Syncopal type of drowning. Diagnosis of true drowning

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. In the final stages of 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. At 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 chest compressions as soon as possible.

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.

Drowning- it's deadly dangerous condition, which occurs when water or other liquids enter the respiratory tract.

There are several immediate causes, or types, of drowning:

1. True, "wet", "blue" drowning- a person dies by choking on water. The most common type of drowning. During the struggle for life, a person makes breathing and swallowing movements, as a result of which the lungs and stomach fill with water.
2. Upper respiratory tract spasm- “dry” drowning, when water does not fill the lungs. This is possible if you suddenly fall into cold water, if you are frightened, or get a head injury while falling into the water. In some people, as a protective reflex in response to a small amount of water entering the glottis.
3. Syncopal, "pale" drowning- drowning is preceded by cardiac arrest, for example due to a sudden change in temperature, etc. Water does not enter the body.

Most often, the drowning mechanism is mixed, so you can accurately establish it according to external signs during the rescue of a drowning person is extremely difficult. Sometimes death occurs from injuries, cardiovascular pathology and other conditions not related to drowning.

Rules for transporting a drowning person:

• It is advisable to transport a drowning person to the shore or to a watercraft by the efforts of two people using life-saving equipment (a lifebuoy or any object with good buoyancy).
• If a drowning person is actively moving in the water, rescuers should remain careful, since the victim can reflexively cause harm to those who come to the rescue.
• A drowning person is grabbed by the armpits from behind, turned face up, and in this position transported to the shore.
• If the victim grabs the rescuer and interferes with movement, you need to take a breath and dive under the water. A drowning person, having lost support, will loosen his grip.
• The faster the victim can be brought to shore, the higher the chances of rescue.

Signs of drowning

Signs initial stage drowning:

• victims retain consciousness, but are not always able to adequately respond to what is happening;
• excited, can break free, run away, refuse medical care, then a phase of inhibition, apathy, lethargy may begin, even to the point of impaired consciousness;
• in the first minutes, breathing and heartbeat are rapid, then slow down;
• chills are observed;
• the abdomen is swollen, vomiting water and stomach contents, coughing often develops;
• bluish skin.

Signs of drowning gradually disappear, but may persist for several days residual effects: weakness, apathy, headaches.

Agony stage:

• the victim is unconscious;
• breathing and heartbeat are weak, arrhythmic;
• the skin is bluish, cold;
• Pink foam may be released from the respiratory tract.

The stage of initial drowning and agony are significantly expressed only with true drowning, however, the effectiveness of resuscitation in this case is higher. With other types of drowning, clinical death develops very quickly.

Stage of clinical death:

• there is no consciousness, breathing or heartbeat;
• the pupil does not react to light;
• no gag reflex.

How dangerous is drowning?

As a result of drowning, the body develops severe pathological changes. In the stage of agony and clinical death, the chances of saving the victim are very small. However, there are known cases of drowned people returning to life after tens of minutes spent in the water. The individual characteristics of the person, the circumstances of the accident and the temperature of the water play a big role here.

Even after successful rescue, the victim must be urgently transported to medical institution, since the consequences of drowning may appear after some time.

First aid for drowning

1. As soon as the victim is on the shore or on board the boat, begin providing assistance. Regardless of the severity of the victim’s condition, it is necessary to call an ambulance.
2. If it is possible to remove a conscious person from the water, first aid is to most effectively remove water from the respiratory tract and stomach, calm and warm the victim. To do this, the rescuer helps the person roll over onto his stomach, bends him over his thigh, taps him on the back, helping him clear his throat. The person is freed from wet clothes, wiped dry, and wrapped up. They give you a warm drink and send you to the hospital as soon as possible.
3. If a drowning person is unconscious, do not waste time determining the stage and type of drowning or calculating the time spent under water. The effectiveness of rescue measures largely depends on the efficiency of your actions. First aid in this case is provided according to a single algorithm:

• Quickly turn the person over onto their stomach, face down, and place your own thigh or knee under the stomach. With your free hand, try to open the victim’s mouth and press with your fingers on the root of the tongue. So with one action you achieve three effects at once:

1. help clear the airways from water, sand and other foreign objects;
2. stimulate the respiratory center;
3. assess the condition of the person being rescued.

• In the first case, a large amount of water pours out of the mouth, a gag reflex occurs, coughing and breathing movements occur, and the person regains consciousness.
• In the second case, no water comes from the respiratory tract and there is no gag reflex. Without wasting a second, turn the victim onto his back and begin artificial respiration.
• If there is no heartbeat, alternate artificial respiration with chest compressions.
• Signs of revival will be pinking of the skin, the appearance of a cough reflex, attempts at spontaneous breathing, pulse and movements.

What not to do?

• Start resuscitation without making sure there is no water in the respiratory tract. If the lungs are filled with water, artificial respiration will not be effective.
• Waste time trying to bring them to their senses with loud shouts, blows to the face, etc.
• Warm the victim with alcoholic drinks.
• Leaving the rescued person unattended after regaining consciousness. A person's condition after drowning is very unstable. It is necessary to constantly monitor your pulse and breathing.
• Neglect medical care and supervision even if the rescue was successful and the victim was feeling well.

Nota Bene!

You should never lose hope of salvation, even if a person has been in the water long time and shows no signs of life. By correctly performing cardiac massage and artificial respiration, you maintain the vitality of the central nervous system and other organs of the victim. There are known cases of successful rescue of people who were under water for up to 30-40 minutes. The likelihood of survival is especially high in cold water, which slows down metabolism, a kind of preservation of the body.

Created using materials:

1. Vertkin A. L., Bagnenko S. F. Guide to emergency medical care. - M.: GEOTAR-Media, 2007.
2. Kostrub A. A. Medical reference book for tourists. - M.: Profizdat, 1990. 2nd edition, revised and expanded.
3. Guide to Primary Health Care. - M.: GEOTAR-Media, 2006.
4. Paramedic's Handbook / ed. prof. A. N. Shabanova. - M.: Medicine, 1976.
5. Shvarts L. S. Handbook of emergency physicians and emergency care. - Saratov, 1968.

There are three types of drowning: primary (true, or “wet”), as-

fixed (“dry”) and secondary. Moreover, in case of accidents

death may occur in water not caused by drowning (trauma, heart attack

myocardium, disorder cerebral circulation etc.).

Primary drowning is the most common (75-95% of all accidents)

cases in water). It involves aspiration of fluid into the respiratory tract.

pathways and lungs, and then its entry into the blood.

When drowning in fresh water pronounced hemodilution occurs quickly

and hypervolemia, hemolysis, hyperkalemia, hypoproteinemia, hy-

ponatremia, decreased concentrations of calcium and chloride ions in plasma. Ha-

Severe arterial hypoxemia is typical. After removing the victim

from water and providing him with first aid, pulmonary edema often develops with

discharge of bloody foam from the respiratory tract.

When drowning in sea water, which is hypertonic in relation to

blood plasma, hypovolemia, hypernatremia, hypercalcemia develops,

hyperchloremia, blood thickening occurs. For true drowning at sea

Which water is characterized by the rapid development of edema with discharge from the respiratory

paths of white, persistent, “fluffy” foam.

Asphyxial drowning occurs in 5-20% of all cases. With him

reflex laryngospasm develops and water aspiration does not occur, and

asphyxia occurs. Asphyxial drowning occurs more often in children and

women, as well as when the victim gets into contaminated, chlorinated

new water. At the same time, water enters the stomach in large quantities. Maybe

pulmonary edema develops, but not hemorrhagic.

Secondary drowning occurs as a result of cardiac arrest

due to the victim getting into cold water (“ice shock”,

"immersion syndrome"), a reflex reaction to water entering the breathing

body tract or middle ear cavity with damaged tympanic membrane

ponke. Secondary drowning is characterized by pronounced spasm of the peripheral

some vessels. Pulmonary edema, as a rule, does not occur.

Symptoms The condition of the victims removed from the water is largely determined by

divided by the duration of stay under water and the type of drowning, the presence

mental trauma and cooling. In mild cases, consciousness may be

preserved, but the patients are agitated, trembling and frequent vomiting are noted. At

relatively long true or asphyxial drowning, consciousness is reduced

tanno or absent, sudden motor agitation, convulsions. Skin

the integument is cyanotic. Secondary drowning is characterized by severe pallor

skin. The pupils are usually dilated. Breath bubbling

frequent or during prolonged stay under water rare with the participation

auxiliary muscles. When drowning in sea water, swelling quickly increases

lungs. Severe tachycardia, sometimes extrasystole. With prolonged and

In secondary drowning, the victim may be removed from the water without recognition.

kov breathing and cardiac activity.

Complications. In case of true drowning in fresh water, already at the end of the first

hours, sometimes later, hematuria develops. Pneumonia and atelectasis mild

which can develop very quickly, at the end of the first day after drowning

With severe hemolysis, hemoglobinuric nephrosis and

acute renal failure.

Urgent Care. The victim is removed from the water. If you lose consciousness

artificial ventilation the easy way mouth to nose preferably

start on the water, however, these techniques can only be performed by a well-prepared

trained, physically strong rescuer. Artificial ventilation

carried out as follows: the rescuer passes his right hand under the right

howl with the victim’s hand, being behind his back and to the side. Your right

The rescuer closes the victim’s mouth with his palm, while simultaneously pulling

up and forward his chin. Blowing air into the nasal passages

y drowned.

When extricating a victim onto a boat, rescue boat or shore

it is necessary to continue artificial respiration, for this purpose you can use

use an airway or oronasal mask and a Reuben bag. When from-

no pulse on carotid arteries should immediately begin indirect

heart massage. It is a mistake to try to remove “all” the water from the lungs.

In case of true drowning, the patient is quickly placed with his stomach on his hip

the rescuer's leg and with sharp jerking movements they squeeze the side

higher surfaces of the chest (within 1015 s), after which again

turn him on his back. The oral cavity is cleaned with a finger wrapped in a handkerchief

or gauze. If trismus occurs masticatory muscles, you should press

fingers on the area of ​​the corners of the lower jaw. If there is an electrical or

foot suction to clean the oral cavity, you can use a rubber ca-

tether is large in diameter, but in case of pulmonary edema one should not strive to suction

remove foam from the respiratory tract, as this will only increase swelling.

When carrying out artificial ventilation of the lungs using methods from the mouth to

mouth or mouth to nose, one condition is absolutely necessary:

the patient's head should be in the position of maximum occipital extension

Baniya. Providing assistance while standing at the side of the victim, using one hand

holds his head in an extended position, pressing his palm on his forehead,

and with the other hand he slightly opens his mouth by the chin. At the same time, I do not follow

does not bring the lower jaw forward, since with the correct position of the

When the patient catches the root of the tongue and the epiglottis shifts anteriorly and opens

access of air to the larynx. The rescuer takes a deep breath and, snuggling

with his lips to the patient’s mouth, exhales sharply. In this case it follows 1 and

With the second fingers of the hand placed on the forehead, squeeze the wings of the nose to prevent

preventing air from escaping through the nasal passages. If you do not open the patient's mouth

it is possible or the oral cavity is not cleared of contents, to blow air

through the victim's nose, covering his mouth with your palm. The rhythm is artificial

slow breathing 12-16 per 1 min.

In some cases, the respiratory tract of a drowned person may not be

passable due to the presence of a large foreign body in the larynx or persistent

laryngospasm. In this case, tracheostomy is indicated, and in the absence

necessary conditions and tools - conicotomy.

After delivering the patient to the rescue station, resuscitation measures

The protests must be continued. One of the most common mistakes is

premature termination of artificial respiration. The presence of

increased respiratory movements, as a rule, do not indicate recovery

deprivation of complete ventilation of the lungs, so if the patient does not have

consciousness or pulmonary edema has developed, it is necessary to continue artificial

breath. Artificial respiration is also necessary if

the victim has breathing rhythm disturbances, increased breathing rate of more than 40

in 1 min, sharp cyanosis.

While breathing is maintained, inhalation of ammonia vapor should be carried out.

alcohol (10% ammonia solution).

In case of chills, it is necessary to thoroughly rub the skin, wrap

the victim in warm, dry blankets. The use of heating pads is contraindicated

if consciousness is absent or impaired.

In case of breathing problems and pulmonary edema, tracheal intubation and

carrying out artificial ventilation of the lungs, preferably 100% oxygen

house. Intravenous fluid can be used to perform intubation.

muscle relaxants (listenone - 100-150 mg) with preliminary administration of 0.1%

atropine solution - 0.8 ml. If the patient is suddenly excited, atropine and

Listenone can be injected into the root of the tongue. If you have a RO type respirator,

“Phase”, “Lada” shows output resistance +8; +15 cm water. Art. under

blood pressure control.

Particular attention should be paid to the danger of premature cessation of use.

artificial ventilation of the lungs. The emergence of independent breathing

movements does not mean restoration of adequate pulmonary ventilation

tions, especially in conditions of pulmonary edema.

After tracheal intubation and initiation of artificial respiration, it is necessary

insert a tube into the stomach and evacuate the water and stagnant fluid accumulated in it

content.

In case of drowning in fresh water, a victim in a hospital setting

with severe cyanosis, swelling of the neck veins, high central venous

pressure, bloodletting in a volume of 400-500 ml from the central vein is indicated

(subclavian or jugular). In case of severe hemolysis, intravenous

new transfusion of 4-8% sodium bicarbonate solution in a dose of 400-600 ml

(under control of acid-base status). Artificial background

created metabolic alkalosis, Lasix 40-60 mg should be administered

2-3 times a day until gross hematuria disappears.

For hypoproteinemia, transfusion of concentrated protein is indicated.

(20% albumin - 100-150 ml).

At late development pulmonary edema, if there are no indications for artificial

ventilation of the lungs, inhalation of oxygen passed through

50% alcohol or antifomsilane. If pulmonary edema develops against the background of arterial

al hypertension, indicated intravenous administration ganglion blockers (ar-

Fonad 5% solution - 5 ml or pentamin 5% solution - 0.5-1 ml in 200 ml 5%

glucose solution drip under strict control of blood pressure). It is necessary to

changing large doses of corticosteroids - 800-1000 mg hydrocorgisone or

150-180 mg of prednisolone per day. Previous use of antibiotics is indicated

for the prevention of aspiration pneumonia. To combat motor anxiety

awakening and for the purpose of protecting the brain (prevention of hypoxic encephalopathy -

tii) intravenous administration of sodium hydroxybutyrate is indicated - 120-150 mg/kg

or neuroleptanalgesics - 0.3-0.7 mg menthanil with 12-15 mg droperidol.

In case of drowning in sea water, artificial ventilation with half

Residential pressure at the end of the outlet should be started as early as possible.

Transfusion of protein solutions (plasma, albumin) is indicated. Special attention

should be focused on eliminating hypovolemia and correcting rheological

properties of blood. Intravenous transfusion of rheopolyglucin is indicated, previously

use of heparin - 20,000-30,000 units/day.

The rest of the therapy is carried out according to the principles described above.

Hospitalization. At severe forms drowning of the victim is necessary

transported not to the nearest hospital, but to a well-equipped department -

Research Institute of Reanimation. During transportation, you must continue to use

artificial ventilation and all other necessary measures. Beli

was introduced gastric tube, it is not removed during transportation.

If for some reason tracheal intuition was not performed, trans-

The victim must be ported on his side with the headrest lowered.

At the first signals from the victim, you need to rush to his aid, but first assess your safety.

Relaxing near a pond if safety rules are not followed can result in drowning. This often occurs due to alcohol intoxication, damage to the spinal cord when diving in an unknown place, or due to reflex cardiac arrest. The first thing to do in case of drowning is to get the victim out and call an ambulance. But by the time the brigade gets there, biological death may occur. Therefore, in order to prevent a tragic outcome, you need to know how first aid for drowning is provided at the pre-medical stage.

The difficulties in providing emergency care lie in the fact that there are different types of drowning. Before indicating the sequence of assistance, it is necessary to analyze the causes and mechanisms of development different types drowning.

There are 3 types:

True drowning

The true one is divided into drowning in fresh and sea water. It develops when water enters the lungs, most often while swimming. When removing the victim, he often foams at the mouth. The most common type.

Asphyxial drowning occurs when ice or chlorinated water enters the trachea, which causes a reflex spasm of the vocal cords - laryngospasm. This is how people who swim poorly or are in drunkenness.

Syncopal drowning is when, when falling from a height, upon contact with cold water, a reflex arrest of the heart and breathing occurs. Clinical death occurs with all its signs.

We can say that this is the most favorable type of drowning, since there is no damage to the lungs from water. In cold water, the period of clinical death can increase to 10-15 minutes. And children can spend about half an hour in clinical death.

Sudden exposure of the body to ice water when falling from a height can cause reflex cardiac arrest.

Help for true drowning

This is the most common type of drowning. Victims of drowning can include people who cannot swim or are intoxicated, as well as professional swimmers. The appearance of the victim after he is removed from the water has specific characteristics:

• blue skin of the face and neck;
• swollen veins in the neck;
• pink foam from nose and mouth.

While in the water, for some reason, a person begins to drown. He tries not to breathe for as long as possible, which leads to blackout due to oxygen starvation of the brain. After this, water fills the lungs and stomach in large quantities.

Regardless of whether the water is fresh or salty, it has a damaging effect on the lungs, destroying them. In true drowning, excess fluid enters the bloodstream and an overflow occurs. circulatory system, which the heart may not be able to cope with and will stop if this has not already happened at the time it is removed from the water.

Important! Only someone with lifeguard skills, a good swimmer and a good physical fitness can help a drowning person. developed person. An untrained and poor swimmer may drown along with the victim. Therefore, before jumping into the water you need to weigh your strength. If you are unsure of them, then it would be more reasonable to call someone for help.

First medical aid for drowning begins with removing the patient to shore. If the victim is conscious, then you need to be careful, since a person in panic can harm the rescuer. If the victim is unconscious, then when transporting him to the shore, you need to make sure that he does not go under water.

First medical aid for drowning begins with removing the patient to shore.

Important! As soon as it becomes known that someone has drowned or is drowning, an ambulance should be called immediately. It must be taken into account that bodies of water are usually located far from the city and emergency stations.

After delivering the victim to shore, you must immediately begin providing first aid. The main thing in rescuing a drowning person is to quickly navigate the situation, since every minute counts.

Action	Description
	If the victim shows signs of life, it is necessary to urgently remove water from the respiratory tract. If the victim is unconscious, cardiopulmonary resuscitation should be started immediately.
	The easiest way to remove water from the stomach is to hang the victim over the knee and use your fingers to press on the root of his tongue. If vomiting water mixed with food and coughing occurs, then you need to continue actions until the water completely leaves the stomach and lungs.
	Even if you succeed in inducing a gag reflex, you need to be prepared that the person’s heart will stop.
	The absence of pulsation indicates cardiac arrest. To start it, you need to perform an indirect cardiac massage. · arms straightened at the elbows with palms in the middle of the sternum; · We perform compressions at a frequency of 100 per minute, pressing to a depth of 4-5 cm.
	It is possible to perform artificial respiration on a drowned person, but if there are no means of protection, it is not recommended, since during compressions water from the lungs and stomach will drain from the mouth.
	We resuscitate the patient either until a pulse appears or before the ambulance arrives.
	After breathing and heartbeat have resumed, the victim should be placed on his side,
	The victim must not be left unattended. Repeated cardiac arrest or development of pulmonary edema is possible.
	If the heart stops again, cardiopulmonary resuscitation must be started again.
	Signs of incipient edema are: · wheezing when breathing, similar to bubbling water; appearance of pink foam; · breathing disorder.
	If there are signs of pulmonary edema, then it is necessary to sit the victim in a semi-sitting position.
	Apply tourniquets to the upper third of the thigh.
	Apply something hot to your feet.

After everything possible has been done, you need to wait for the ambulance. It is highly undesirable to take a patient to a medical facility on your own without an accompaniment. V Racha.

Help with asphyxial and syncope drowning

Asphyxial drowning is characterized by laryngospasm, as a result of which a person cannot take a breath. Due to hypoxia, he loses consciousness and may experience cardiac arrest. With syncopal drowning, reflex asystole develops, that is, cardiac arrest.

The victim has a characteristic appearance:

• pale skin color;
• dry foam at the mouth, which is easily removed;
• lack of breathing and heartbeat.

Pre-hospital emergency care for these types includes the following algorithm of actions:

There is no need to empty the lungs of water, since there is none there.

Action	Description
	If you spot a drowning person, you should immediately call an emergency team.
	Bring the victim ashore.
	In winter, you should not waste time transporting the patient to a warm place; resuscitation should begin right on the shore.
	We free the chest from clothing, if any.
	Begin resuscitation of the patient: cardiac massage and artificial respiration in a ratio of 30:2. If there is no result, the victim must be resuscitated within 40 minutes.
	After vascular pulsation appears, you need to take the person to a warm place, change him and give him a warm drink.

Important! Drowning in winter most often develops as asphyxial or syncope.

Cold water leads to a sharp oppression of all metabolic processes in the body, so clinical death may not turn into biological death for a long time.

This means that in winter a drowned person, even after half an hour in the water, has a chance to return to life if first aid is provided correctly.

First aid for drowning in children

Parents should know a clear algorithm for urgent actions.

In children, drowning occurs more often in a swimming pool than in open water.

Helping a drowning child step by step:

Action	Description
	At the first sign of drowning, remove the child from the water.
	Call an ambulance.
	If the child is unconscious, begin CPR. Small children need to perform it at a frequency of 100-120 per minute. In children under 8 years of age, 15 compressions are followed by 2 artificial breaths. In older children the usual ratio is 30:2.
	Indirect cardiac massage is performed by pressing the sternum by 2-3 cm. In adult children it is performed as usual with both hands, and in infants with two fingers.
	Artificial respiration is performed using mouth-to-mouth or mouth-to-nose methods.
	You need to resuscitate the child for at least 40 minutes, especially after removing him from cold water. The child's body is able to survive up to 1 hour of clinical death in ice water without disturbances in the central nervous system.
	After breathing and pulse resume, you need to lay the child on his side and warm him up.

How to provide first aid to an injured child is well shown in the video in this article.

Skills in providing emergency assistance in case of drowning are a guarantee of saving a person from death.

Drowning- this is the closing of the respiratory openings of the mouth and nose by immersing the face in a liquid or semi-liquid medium, causing closure of the airways or reflex closure (spasm) of the glottis, accompanied by disruption or cessation of external respiration and causing death from suffocation.

Drowning can occur while swimming in fresh and salt water, in various reservoirs, rivers, lakes, the sea, a bathtub, falling into a puddle, liquid mud, falling into various containers filled with technical or food liquids, semi-liquid masses, and sewage.

Drowning is facilitated by intoxication, overwork, hypothermia, increased sweating, overheating of the body, fullness of the stomach with food, a sharp change in blood circulation conditions in water, increased stress on the cardiovascular system, mental factors, diseases of the cardiovascular and nervous systems, and injuries.

Swimming in cold water or prolonged exposure to relatively warm water can lead to convulsive contractions of certain muscle groups. This reaction occurs when swimming in one style for a long time, a feeling of fear, and panic. Occasionally, the so-called “immersion syndrome” (water, ice or cryogenic shock) occurs, arising in connection with sharp drop temperatures that cause overirritation of skin thermoreceptors, vasospasm, cerebral ischemia and reflex cardiac arrest.

Most often, drowning is caused by injuries caused by incompetent diving, diving in a shallow place, hitting objects on the water, in the water and at the bottom. Sometimes there is damage from parts of water transport. Damage caused by sharp tools and firearms is extremely rare.

The sudden and rapid immersion of a person in water, depending on the low temperature of the water compared to the body and the surrounding air, hydrostatic pressure changing with the depth of immersion, psycho-emotional stress, causes certain changes that determine the type of drowning and the genesis of death.

Drowning can occur in several types. Among them are: aspiration (true, wet drowning), spastic (asphyxial, dry drowning), reflex (syncope) and mixed types.

Death in water sometimes occurs due to diseases (myocardial infarction, non-traumatic cerebral hemorrhage), as well as injuries not related to drowning.

The pattern and duration of drowning is influenced by a number of conditions, such as the temperature of the water, fresh or salty, the speed of the current, waves, training in cold water, the will to live.

The aspiration type is characterized by filling of the respiratory tract and alveoli with fluid and a significant dilution of the blood by the absorbed fluid. This type of drowning occurs in several phases, just like mechanical asphyxia.

At the onset of true (wet) drowning, the person is conscious and fighting for his life. Trying to escape, thanks to the movements of his arms and legs, he either floats to the surface, then plunges into the water again, screams, calls for help, and grabs onto surrounding objects.

When immersed in water, a person instinctively holds his breath (pre-asphyxial period) for a varying amount of time, depending on his state of health and fitness (about 1 minute), and tries to emerge.

On the surface it takes convulsive breaths and makes chaotic swimming movements. Due to the increasing lack of oxygen in the body, involuntary respiratory movements appear. The accelerated breathing rate during surfacing increases tissue oxygen consumption. Respiratory failure is aggravated by aspiration of even small amounts of water, coughing in response to irritation of the trachea, and bronchospasm. Then comes a deep breath (inspiration), and water under pressure enters the oral cavity, nose, larynx, trachea and bronchi, causing irritation of the receptors of their mucous membranes, which is transmitted to the cerebral cortex, where the process of excitation occurs. Overirritation of the mucous membranes leads to the release of a large amount of mucus containing protein, which during breathing mixes with water and air, forming a persistent grayish-white or pinkish foam, colored in this color by an admixture of blood from the ruptured blood vessels of the alveoli (stage of inspiratory dyspnea).

Taking convulsive breaths while surfacing, a person can swallow water. Full stomach complicates the movement of the diaphragm. Physical stress and fear further increase oxygen deficiency, irritating the respiratory center. Involuntary respiratory movements occur under water (stage of expiratory dyspnea). Following this reflexively a deep exhalation occurs, expelling the air contained there along with the water from the respiratory tract. At 3-4 minutes a spill occurs protective braking bark. By this time, consciousness is usually lost, air bubbles appear on the surface of the water and the person sinks to the bottom. At the middle or end of the second minute after immersion in water, general cramps Due to the spread of overexcitation processes throughout the cortex and their capture of the motor zones of the cortex, reflexes are lost. The person becomes motionless. Next, the waves of initial motor excitation begin to descend into the underlying parts of the central nervous system and, reaching the cervical part of the spinal cord, cause a series of deep but rare breaths with wide open mouth(so-called terminal respiratory movements). Water, when swallowed, enters the stomach and the initial part of the small intestine. In the stage of terminal respiration, it enters the airways in a wide stream under pressure that increases with the depth of the body's immersion, filling the bronchi and alveoli. Due to high pulmonary pressure expansion of the alveoli develops - alveolar emphysema. Water enters the tissue of the interalveolar septa, breaks the walls of the alveoli, penetrates the lung tissue, displaces the air in the bronchi, and mixes with the air contained in the lungs (normally up to 2.5 liters). Through capillaries, water enters the vessels of the pulmonary circulation, significantly diluting the blood and hemolyzing it. Blood diluted with water penetrates the left half of the heart, and then into big circle blood circulation A final cessation of breathing occurs, soon the heart stops working, and after 5-6 minutes death occurs from lack of oxygen (Fig. 281).

When examining a corpse in cases of wet drowning, paleness of the skin is observed, resulting from spasm of the skin capillaries, goose bumps caused by contraction of the muscles that lift the hair, grayish-white or pink persistent fine bubble foam around the respiratory openings of the nose and mouth, described by the Russian scientist Krushevsky in 1870 It occurs as a result of mixing air with a large amount of mucus containing protein, released due to irritation of the mucous membrane of the respiratory tract with water. This foam lasts up to 2 days. after removing the corpse from the water, and then dries to form a film. Its formation is facilitated by the leaching of a surfactant (sulfactant) from the surface of the alveolar epithelium, which ensures the straightening of the alveoli during breathing, which was noted by the Ukrainian scientist Yu.P. Zinenko in 1970

The presence of foam indicates active breathing movements in the process of drowning. Due to the rupture of blood vessels in the alveoli, the released blood turns the foam pinkish.

The spastic type is caused by persistent reflex laryngospasm, which closes the entrance to the respiratory tract due to irritation of the respiratory tract receptors by water.

This type of drowning occurs when water with a temperature of about 20 ° C suddenly enters the upper respiratory tract. Water irritates the mucous membranes and endings of the upper laryngeal nerve, leading to spasm of the vocal cords and reflex cardiac arrest. Spasm of the vocal cords closes the glottis, which prevents water from entering the lungs during a dive and air from leaving the lungs when surfacing. A sharply increased intrapulmonary pressure causes acute asphyxia, accompanied by loss of consciousness. The phases of deep and atonal breathing are manifested by intense movements of the chest. Sometimes there may be no terminal pause. Due to the decline in cardiac activity, conditions are created for the development of pulmonary edema, a violation of the permeability of the alveolar-capillary membranes, which causes the entry of blood plasma into the air spaces of the final units of the lungs (alveoli), which, mixing with air, forms a persistent fine-bubble foam. Edema can also be caused by mechanical damage to the membrane due to a drop in intrapulmonary pressure due to intense false inspiration with a closed glottis.

Sometimes a small amount of fluid enters the airways, which is quickly absorbed, especially in cases of drowning in fresh water, and does not cause blood thinning. On the cut, the lungs are dry, and therefore such drowning is called asphyxial, or dry, or drowning without aspiration of water.

The likelihood of laryngospasm depends on age, body reactivity, gender, water temperature, contamination with chemical impurities, chlorine, sand, shells and other suspended particles. Laryngospasm is most often observed in women and children.

During examination of the corpse, attention is paid to the blue-purple coloration of the skin, especially in the upper parts of the body, abundant confluent cadaveric spots, hemorrhages in the skin of the face and mucous membrane of the eyelids, dilation of the vessels of the white membrane of the eyes. Occasionally, white fine-bubble foam is found around the openings of the nose and mouth.

An internal examination reveals severe emphysema of the lungs, their fluffiness, multiple pinpoint hemorrhages under the organ pleura, epicardium, in the mucous membrane of the respiratory and urinary tract, gastrointestinal tract against the background of dilated vessels. Rasskazov-Lukomsky-Paltauf spots are absent. The right ventricle of the heart is filled with blood. Blood in the heart can be in the form of clots, especially in the case of alcohol intoxication. The stomach usually contains a significant amount of watery contents, and the internal organs are filled with blood.

Sometimes drowning begins as an asphyxial type, and ends as a true drowning, when laryngospasm is resolved by water penetrating the respiratory tract and lungs. You can distinguish true insulation from false insulation by the signs given in table. 26.

Occasionally, signs of asphyxial and true drowning are absent. This kind of drowning is called reflex (syncope). This type is associated with rapid reflex cessation of breathing and primary cessation of cardiac activity as a response of the body to the aquatic environment in extreme conditions(water shock, allergic reaction to water, etc.).

It occurs from the action of cold water on the body, which increases spasm of blood vessels in the skin and lungs. Contraction of the respiratory muscles occurs, resulting in severe disturbances in breathing and cardiac activity, brain hypoxia, leading to the rapid onset of death even before the development of drowning itself. Syncopal type drowned contribute to: emotional shock immediately before immersion in water (shipwreck), hydroshock caused by exposure to very cold water on the skin, laryngopharyngeal shock from the action of water on the receptor fields of the upper respiratory tract, irritation of the vestibular apparatus by water in people with a perforated eardrum.

Death in the waterrarely occurs in expert practice. As a rule, it is observed in people suffering from diseases of cardio-vascular system(angina pectoris, post-infarction cardiosclerosis, acute coronary and respiratory failure), pulmonary tuberculosispneumosclerosis,diseases of the central nervous system (ecilepsy mental disorders). The cause of death in water among divers can be pulmonary barotrauma, nitrogen narcosis, oxygen starvation oxygen poisoning, subarachnoid hemorrhage in diseases of the cerebral vessels, allergic shock to water associated with the effect of an allergen in water on a sensitized organism, fainting followed by a reflex caused by irritation of the nasopharynx and larynx by water, leading to drowning, prolonged exposure to water at a temperature of +20 °C, causing progressive heat loss, leading to hypothermia of the body, damage to the tympanum membranes with subsequent irritation of the middle ear by water and reflex cardiac arrest or water entering the middle ear through a perforated eardrum due to a previous disease, irritation of the vestibular apparatus, leading to vomiting and drowning, loss of orientation in survivors, irritation of water entering the mouth, upper respiratory tract ways, aspiration of vomit upon the onset of unconsciousness.

An internal examination reveals fluid in the tympanic cavities of the middle ear. She penetrates through eustachian tubes or a damaged eardrum. The same fluid is revealed when opening the sinuses of the frontal and basal bones of the skull. It enters these sinuses due to laryngospasm, which causes a decrease in pressure in the nasopharynx and the flow of water into the pear-shaped slits. The volume of water in them can reach 5 ml, which was first noticed and described by V.A. Sveshnikov (1965).

Drowning may be accompanied by an outpouring of blood into the tympanic cavities, mastoid cells and caves. It can be in the form of loose accumulations or abundant soaking of the mucous membranes. Their occurrence is associated with increased pressure in the nasopharynx, circulatory vascular disorders, which, in combination with severe hypoxia, lead to increased permeability vascular walls and an outpouring of blood.

IN tympanic cavity sand and other foreign particles from the reservoir are found. Blood effusions are detected in the middle ear and eardrum.

When examining the corpses of drowned people, bilateral, located parallel to the longitudinal fibers, blood dissections of the sternocleidomastial and large pectoral muscles(Paltauf), broad and scalene muscles, as well as neck muscles (Reuters). They occur as a result of severe muscle tension during an attempt to escape from drowning. Occasionally, vomit is found around the nose and mouth and in their openings, indicating vomiting in the agonal period.

The mucous membrane of the entrance to the upper respiratory tract is reddened, swollen, sometimes with pinpoint hemorrhages, which is explained by the irritating effect of water.

The same foam as in the circumference of the mouth and nose is also detected in the respiratory tract. Sometimes foreign inclusions are found in it (sand, algae, silt, small and large stones), indicating drowning in a shallow place.

Foreign particles can penetrate into the corpse when they are in or remain in the body for a long time. muddy water, containing them, in reservoirs with fast currents, and therefore their evidentiary value is small. Large stones and pebbles that have penetrated deeply into the trachea indicate active aspiration during the convulsive period of drowning. Sometimes gastric contents are found in the respiratory tract, penetrating to the small bronchi. In such cases, it is necessary to note whether it is squeezed out of the bronchi on the incision. Its presence indicates vomiting in the agonal period. Occasionally, mucus is found in the respiratory tract. Foam in the respiratory tract can form as a result of pulmonary edema, during vigorous artificial respiration, mechanical asphyxia from compression of the neck with a noose or hands and, as a result, prolonged agony. The mucous membrane of the trachea and bronchi is edematous, cloudy, the foam is usually unstable and large-bubbly.

Lungs - large, completely fills pleural cavities and sometimes “stick out” from them, cover the heart, are emphysematously swollen, increased in volume and sometimes in weight, which is explained by the penetration of fluid during wet drowning. The edges of the lungs are rounded, overlap each other, and sometimes cover the heart sac. On the surface of the lungs you can see imprints of the ribs, appearing traps, between which lung tissue acts in the form of ridges - “the lung of a drowned man.” Similar imprints are found on the posterolateral surfaces of the lungs. Such changes are explained by the pressure of water penetrating through the respiratory tract into the lungs on the air present there, which breaks the walls of the alveoli and passes under the pulmonary pleura, causing emphysema. Water penetrates to replace the displaced air. As a result, the lungs significantly increase in volume, exerting pressure from the inside on the chest, as a result of which transverse grooves appear on them - traces of pressure from the ribs.

An increase in lung volume occurs during vigorous and prolonged artificial respiration, which must be remembered when examining a corpse. Upper lobes and adjacent ones root of the lung the edges are usually dry and air-stretched. The organ pleura is cloudy, under it there are rather large diffuse reddish-pink spots with indistinct blurry boundaries, described independently of each other by Rasskazov (1860), Lukomsky (1869), Paltauf (1880) and received in the literature the name Rasskazov-Lukomsky-Paltauf spots. Their color and size are determined by the amount of water that has entered the systemic circulation through the torn and gaping capillaries of the interalveolar septa, and by hemolysis of the blood, as a result of which the diluted and hemolyzed blood becomes lighter, its viscosity decreases, it thins out, and the hemorrhages blur, acquiring fuzzy contours. The lungs become “marbled” due to the alternation of protruding pink and receding red areas. Drowning in sea water does not cause hemolysis, and they retain their normal color.

It feels light and doughy to the touch, reminiscent of a sponge soaked in water. With wet drowning, the lungs are distinguished by their enormous volume, with alternating dry areas with watery ones, and take on a gelatinous appearance. A foamy liquid similar to that contained in the respiratory tract flows from the cut surface of such lungs. The lungs are heavy, full of blood, with hemorrhages under the pulmonary pleura.

In cases of dry drowning, the lungs are emphysematously swollen, dry, under the pulmonary pleura, mucous membrane of the gastrointestinal tract, renal pelvis, bladder - Tardieu spots, which form during the period of inspiratory dyspnea. In the initial parts of the respiratory tract there may be particles of sludge, etc. The venous system is congested with blood with a small amount of dark red clots.

Drowning in sea water, which is a hypertonic environment in relation to blood, results in the release of blood plasma into the alveoli, which leads to the rapid occurrence of pulmonary edema and pulmonary failure. The blood does not thin, its viscosity increases, there is no hemolysis of red blood cells, and Rasskazov-Lukomsky-Paltauf spots are not observed. Areas of atelectasis are combined with foci of emphysema and uneven blood supply.

Thinning of the blood contained in the cavity of the left ventricle is a consequence of intravascular hemolysis and is a valuable sign that occurs only during true drowning in fresh water, which quickly permeates the endocardium of the left ventricle and the intima of the aorta.

Examining the corpses of drowned people, F.I. Shkaravsky drew attention to the swelling of the liver, bed and walls of the gallbladder of drowned people.

As a result stagnation and an increase in the volume of fluid in the bloodstream, the volume and weight of the liver increase.

The sections are noticed by the large amount of liquid in the stomach, sometimes mixed with silt, sand, and aquatic plants, which penetrate the stomach when swallowed during drowning. The same fluid is found in the duodenum, where it passes only through the intravital open pylorus as a result of enhanced reflex peristalsis, which can be considered a sign of drowning.

Overfilling of the stomach with swallowed water, especially sea water and polluted water, causes vomiting. On the gastric mucosa there are striped hemorrhages, as well as ruptures in the area of ​​the lesser curvature, resulting from vomiting in the agonal period or hitting the stomach with water. Occasionally, pinpoint hemorrhages occur under the pancreatic capsule.

Signs of a corpse being in water, accompanying signs of drowning, include: wet clothes covered with silt, sand with the presence in its folds of shells, fish, crayfish, water beetles, algae and fungi characteristic of a given body of water, sticky hair, sharp pallor of the skin, raised vellus hair (“goose bumps”), wrinkling of the breast nipples, areola of the breast and mammary glands, scrotum, glans penis, pink color of the skin at the edges of cadaveric spots, rapid cooling of the corpse, skin maceration phenomena, “bath hand”, “skin” laundress", "glove of death", "groomed hand", post-mortem hair loss, rapid development of decay, fat wax, post-mortem damage.

Sharp pallor of the skin is formed when immersed in cold water - below body temperature, which causes contraction of the blood vessels of the skin and pallor of its integument.

The pink color of the skin at the edges of cadaveric spots occurs due to swelling and loosening of the epidermis under the influence of water. This facilitates the penetration of oxygen through the skin, which oxidizes hemoglobin and turns it into oxyhemoglobin.

The pink color of the skin is also observed on the surface of the skin, free from cadaveric spots, if the body is removed from cold water, which was noted by E. Hoffman and A.S. Ignatovsky.

“Goose bumps” are formed when the skin is exposed to cold water or cold alone, and in some disorders of the nervous system - due to contraction of smooth muscles.

The surface of the skin is covered with multiple tubercles, the formation of which is caused by the contraction of smooth muscle fibers connecting the surface layers of the skin with the hair follicles. As a result, they lift them to the free surface of the skin, forming small tubercles at the places where the hairs emerge.

Irritation of the skin by water leads to a contraction of the muscle fibers of the breast nipples, the areola of the breast, and the scrotum, as a result of which their contraction occurs 1 hour after being in the water.

Their development is significantly influenced by the temperature of the environment, air, depth of the reservoir, concentration of salts in the environment (fresh or salty), mobility of water (standing or flowing), flow speed, thermal conductivity of the environment, clothing, gloves and shoes.

Maceration is one of the signs of a corpse being in water. Maceration, or softening, is formed under the influence of water, as a result of which the epidermis becomes soaked, swells, wrinkles and gradually peels off on the palms and soles. Maceration is clearly visible in places where the skin is thick, rough, and calloused. It starts with the hands and feet. Initially, whitening and fine folding of the skin appear (weak maceration, “bath skin”), then a pearly white color and large folding of the skin (clearly expressed signs of maceration - “washerwoman’s skin”). Gradually, complete separation of the epidermis occurs along with the nails (sharply expressed signs of maceration). The skin is removed along with the nails (the so-called “death glove”). After its removal, smooth skin devoid of epidermis remains (the “sleek hand”).

Subsequently, maceration spreads to the entire body.

Warm running water accelerates maceration. Cold water, gloves and shoes delay it. The degree of development of maceration allows us to roughly judge how long the corpse has been in the water. The literature presents different periods of appearance of initial and final signs of maceration without taking into account water temperature. The most complete terms of development of skin maceration depending on water temperature were studied by Ukrainian scientists E.L. Tunina (1950), S.P. Didkovskaya (1959), supplemented by I.A. Kontsevich (1988) and are presented in table. 27.

Due to loosening of the skin after about 2 weeks. hair loss begins and by the end of the month, especially in warm water, complete baldness occurs. In places where hair has fallen out, their holes are clearly visible.

The presence of vernix lubrication protects the skin of newborns from maceration. Its first signs appear by the end of 3-4 days, and complete separation of the epidermis - by the end of the 2nd months in summer and for 5-6 months. in winter.

A drowned person sinks to the bottom and at first, if there is no strong current, remains in place, but rot develops and the corpse floats to the surface.

Putrefactive changes begin to develop from the intestines, then the corpse floats up if there are no mechanical obstacles. The lifting force of putrefactive gases is so great that a load weighing 30 kg with a total weight of 60-70 kg is not an obstacle to ascent.

D.P. Kosorotov (1914) gives an example when a ship with 30 oxen in the hold sank in the ocean off the coast of India. All efforts to raise it from the water were in vain, but after a few days the ship floated to the surface due to the development of putrefactive gases in the corpses of the oxen.

In warm water, decay processes develop faster than in cold water. In small bodies of water with a water temperature of more than 22 °C, a corpse can float to the surface on the second day. In central Russia, corpses float to the surface on the second or third day, depending on the water temperature. According to the Japanese researcher Furuno, from July to September, in cases of drowning at a depth of 1-2 m, the corpse floats up after 14-24 hours, at a depth of 4-5 m - after 1-2 days, at a depth of 30 m - after 3-4 days . In winter, corpses can remain in the water for up to several months. Rotting in water occurs more slowly than in air, but after removal from water, putrefactive processes proceed extremely rapidly. Within 1-2 hours after removing the corpse, the skin takes on a greenish color, cadaveric emphysema develops, the corpse begins to swell, the skin becomes dirty green, a putrefactive venous network and blisters appear. A foul odor emanates from the corpse. In corpses that are in water for 18 hours in summer and 24-48 hours in winter, along with whitening of the hands and feet, the light blue color of the skin turns into a brick-red color of the head and face to the ears and the upper part of the occipital region. The head, neck and chest acquire a dirty green color interspersed with dark red after 3-5 weeks in summer, after 2-3 in winter months In 5-6 weeks. in summer and winter more than 3 months the body is swollen with gases, the epidermis peels off everywhere, the entire surface takes on a gray or dark green color with a putrefactive venous network. The face becomes unrecognizable, the color of the eyes is indistinguishable. Determining the length of time a corpse spent in water becomes impossible in the summer after 7-10 weeks. and in winter after 4-6 months due to the development of putrefactive changes. If something prevents the ascent, then the rotting that has begun is stopped and the formation of adipose wax gradually occurs.

Occasionally, corpses removed from the water are covered with algae or fungi. In corpses in running water, vellus algae in the form of scattered shaggy areas are found on the 6th day, on the 11th day they are the size of a nut, on the 18th day the corpse is dressed as if in a fur coat of algae, which after 28- After 30 days they fall off, after which on the 8th day a new growth follows, which has the same course.

In addition to these algae, after 10-12 days, mucus-like fungi appear in the form of small circles of red or of blue color with a diameter of 0.2-0.4 cm.

The presence of a corpse in water is judged by the presence of fluid in the tympanic cavity of the middle ear, in the sinuses of the main bone (V.A. Sveshnikov’s symptom), fluid in the respiratory tract, esophagus, stomach, small intestine, pleural (Krushevsky’s symptom) and abdominal (Moro’s symptom) ) cavities, plankton in the lungs when the skin is intact and in other organs when it is damaged.

Moro in the pleural and abdominal cavities discovered blood-colored liquid in an amount of up to 200 ml, which leaked into the pleural cavities from the lungs, and into the abdominal cavity from the stomach and intestines. How long the corpse has been in the water can be determined by the flow of fluid into the pleural cavities and the disappearance of signs of drowning. The presence of fluid in the pleural and abdominal cavities indicates that the corpse had been in water for 6-9 hours.

The enlargement of the lungs when the corpse is in water gradually disappears by the end of the week. Rasskazov-Lukomsky-Paltauf spots disappear after the corpse remains in water for 2 weeks. Tardieu spots are detected on the surface of the lungs and heart up to a month after drowning (Table 28).

Laboratory diagnostics for drowning

Many laboratory methods have been proposed for the diagnosis of drowning. Among them, the most widespread are microscopic research methods - the histological method of studying diatoms plankton and pseudoplankton.

Plankton- the smallest organisms of plant and animal origin found in tap water, water of various bodies of water, in the air. They are characteristic of a given reservoir and have specific features. In the diagnosis of drowning highest value has phytoplankton, and especially diatoms. Their shell consists of silicon, which can withstand high temperatures, strong acids and alkalis. The shape of the diatom is varied and typical for each body of water.

Plankton, along with water, enters the mouth, from there into the respiratory tract, lungs, from them through the vessels into the left heart, the aorta and through the vessels spread throughout the body, lingering in the parenchymal organs and bone marrow ge long tubular bones(Fig. 282). Plankton persists for a long time in the sinuses of the main bone and can be found in scrapings from its walls. Along with water from the lungs, grains of sand and starch grains suspended in water, the so-called pseudoplankton, can also enter the bloodstream (Fig. 283). Until recently, methods for detecting plankton and pseudoplankton were considered the most convincing methods for diagnosing drowning. Their subsequent examination showed the possibility of post-mortem penetration of plankton elements into the lungs and other organs of the corpse with damage to the skin. Therefore, the detection of plankton and pseudoplankton has evidential value only if the skin is intact.

Currently, the histological method of studying internal organs has become widespread. The most characteristic changes are found in the lungs and liver. In the section of the lungs, foci of atelectasis and emphysema, multiple ruptures of the interalveolar septa with the formation of so-called spurs facing the inside of the alveoli, focal effusions of blood into the interstitial tissue, and swelling are revealed. In the lumen of the alveoli there are light pink masses with an admixture of a certain amount of erythrocytes.

In the liver there are signs of edema, expansion of precapillary spaces with the presence of protein masses in them. The wall of the gallbladder is swollen, collagen fibers are loosened.

A human corpse found or recovered from water may show a variety of injuries. A correct assessment of their morphology and localization will allow a correct assessment of what happened and avoid wasting time searching for non-existent intruders. The main questions that an expert must answer are: by whom, during what, by what and how long ago the damage was caused.

The most common injuries occur during diving. They are formed when the jump technique is performed incorrectly, hitting objects on the path of the fall, objects in the water, hitting the water, hitting the bottom and objects on it and in it. Impacts on objects in the path of falling, located in water, and objects at the bottom cause extremely varied damage, reflecting the characteristics of the contacting surfaces and localized in any of the areas of the body, on any of its surfaces, sides, levels (Fig. 284).

When assessing them, it is necessary to take into account the position of the corpse in the water after death. The human body in its own way specific gravity slightly heavier than water. The presence of a small amount of clothing and gases in the gastrointestinal tract allows the corpse to remain at the bottom for a certain time. A significant amount of gases in the gastrointestinal tract and developed during the process of decay quickly lifts the corpse from the bottom, and it begins to move under water and then floats to the surface. Persons in warm clothes sink to the bottom faster. The dressed corpses of men usually float face down, with their heads bowed, the corpses of women float face up, and their legs, weighed down by a dress, can be lowered below the head. This situation is explained anatomical structure male and female bodies.

The impact of a stream of water at the moment of entering it sometimes causes ruptures of the eardrum. The entry of water into the middle ear cavity causes loss of orientation of movements in the water. Those who jump into the water experience ruptured eardrums, injuries in the lumbar region, contusions and dislocations of the lumbar spine due to bending of the body entering the water, sprains of ligaments and muscles, depression spinous processes of the vertebrae, spinal fractures from impact with water. If you fall into the water incorrectly, there may be bruises and ruptures of internal organs, shock, fractures of tubular bones, and dislocation of the shoulder joint.

Occasionally, the injuries found in victims are not fatal in themselves, but can cause a short-term loss of consciousness sufficient to cause drowning.

Hitting the water while entering it flat causes bruises, bruises and damage to internal organs, the severity of which is determined by the angle and height of the fall. A blow to the epigastric region of the abdomen or the external genital area sometimes causes shock, leading to death. An incorrectly performed “soldier” jump with legs spread apart causes bruises of the heels, scrotum, and testicles with the subsequent development of traumatic epididymitis. The “swallow” jump causes damage to the hands of one or both hands, any surface of the head, the chin, and at the handle of the sternum from a blow with the chin. Fractures of the base of the skull and spine are sometimes observed, accompanied by trauma to the brain and spinal cord, causing paralysis of the limbs due to the level of damage to the spinal cord.

Drowning in a shallow place is accompanied by the formation of abrasions on the limbs and torso from impacts on the bottom and objects located on it.

Parts of sea and river vessels cause a variety of damage, including body separation. The rotating propeller blades cause slash-like damage. The presence of several equally directed fan-shaped wounds indicates the action of propeller blades that have the same direction of rotation.

The significant time spent by a corpse under water in a stagnant body of water and developing putrefactive changes do not exclude the possibility of the corpse moving along the bottom and in various layers of water, dragging along the bottom with impact on various objects located in the water and on the surface. In bodies of water with running water, the listed damage can occur even before putrefactive changes develop. In mountain rivers and fast-flowing rivers, corpses sometimes travel a considerable distance. Depending on the topography of the bottom, objects on it and individual stones, rapids, driftwood, clothing and shoes are sometimes completely removed, and the remaining ones suffer from various damage caused by friction and snagging. Damage to a corpse caused by dragging and impact is localized on the skin, nails and even bones of any surface of the body. For water movement, transverse tears in the trouser legs are typical in the area knee joints, wear on the toes of shoes in men and heels in women, abrasions on the back of the hands. This localization and morphology of the damage is explained by the fact that the man’s corpse floats face down, and the woman’s – up. In these cases, cadaveric spots in men primarily form and are located on the face.

Damage caused by sharp objects can be caused by dragging along the bottom, but unlike sharp tools and weapons used to take life, these damages are single, superficial, localized in various areas of the body, including those inaccessible to one’s own hand.

Damage to corpses in water is sometimes caused by water rats, snakes, crayfish, fish, snails, stingrays, crabs, amphipods, birds, and leeches. Leeches cause typical damage, forming multiple T-shaped superficial wounds. Fish gnawing on a corpse leave funnel-shaped depressions on the skin. Crayfish and crustaceans can eat anything soft fabrics, penetrate the cavities and eat all the internal organs.

Atonal injuries occur in the final stages of drowning during convulsions. They manifest themselves as abrasions, broken nails, bruises on the forearms, abrasions on the anterolateral surfaces of the body, etc.

Attempts to provide assistance are accompanied by extensive abrasions on the lateral surfaces of the chest. Their presence indicates artificial respiration and chest compressions.

Damage from rough removal from the water with hooks, “crampons”, etc. are localized in any area of ​​the body and reflect the characteristics of their active part.

Inspection of the scene of a drowning incident

The investigator's protocol for examining the scene of the incident must reflect the temperature of the water and air, the mobility of the water, the speed of the current, the depth of the reservoir, the position of the corpse in the water - face up or down, and the method of removing the corpse from the water. The corpse is oriented in relation to the flow of the river, its turn or some other fixed landmark.

By examining the corpse, the presence or absence of objects holding the body on the surface of the water (life jacket, etc.) or contributing to its immersion (stones tied to the body, etc.) is noted.

Damage to clothing and shoes is described according to generally accepted schemes. Examining the skin, note its pallor or pinkish color, the presence or absence of goose bumps.

Particularly carefully at the scene of the incident are studied cadaveric phenomena, which, after removing the corpse from the water in the air, develop extremely quickly. The examination focuses on the color of the corpse's spots, which have a pinkish tint, indicating the presence of the corpse in water, their localization on the face and head, indicating the position of the corpse in the water, the degree of development of putrefactive changes, indicating where they are most pronounced, the presence or absence of hair, the degree of their retention by pulling the hair in different areas of the head. If there is no hair, the area and degree of expression of their holes is indicated.

When examining the face, note the presence or absence of pinpoint hemorrhages in the connective membranes of the eyes, dilation of their vessels, accumulations of fine bubble foam in the openings of the nose and mouth, the amount and color (white, gray-red), vomit, damage in protruding areas of the face.

When describing the body of a corpse, they focus on the wrinkling of the areola, nipples, scrotum and penis.

When recording signs of skin maceration, indicate: localization of areas (palm surface, nail phalanges, plantar and dorsal surfaces of the feet, etc.), the severity of maceration - whitening, loosening, swelling of the epidermis, folding (shallow or deep), coloring, degree of retention of the epidermis by stretching, absence of epidermis on the extremities, swelling and separation of it in other areas of the body from underlying layers of skin.

When examining the hands, they note the clenching of the fingers into a fist, the presence of sand or silt in it, abrasions with traces of sliding on the back surface of the hands, the presence of sand, silt under the nails of the fingers, etc.

It is not advisable to untie tied hands and feet at the scene of the incident, since it is better to carefully examine the knots and loops during the examination of the corpse in the autopsy room. At the scene of the incident, they describe the material from which the knots and loops are made, and their location on the limbs. The load tied to the corpse is not removed at the scene of the incident, indicating only the place of fixation, and is sent for examination along with the corpse.

Algae and fungi are described by indicating location, color, degree of distribution over surfaces and areas of the body, type, length, thickness, consistency, and strength of connection with the skin.

Before taking a water sample, it is necessary to rinse a liter glass twice with water from the given body of water in which the drowning occurred. Water is taken from the surface layer at a depth of 10-15 cm at the place of drowning or the place where the corpse was found. The container is closed and sealed by the investigator; the label indicates the date, time and place where the sample was taken, the name of the investigator who collected the water, and the case number for which the water was collected.

When corpses are found in puddles or containers (including bathtubs), their size, the depth of the container, what and how much they are filled with, and the temperature of the liquid are noted. If there is no water in the bath, this must be reflected in the protocol.

When describing the pose of a corpse, they indicate which areas of the body are immersed in liquid, which are above it, if the body is completely immersed in water, then at what depth it is and in what layer of water. If the corpse comes into contact with container parts, then the contacting area of ​​the body and parts are described. Diagnosis of drowning is based on a combination of morphological features of laboratory test results and the circumstances of the case, which can be decisive in establishing the type of drowning and death in water. Drowning - an accident - is evidenced by eyewitness testimony about the circumstances of immersion in water, alcohol consumption (confirmed by the results of laboratory tests), and the presence of diseases.

Suicide is supported by the failure to take rescue measures, tying up a load, tying up limbs, and the presence of non-lethal injuries that suicides inflict near water. In these cases, death occurs not from injuries, but from drowning. Criminal deprivation of life is indicated by the presence of injuries that the victim could not have caused to himself.

Information necessary for an expert to conduct an examination in case of drowning

In the establishing part of the resolution, the investigator must reflect: from which body of water the corpse was extracted, the place of its discovery - in the water or on the shore, full or partial immersion in water, whether there was a person in the water, the temperature of the water and air, the speed of the current, the mobility of the water, the depth of the reservoir , method of extraction from the water (with hooks, crampons, etc.), testimony of witnesses about the circumstances of the victim’s immersion in the water, an attempt to stay on the surface of the water, alternating immersion with appearing above the surface of the water, information about the previous fight, drinking alcohol, diving, participation in competitions on water, a shipwreck, provision of first aid by a specialist or an outsider, diseases that the victim had at the time of drowning and had suffered previously.

The type of drowning (true or asphyxial) determines one or another morphological picture revealed by examination of the corpse.

External examination of a corpse in a dissection room differs from that at the scene of the incident in the particular thoroughness of the examination and recording of the identified features of nodes and loops, weighing of the load used to hold the corpse at the bottom, sketching and detailed photographing of the damage.

Internal examination uses a variety of sectional techniques and additional research methods aimed at detecting injuries, changes typical of drowning, and painful changes that contribute to death in water.

Hemorrhages are found in the soft coverings of the head, which may be the result of pulling the victim by the hair. It is obligatory to open the cavities of the middle ear, sinus of the main bone, with a description of their contents, its nature and quantity, condition eardrums, the presence or absence of holes in them, examination of the muscles of the torso, opening of the spine, examination of the spinal cord, especially in the cervical region. When examining the neck and its organs, they focus on the presence of soft tissue dissections with blood, fine bubble foam in the respiratory tract, its color, quantity, foreign fluid, sand, silt, pebbles (indicating their sizes), note the presence, nature and amount of free fluid in pleural and abdominal cavities. Carefully examining the lungs, record their size, traces of pressure from the ribs, describe their surface, shape and contours of hemorrhages, pay attention to gas bubbles under the pulmonary pleura, the consistency of the lungs, color on the section, the presence and amount of edematous fluid or dryness of the cut surface, reflect the blood supply of the lungs , heart and other organs, blood condition (liquid or with clots). To clarify the dilution of blood with water, a simple test is used, which is made by applying a drop of blood from the left ventricle to filter paper. Thinned blood forms a lighter ring, indicating hemolysis and blood thinning.

When examining the gastrointestinal tract, the presence of foreign bodies and fluid in the stomach and duodenum, its nature and quantity (free fluid, dilution of the contents) are noted. The stomach and duodenum are bandaged before being removed from the corpse, and then, above and below the ligatures, they are cut and placed in a glass vessel to settle the liquid. Dense particles will settle to the bottom, with a layer of liquid above them sometimes covered with foam. The presence of fluid in the duodenum is one of the most reliable signs drowning, indicating increased peristalsis, but this sign has diagnostic value only on fresh corpses. Particular attention is paid to the lesser curvature of the stomach, where there may be ruptures of the mucous membrane. The diagnosis of drowning is confirmed by laboratory tests for the presence of diatom plankton elements in the internal organs. For the study, an unopened kidney is taken with a ligature placed on the pedicle in the hilum area, about 150 g of the liver, the wall of the left ventricle of the heart, brain, lung, fluid from the cavity of the middle ear or the sinus of the main bone. The femur or humerus is completely removed from putrefactively altered corpses. In addition to testing for diatom plankton, it is also necessary to carry out a histological study to determine changes caused by drowning and diseases that contribute to death in water.