulsation begins to be detected carotid arteries, the previously dilated pupils narrow, and the cyanosis decreases. When these first signs of life appear, indirect cardiac massage should be continued until a heartbeat begins to be heard.

If resuscitation is carried out by one person, then it is recommended to alternate chest compressions and artificial respiration as follows: for 4-5 pressures on the sternum, 1 air injection is performed. If there are two rescuers, then one is engaged in chest compressions, and the other is engaged in artificial ventilation of the lungs. In this case, 1 air injection is alternated with 5 massage movements.

It should be taken into account that the victim’s stomach may be filled with water or food masses; this makes it difficult to carry out artificial ventilation of the lungs, chest compressions, and provokes vomiting.

After the victim is brought out of the state of clinical death, he is warmed up (wrapped in a blanket, covered with warm heating pads) and massage the upper and lower limbs from the periphery to the center.

In case of drowning, the time during which a person can be revived after being removed from the water is 3-6 minutes.

Great importance The temperature of the water affects the timing of the victim’s return to life. When drowning in ice water when the body temperature drops, revival is possible even 30 minutes after the accident.

No matter how quickly the rescued person regains consciousness, no matter how good his condition may seem, placing the victim in a hospital is an indispensable condition.

Transportation is carried out on a stretcher - the victim is placed on his stomach or on his side with his head bowed. When pulmonary edema develops, the position of the body on the stretcher is horizontal with the head end raised. During transportation, artificial ventilation is continued.

Drowning is a type of mechanical asphyxia (suffocation) resulting from water entering the respiratory tract.
The changes that occur in the body during drowning, in particular, the timing of dying under water, depend on a number of factors:

on the nature of the water (fresh, salty, chlorinated fresh water in swimming pools)
on its temperature (icy, cold, warm)
from the presence of impurities (silt, mud, etc.)
on the state of the victim’s body at the time of drowning (overwork, excitement, alcohol intoxication, etc.)

True drowning occurs when water enters the trachea, bronchi and alveoli. Typically, a drowning person experiences severe nervous excitement; he expends colossal energy to resist the elements. Taking deep breaths during this struggle, the drowning person swallows a certain amount of water along with the air, which disrupts the rhythm of breathing and increases body weight. When an exhausted person plunges into water, breathing occurs as a result of a reflex spasm of the larynx (closing of the glottis). At the same time, carbon dioxide quickly accumulates in the blood, which is a specific irritant of the respiratory center. Loss of consciousness occurs, and the drowning person makes deep breathing movements under water for several minutes. As a result, the lungs are filled with water, sand and air is forced out of them. The level of carbon dioxide in the blood increases even more, a repeated breath-hold occurs, and then deep dying breaths occur for 30-40 seconds. Examples of true drowning include drowning in fresh and sea water.

Drowning in fresh water. When fresh water enters the lungs, it is quickly absorbed into the blood, since the concentration of salts in fresh water is much lower than in the blood. This leads to blood thinning, increasing its volume and destroying red blood cells. Sometimes pulmonary edema develops. A large amount of persistent pink foam is formed, which further disrupts gas exchange. The circulatory function ceases as a result of impaired contractility of the ventricles of the heart.

Drowning in sea water. Due to the fact that the concentration of dissolved substances in sea water is higher than in the blood, when sea water enters the lungs, the liquid part of the blood, along with proteins, penetrates from the blood vessels into the alveoli. This leads to thickening of the blood, increasing the concentration of potassium, sodium, calcium, magnesium and chlorine ions in it. A large amount of fluid heats up in the alveoli, which leads to their stretching and even rupture. As a rule, when drowning in sea water, pulmonary edema develops. The small amount of air that is in the alveoli contributes to the whipping of liquid during breathing movements with the formation of a stable protein foam. Gas exchange is sharply disrupted and cardiac arrest occurs.

When conducting resuscitation measures The time factor is extremely important. The earlier the revival begins, the greater the chances of success. Based on this, it is advisable to start artificial respiration already on the water. To do this, air is periodically blown into the victim’s mouth or nose while he is being transported to the shore or to the boat. The victim is examined on shore. If the victim has not lost consciousness or is in a state of slight fainting, then to eliminate the consequences of drowning, it is enough to sniff ammonia and warm the victim.
If the circulatory function is preserved (pulsation in the carotid arteries), there is no breathing, the oral cavity is freed from foreign bodies. To do this, clean it with a finger wrapped in a bandage, and remove removable dentures. Often the victim’s mouth cannot be opened due to spasm of the masticatory muscles. In these cases, mouth-to-nose artificial respiration is performed; if this method is ineffective, use a mouth dilator, and if it is not available, then use some flat metal object (do not break the teeth!). As for freeing the upper respiratory tract from water and foam, it is best to use suction for these purposes. If it is not there, the victim is placed stomach down on the rescuer’s thigh, bent at the knee joint. Then they sharply and energetically squeeze his chest. These manipulations are necessary in cases of resuscitation when artificial ventilation of the lungs is impossible due to blockage of the airways with water or foam. This procedure must be carried out quickly and energetically. If there is no effect within a few seconds, artificial ventilation of the lungs must be started. If the skin is pale, then you need to proceed directly to artificial ventilation of the lungs after cleansing the oral cavity.
The victim is laid on his back, freed from restrictive clothing, his head is thrown back, one hand is placed under the neck, and the other is placed on the forehead. Then the victim’s lower jaw is pushed forward and upward so that the lower incisors are in front of the upper ones. These techniques are performed to restore the patency of the upper respiratory tract. After this, the rescuer takes a deep breath, holds his breath a little and, pressing his lips tightly to the mouth (or nose) of the victim, exhales. In this case, it is recommended to pinch the nose (when breathing mouth to mouth) or the mouth (when breathing mouth to nose) of the person being revived with your fingers. Exhalation is carried out passively, while the airways must be open.
It is difficult to carry out artificial ventilation of the lungs for a long time using the method described above, since the rescuer may develop undesirable disorders of the cardiovascular system. Based on this, when carrying out artificial ventilation, it is better to use mechanical breathing.
If, during artificial ventilation of the lungs, water is released from the victim’s respiratory tract, which makes it difficult to ventilate the lungs, you must turn your head to the side and raise the opposite shoulder; in this case, the mouth of the drowned person will be below the chest and the liquid will pour out. After this, artificial ventilation can be continued. In no case should you stop artificial ventilation of the lungs when independent respiratory movements appear in the victim, if his consciousness has not yet recovered or the breathing rhythm is disrupted or sharply increased, which indicates incomplete restoration of respiratory function.
In the event that there is no effective blood circulation (no pulse in large arteries, heartbeats cannot be heard, blood pressure cannot be determined, the skin is pale or bluish), an indirect heart massage is performed simultaneously with artificial ventilation of the lungs. The person providing assistance stands on the side of the victim so that his arms are perpendicular to the surface of the chest of the drowned person. The resuscitator places one hand perpendicular to the sternum in its lower third, and places the other on top of the first hand, parallel to the plane of the sternum. The essence of chest compressions is a sharp compression between the sternum and the spine; in this case, blood from the ventricles of the heart enters the systemic and pulmonary circulation. The massage should be performed in the form of sharp jolts: there is no need to strain the muscles of the arms, but you should, as it were, “throw” the weight of your body down - this leads to a flexion of the sternum by 3-4 cm and corresponds to the contraction of the heart. In the intervals between pushes, you cannot lift your hands from the sternum, but there should be no pressure - this period corresponds to the relaxation of the heart. The resuscitator's movements should be rhythmic with a frequency of pushes of 60-70 per minute.
The massage is effective if the pulsation of the carotid arteries begins to be detected, the previously dilated pupils narrow, and the cyanosis decreases. When these first signs of life appear, indirect cardiac massage should be continued until a heartbeat begins to be heard.
If resuscitation is carried out by one person, then it is recommended to alternate chest compressions and artificial respiration as follows: for 4-5 pressures on the sternum, 1 air injection is performed. If there are two rescuers, then one is engaged in chest compressions, and the other is engaged in artificial ventilation of the lungs. In this case, 1 air injection is alternated with 5 massage movements.
It should be taken into account that the victim’s stomach may be filled with water or food masses; this makes it difficult to carry out artificial ventilation of the lungs, chest compressions, and provokes vomiting.
After the victim is brought out of the state of clinical death, he is warmed up (wrapped in a blanket, covered with warm heating pads) and the upper and lower extremities are massaged from the periphery to the center.
In case of drowning, the time during which a person can be revived after being removed from the water is 3-6 minutes.
The temperature of the water has a great influence on the time it takes for the victim to return to life. When drowning in ice water, when the body temperature drops, revival is possible even 30 minutes after the accident.
No matter how quickly the rescued person regains consciousness, no matter how good his condition may seem, placing the victim in a hospital is an indispensable condition.
Transportation is carried out on a stretcher - the victim is placed on his stomach or on his side with his head bowed. When pulmonary edema develops, the position of the body on the stretcher is horizontal with the head end raised. During transportation, artificial ventilation is continued.