Drowning. Causes and mechanism of development of a pathological condition

At the first signals of the victim, you need to rush to help him, but first assessing your safety.

Rest near a pond, if safety rules are not followed, may result in the development of drowning. This is often due to alcohol intoxication, damage to the spinal cord when diving in an unknown location, or due to reflex cardiac arrest. The first thing to do when drowning is to get the victim and call an ambulance. But until the team arrives, biological death may occur. Therefore, in order to prevent a tragic outcome, you need to know how first aid is provided for drowning at the pre-medical stage.

Difficulties in providing emergency care lie in the fact that different types of drowning are distinguished. Before you indicate the sequence of the implementation of assistance, you need to analyze the causes and mechanisms of the development of different types of drowning.

There are 3 types:

True drowning

The true is divided into drowning in fresh and sea water. It develops when water enters the lungs, most often during swimming. When removing the victim, his mouth often foams. The most common species.

Asphytic drowning is formed when ice or chlorinated water enters the trachea, which causes a reflex spasm of the vocal cords - laryngospasm. This is how people who do not swim well or are intoxicated usually drown.

Syncope drowning is when, when falling from a height, upon contact with cold water, reflex cardiac and respiratory arrest 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 by 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.

A sudden hit of the body in ice water when falling from a height can cause reflex cardiac arrest.

Help with true drowning

This is the most common type of drowning. Drowning victims can be both people who cannot swim, or intoxicated, and professional swimmers. The appearance of the victim after being taken out of the water has specific characteristics:

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

While in the water, for whatever reason, a person begins to drown. For the maximum possible time he tries not to breathe, which leads to a blackout due to oxygen starvation of the brain. After that, water in large quantities fills the lungs and stomach.

Whether fresh or salty water, it damages the lungs, destroying them. With true drowning, excess fluid enters the bloodstream, an overflow of the circulatory system is formed, with which the heart may not be able to cope and will stop, if this has not already happened at the time of its extraction from the water.

Important! A drowning man can only be helped by someone with the skills of a lifeguard, a good swimmer and a physically developed person. An untrained and poorly floating helper can drown with the victim. Therefore, before jumping into the water, you need to weigh your strength. If you are unsure of them, then it makes more sense to call someone for help.

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

First aid for drowning begins with taking the patient to the shore.

Important! As soon as it became known that someone has drowned or is drowning, then an ambulance team must be called immediately. It should be borne in mind that water bodies are usually located far from the city and emergency stations.

After delivering the victim to the shore, you need to immediately start providing first aid emergency aid. In rescuing a drowning person, the main thing is to quickly navigate the situation, since every minute counts.

Act	Description
	If the victim shows signs of life, it is necessary to urgently remove the 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 weigh the victim over the knee and press on the root of the tongue with your fingers. If there is vomiting of water mixed with food and a cough, then you need to continue the actions until the water completely leaves the stomach and lungs.
	Even if it was possible to induce a gag reflex, you need to be prepared that a person's heart will stop.
	The absence of pulsation indicates cardiac arrest. To start it, you need to perform an indirect heart massage. • arms are straightened at the elbows with palms in the middle of the sternum; We carry out compressions at a frequency of 100 per minute, pushing to a depth of 4-5 cm.
	It is possible to give artificial respiration to a drowned person, but if there are no protective equipment, then it is not recommended, since during the compressions, water from the lungs and stomach will leave the mouth.
	We reanimate the patient either before the pulse appears or before the ambulance arrives.
	After the resumption of breathing and heartbeat, you need to lay the victim on one side,
	The victim must not be left unattended. Re-cardiac arrest or pulmonary edema may develop.
	If the heart stops again, CPR should be started again.
	Signs of incipient edema are: Wheezing when breathing, similar to the bubbling of water; · The appearance of pink foam; • respiratory failure.
	If there are signs of pulmonary edema, then it is necessary to seat the victim in a half-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 team. It is highly undesirable to take a patient to a medical facility on your own without an escort incrustacean.

Asphyxia and syncope drowning assistance

Asphytic drowning is characterized by laryngospasm, due to which a person cannot breathe. Against the background of hypoxia, he loses consciousness and can survive cardiac arrest. With syncope 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-medical emergency care for these types includes the following algorithm of actions:

There is no need to empty the lungs of water, since it is not there.

Act	Description
	If a drowning person is identified, you must immediately call the emergency team.
	Deliver the victim to the shore.
	In winter, do not waste time transporting the patient to a warm place, resuscitation should be started right on the shore.
	We release the chest from clothes, if any.
	Start resuscitation of the patient: heart massage and artificial respiration in a ratio of 30: 2. If there is no result, the victim must be resuscitated within 40 minutes.
	After the appearance of pulsation of blood vessels, you need to take the person to the warmth, change his clothes and give him a warm drink.

Important! Drowning in the winter most often develops as an asphytic or syncopal type.

Cold water leads to a sharp suppression 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 man, even after half an hour in the water, has a chance to return to life with proper first aid.

First aid for drowning children

Parents should know a clear algorithm for urgent action.

In children, drowning develops more often in the pool than in the open water.

Help for a drowning child on points:

Act	Description
	At the first sign of drowning, remove the child from the water.
	Call an ambulance.
	If the child is unconscious, start cardiopulmonary resuscitation. Small children need to carry out it at a frequency of 100-120 per minute. In children under 8 years of age, after 15 compressions, 2 artificial breaths follow. In older children, the usual ratio is 30: 2.
	An indirect cardiac massage is performed with pushing the sternum 2-3 cm. In adult children, it is performed as usual with both hands, and in infants with two fingers.
	Artificial respiration is performed by mouth-to-mouth or mouth-to-nose methods.
	The child needs to be resuscitated 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 the resumption of breathing and pulse, you need to lay the child on one side, warm it up.

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

Drowning emergency skills are a guarantee of saving a person from death.

The most common cause of death in nature is drowning. At risk are not only those who cannot swim, but also people who are in a state of altered consciousness, as well as children and heart disease.

Terminology

According to the latest amendments, drowning is a process that causes damage to the respiratory tract due to being in a liquid environment. Previously, this definition sounded like death from the ingress of water (or other liquids) into the respiratory tract and lungs. But it was not accurate enough.

The modern formulation implies that the liquid becomes a barrier to air entering the respiratory tract. But this does not mean that a person must necessarily die. It will count as drowning anyway.

Drowning types

There are several types of drowning, depending on the mechanism of the process:

1. True (wet), also called aspiration - occurs when the lungs or airways are filled with a large amount of fluid. It usually happens if a person flounders with the last bit of strength.
2. False (dry), or asphyxical drowning - occurs due to reflex spasm of the glottis. In this case, neither air nor liquid gets into the lungs, and the person dies from suffocation.
3. Syncope drowning - occurs in cold water. It causes reflex vasospasm and cardiac arrest. Death in water, in fact, has nothing to do with the liquid that enters the respiratory tract after the victim has dived to the bottom.
4. Mixed type - characterized by the presence of signs of several types of drowning at once.

Reasons for drowning

First of all, drowning occurs due to the fact that bathers neglect the rules of behavior on the water, such as: "do not swim behind the buoys", "do not swim in reservoirs with an unknown bottom", "do not swim in a storm." In addition, people who cannot swim and suddenly fall into the water at a considerable depth begin to flounder, quickly waste energy and air, and thereby accelerate their dive.

Scuba divers and divers often fail to time the correct time and drown, or they develop an attack of decompression sickness if they ascend too quickly. Factors such as waterfalls and whirlpools, strong currents or muddy bottoms are of particular importance.

Drowning mechanism

Death in water can be roughly divided into two types: freshwater and sea, because the chain of pathological reactions will be different. Fresh water enters the bloodstream through the wall of the alveoli and dilutes it. Consequently, the volume of circulating fluid (BCC) rapidly increases, the load on the heart increases, and all this leads to its arrest. In addition, due to fresh water, hemolysis (destruction) of erythrocytes occurs. At the same time, the amount of free bilirubin, hemoglobin and potassium increases in the body. The kidneys cannot cope with this load and may fail.

Drowning in salt water, on the contrary, leads to thickening of the blood, and as a result, increased thrombus formation. Most often, cardiac arrest occurs due to coronary artery thrombosis. Syncope drowning has a reflex mechanism and is not related to the mineral composition of the liquid, but directly depends on its temperature and the conditions under which a person was in the water (for example, a sharp blow when falling).

Critical periods

With true drowning in water, three clinical periods are distinguished:

1. Initial, during which the victim can still hold his breath. If a person is saved at this moment, then he will react inadequately to the situation, his skin and mucous membranes are cyanotic, breathing is frequent, shallow, noisy. There may be a cough. High blood pressure is replaced by hypotension and bradycardia. There can be a significant amount of water in the stomach and vomiting is possible. A person usually recovers quickly from an accident.
2. The agonal period is characterized by the fact that the victim is unconscious. He still has heartbeat and breathing, but muscle activity is fading away. The skin is bluish, cold. At this point, pulmonary edema sets in, and a dense pink foam comes out of the mouth.
3. Clinical death does not outwardly differ from the agonal period. The person is motionless, there is no pulse even on the large arteries, cardiac arrest is observed. without reaction to light. If you get a person out of the water at this moment, then cardiopulmonary resuscitation is unlikely to be successful.

Symptoms

While a person is still in the water, the following signs of drowning can be distinguished:

• the characteristic position of the head relative to the body (if the victim lies on his back, then the head is thrown back, and if on the stomach, the head is completely immersed in water);
• the eyes are closed or hidden under the hair;
• convulsive sighs are possible;
• the person makes attempts to roll over.

Asfectic drowning is characterized by alcohol intoxication or head injuries. arrhythmic, palpable only on large vessels. The lower airways are usually clear or contain little fluid. Death occurs in four to five minutes. Laryngospasm and tooth clenching prevent resuscitation.

Syncopal drowning is possible even from a small amount of water. In this case, it comes quickly. The skin color during syncope drowning is very pale, the pupils do not react to light, and "ice shock" develops.

Forensic-medical examination

Syncope drowning leaves behind the characteristic signs that can be seen on autopsy at the forensic office. Among others, signs of rapid death prevail, such as bright cyanotic spilled liquid blood in the cavities of the heart and great vessels, as well as the absence of pink persistent foam at the mouth.

In addition, with true drowning, fluid is found in the terminal sections of the bronchioles and in the sphenoid bone of the skull, the lungs are swollen, ribs are imprinted on them, there are hemorrhages under the pleura. Plankton living in the reservoir is found not only in the stomach and lungs, but also in other organs, which suggests that it got there with the blood stream.

You can also identify signs of finding a corpse in water: the skin is pale, wrinkled at the fingertips (the so-called "washerwoman's hands"), and with prolonged exposure to the liquid, it can slip off along with the nails like gloves. The presence of sand, silt and algae on the victim's clothes and hair also suggests that the corpse was fished out of the water.

The longer the body is in the water, the more difficult it is to determine the cause of death, and if they have any injuries on it, the marine fauna will quickly reach the corpse and can damage the remains to such an extent that all physical evidence will be destroyed.

Emergency care algorithm

These rules are the same for all types of water assistance. when drowning is a sequential algorithm of actions that will help you quickly make a decision in a critical situation.

First, you need to make sure that the life of the rescuer is not in danger. This is important because the benefits of salvation must outweigh the potential harm. The victim is removed from the water. This must be done carefully, as the person may have a spinal fracture and therefore must be transported from the reservoir on a board or shield.

Secondly, to lay the victim so that his stomach rests on the knee of the rescuer, but only on condition that no more than three to five minutes have passed since the moment of drowning. If at the time of catching a person from a reservoir he has long been unconscious, then you must immediately proceed to Clean the oral cavity for better air passage. At this stage, be sure to call an ambulance.

From the third step, emergency care for drowning begins - you need to check the pupils, pulse, and the presence of breathing. Then, after making sure that all of the above signs are absent, CPR should be started. Continue pumping your heart and breathing in air until the ambulance team arrives. Failure to breathe spontaneously can save the victim's life.

Assistance in drowning after restoration of breathing, heartbeat and consciousness consists in warming a person and controlling vital signs. Unfortunately, nothing significant can be done for the victim before the arrival of the doctors.

Treatment

Properly provided emergency care for drowning can help doctors stabilize the victim in the future. If spontaneous breathing has not recovered, then the patient is transferred to artificial lung ventilation, the trachea and bronchi are sanitized. Drug therapy necessarily includes the prevention of pulmonary edema and acute cardiovascular failure. If the drowning was in fresh water, then diuretics and blood components are prescribed, and when drowning in a salt pond, saline and glucose are prescribed. The acid-base state must be corrected. After emergency measures, as a rule, a short course of antibiotics is prescribed to prevent infection.

Drowning ranks 3rd among the causes of unintentional death and accounts for 7% of all deaths associated with injury. At least 1/3 of the survivors suffer from moderate to severe neurological complications. This water accident is a common cause of disability and death, especially in childhood.

At the 2002 World Congress on the subject in Amsterdam, a group of experts proposed a new consensus definition for drowning in order to reduce confusion over the number of terms in the literature, there are more than 20. The definition given by experts is: to primary respiratory failure from immersion in a liquid medium. "

Table of contents:

We will use the old wording to make it easier for readers to understand the types of state.

Additionally, the type of water in which the immersion took place is considered: fresh or salty. This is important for the second stage of correction of the condition, since electrolyte disturbances in the blood serum are associated with the salinity of water, especially when a large amount of it is ingested.

The first stage in helping a drowned man is to carry out resuscitation measures.

Drowning can be further classified as damage with cold (air temperature less than 20 ° C) or warm water (20 ° C or higher). Despite the fact that a low temperature leaves more chances for life, secondary hypothermia itself, with prolonged hypothermia, is often fatal.

Infectious complications are more often recorded when liquid gets from a natural or artificial fresh water body.

Prolonged stay in water without breathing affects the central nervous and cardiovascular systems, therefore, correction of hypoxemia (low oxygen content in the blood) and acidosis (violation of acid-base balance with a shift towards the acid side) is performed.

note

The degree of damage to the central nervous system depends on the severity and duration of hypoxia (pathological process in tissues, oxygen starvation, a consequence of hypoxemia).

Preventing violations is key to reducing the morbidity and mortality from drowning.

Knowing the basics of resuscitation can save a person's life and prevent complications.

Breathing stops after 5-10 minutes, and the heart stops 15 minutes after being underwater.

Etiology

Drowning can be primary or occur against the background of the following events:

• acute condition (, etc.);
• damage to the head or spine;
• cardiac arrhythmia;
• or drug intoxication;
• hyperventilation;

The reasons vary depending on age.

Babies

Babies are more likely to drown in tubs or buckets of water. Most of them died during a brief (less than 5 minutes) lack of adult supervision.

Children aged 1-5 years

Tragedy occurs when using swimming pools, in ditches filled with water, garden ponds and water bodies located near the house.

Adequate childcare and limited access to dangerous areas can prevent tragedy in most cases.

Young people aged 15-19

Young people usually drown in ponds, lakes, rivers, seas. Death is caused by spinal and head injuries resulting from diving into an unknown body of water with a shallow depth or with a dangerous bottom (stones, driftwood, metal structures, broken glass, etc.).

Alcohol and, to a lesser extent, drugs were used on many occasions. Australian, Scottish and Canadian researchers showed that 30-50% of adolescents and adults who drowned in boat accidents were intoxicated, which was confirmed by special tests.

All age groups

Conditions that can lead to drowning of a person of any age:

• some neurological diseases associated with a loss of neuromuscular control (severe and other disorders);
• water sports;
• injury to the cervical spine and head trauma associated with surfing, water skiing, diving, diving, etc.
• watercraft accidents and other injuries (bites, lacerations).

note

The appearance of a drowning person in life may differ from the "Hollywood" representations: the victim of water does not always shout, calls for help and waves his hands.

What happens to the human body when drowning

There are several options that lead to an unfavorable outcome without timely assistance.

First option: wet or blue drowning

Drowning in fresh water

Fresh water enters the respiratory tract, lungs and stomach, and then is actively absorbed into the blood, thinning it.

The electrolyte balance is disrupted, erythrocytes are massively destroyed, the oxygen level decreases, and the content of carbon dioxide, toxic to the body, increases.

After resuscitation, the drowned man develops an acute one against the background, the leading symptom is the appearance of bloody foam from the mouth.

So, the changes against the background of fresh water ingress:

• hemodelution;
• hypervolemia, alternating with hypovolemia against the background of pulmonary edema and fluid redistribution;
• hemolysis;
• hyperkalemia;
• hypoproteinemia;
• hyponatremia;
• hypochloremia;
• hypocalcemia.

Drowning in sea water

Sea water has a higher concentration due to the contained salts, compared to fresh liquid and blood.

After the absorption of sea water, thickening occurs, which changes the rheological properties of the blood, and hypovolemia, hypernatremia, hypercalcemia and hyperchloremia also join.

Option two: dry drowning

The mechanism leading to acute hypoxia is different. When exposed to water, reflex closure of the glottis (laryngospasm) develops, which prevents air from entering the lungs.

note

There is no fluid in the respiratory tract.

Most often, pathology is recorded in children and women, when immersed in dirty or chlorinated water.

Liquid is found in large quantities in the stomach.

Option 3: Secondary Drowning

Secondary drowning always accompanies some initial pathology. Loss of consciousness can be triggered, for example, by an epileptic seizure.

Option four: syncope drowning

Spasm of peripheral vessels reflexively leads to cardiac arrest even with minimal water ingress into the respiratory tract.

So, for example, with a sudden immersion in ice water, a spasm of peripheral blood vessels develops with cardiac arrest. Pulmonary edema is uncommon. The skin is pale, there is no bluish tint.

Symptoms and Signs

The clinical picture depends on the length of stay under water, its characteristics, the timeliness and quality of emergency care and the underlying cause.

If the pathological processes have not gone too far, the following symptoms and signs may appear immediately after removal from the water:

• agitation or lethargy;
• cyanosis of the skin;
• noisy breathing with coughing fits;
• instability of blood pressure and heart rate.

The following symptoms are characteristic of agony:

• loss of consciousness;
• violation of the heart rhythm;
• visualization of swollen cervical veins;
• the appearance of foam from the mouth in a small amount with spasm of the glottis (with pulmonary edema - pink foam with blood);
• spastic contractions of the masticatory muscles;
• weak reaction of the pupils to light.

The condition can turn into clinical death: respiratory arrest and absence of a pupillary reflex.

First aid for drowning: how to act

If a person has not yet disappeared under water, it is recommended to swim up to him from behind to prevent a dangerous capture from his side. In a state of shock with paralyzing fear, it is difficult to predict the victim's behavior, so you should not waste time talking, most likely, the potential drowned man no longer perceives the addressed speech.

If, nevertheless, you are captured and pulled down, dive with the drowning person, there is a chance that he will automatically relax his arms in order to make an attempt to stay on the surface.

If the drowning person has gone under water, hold your breath and dive, open your eyes, look around.

If found, take the victim by the hand or hair, push off the bottom and float.

Ask someone to call the resuscitation team.

The victim's lack of breathing is an indication for artificial ventilation, it is recommended to perform it in water, subject to control over the situation and possession of the necessary skills.

note

Rule of 3 "Ps": see, listen, feel.

If there are no injuries, place the drowned person with his stomach on his thigh upside down and with both hands make several strong squeezing movements of the chest in the epigastric region to free the airways from fluid.

With a pale (pale gray skin) drowning against the background of a reflex spasm of the glottis, there is practically no water, so immediately proceed to artificial respiration and indirect heart massage. It is better if you have an assistant: one does artificial respiration, the other does a closed heart massage.

Lay the victim on their back and wrap them in a blanket or blanket.

Often foreign objects (silt, algae, dirt, vomit, mucus, etc.) get into the oral cavity, they must be removed. To do this, wrap a scarf or bandage on 2 fingers and get rid of the excess in a circular motion.

Remove dentures if possible.

Remove clothing from the victim. Remember, even buttons can injure a massage, especially a child.

Proceed with the primary complex of cardiopulmonary resuscitation.

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In a drowned person, paralysis of the respiratory center develops in 3-5 minutes, and the heart continues to work for 15 minutes. If the heartbeat persists, perform only artificial respiration: mouth to mouth, through a handkerchief, with a frequency of 15-18 breaths per minute. The victim's nose should be pinched.

If you can't hear a heartbeat, switch to chest compressions in combination with artificial respiration.

With any type of drowning, it is strictly forbidden to turn the victim's head, this contributes to increased trauma in case of a fracture of the cervical spine.

Transportation is possible only on a hard surface, it is better if a specialized team is engaged in this.

note

Drowning in ice water slows down metabolic processes throughout the body, including in the brain. The chances of recovery in this case are the highest.

Do not waste time moving the victim to a warm room, start resuscitation measures on the spot.

Perform rescue actions before the arrival of an ambulance or until signs of biological death appear (rigor mortis, spots).

If no positive dynamics is observed within 30-40 minutes, there is a likelihood, even with the restoration of breathing and heartbeat, in the future development of severe paralysis and violations of higher brain activity (deep disability).

How are chest compressions and precordial strokes done?

Conditionally divide the sternum into 3 parts and find the border between the middle and lower. In this area, strike with your fist, perhaps the independent heartbeat will be restored. If this does not happen, with the hands clasped in the lock (the leading hand from above), perform rocking movements (2 per second) on the lower sternum.

The arms are perpendicular to the surface of the victim's chest.

For 30 compressions - 2 breaths, if one person performs cardiopulmonary resuscitation. At the time of air injection, cardiac stimulation is stopped.

The drowned person's head is thrown back as much as possible.

For preschool children, massage is performed with one hand, and for infants - with 2 fingers (there is a high probability of rib fracture), the frequency is 100-120 movements per minute.

If 2 people are involved in the assistance, all actions must be coordinated: 4-5 pressures on the sternum on exhalation for one blow of air into the lungs.

Drowning prognosis

Patients who have been resuscitated in a timely manner can fully recover.

Victims who were admitted to the intensive care unit in a coma, with dilated pupils and without breathing, have a serious prognosis.

According to statistics, 35-60% of people needed to continue cardiopulmonary resuscitation upon arrival at the hospital, and 60-100% of the survivors in this group received neurological complications.

Pediatric studies show a 30% mortality rate in children who required specialized treatment for drowning in an intensive care unit. Serious brain damage was recorded in 10-30% of cases.

Mishina Victoria, doctor, medical columnist

Table of contents of the subject "Acute respiratory failure (ARF) in case of airway obstruction. Foreign bodies of the upper respiratory tract. Pulmonary embolism (PE).":
1. Acute respiratory failure (ARF) with airway obstruction. Laryngospasm. Causes (etiology), pathogenesis of laryngospasm. Emergency care for laryngospasm.
2. Bronchiolospasm (bronchial asthma). Causes (etiology), pathogenesis of bronchiolospasm. Emergency care for bronchiolospasm (bronchial asthma).
3. Asthmatic condition. Status asthmaticus. Causes (etiology), pathogenesis of status asthmaticus. Stages of status asthmaticus.
4. Principles of treatment of status asthmaticus. Treatment of status asthmaticus stage 1.
5. Treatment of status asthmaticus 3 (third) stage. Signs of relief of status asthmaticus. Hospitalization issues.
6. Foreign body. Foreign bodies of the upper respiratory tract. Emergency care for foreign bodies.
7. Drowning. True (wet) drowning. Asphyxia (dry) drowning. Syncope type of drowning (death in water). Drowning emergency care.
8. Thromboembolism of the pulmonary artery (PE). Etiology (causes) of thromboembolism. Pathogenesis of pulmonary embolism (PE).
9. Anatomical variants of pulmonary embolism (PE) by localization. Clinical forms of PE. Clinic for pulmonary embolism (PE).
10. ECG (ecg, electrocardiogram) pulmonary embolism (PE). Radiological data of PE. Principles of intensive therapy for pulmonary embolism (PE). Urgent Care.

Drowning. True (wet) drowning. Asphyxia (dry) drowning. Syncope type of drowning (death in water). Drowning emergency care.

Drowning - an acute pathological condition that develops during accidental or deliberate immersion in a liquid, with the subsequent development of signs of ARF and AHF, the cause of which is the ingress of liquid into the respiratory tract.

Distinguish 3 types of drowning in water:
1. True (wet).
2. Asphyxia (dry).
3. Death in water (syncope type of drowning).

Etiology. True drowning... It is based on the ingress of water into the alveoli. Depending on the type of water in which drowning occurred (fresh or sea), there will be a different pathogenesis. Fresh water, due to the difference in the osmotic gradient with blood, quickly leaves the alveoli and enters the vascular bed (see Fig. 10a). This leads to an increase in BCC and hemodilution, pulmonary edema, hemolysis of erythrocytes, a decrease in the concentration of sodium, chlorine and calcium ions in plasma, as well as plasma proteins. When drowning in seawater, as a result of the difference in the osmotic gradient between blood and seawater, and here there is a clear predominance of the seawater gradient over blood, a part of the plasma leaves the vascular bed. In this regard, the mass of circulating blood decreases (up to 45 ml / kg), the hematocrit increases (V.A.Negovsky, 1977).

Figure: ten. Pathogenesis of drowning in fresh (a) and sea (b) water.

Asphyxia drowning occurs without water aspiration. This pathology is based on reflex laryngospasm. The glottis does not allow water to pass through, but it also does not let air through. Death comes from mechanical asphyxia.

Syncope type of drowning (death in water) occurs as a result of reflex cardiac arrest and respiration. The most common variant of this type of drowning occurs when the victim suddenly plunges into cold water.

Clinic... When true drowning is distinguished by 3 periods: initial, agonal and clinical death. The state of consciousness depends on the period of drowning and its type. Respiratory distress can range from noisy to atonal. Cyanosis, chills, goose bumps are observed. When drowning in fresh water, there is a clinic of pulmonary edema, arterial and venous hypertension, tachycardia, arrhythmia. From the upper respiratory tract, foam, sometimes with a pink tint, can be released, as a result of hemolysis of red blood cells. When drowning in sea water, arterial hypotension and bradycardia are more typical.

Urgent Care... Regardless of the water in which drowning occurred, when breathing and cardiac activity stop, the victim needs to carry out a complex of resuscitation measures. Before performing artificial respiration, the upper respiratory tract (URT) should be freed from water and foreign bodies (river sand, algae, silt, etc.). The best way to release the upper respiratory tract, especially in children, is to lift the victim by the legs. If it is impossible to perform this manual, it is recommended to lay the victim with his stomach on the bent knee of the person providing resuscitation care and wait for the fluid to drain from the upper airway (see Fig. 11). This procedure should take no more than 5-10 seconds, after which it is necessary to proceed to the resuscitation aid.

Inpatient treatmentis syndromic in nature and consists of the following areas:
1. Conducting a complex of resuscitation measures and transferring the patient to mechanical ventilation (according to indications).
2. Sanitation of the tracheobronchial tree, therapy of bronchiolospasm, pulmonary edema.
3. Stopping the OSSN.
4. Correction of acid base balance and electrolytes.
5. Prevention of pneumonia and renal failure.

First aid video for drowning patient

Drowning Emergency Care Diagram

Drowning is a type of mechanical suffocation that occurs when the lungs are filled with fluid. The time and nature of death in water depends on external factors and the state of the organism. About 70,000 people around the world die from drowning every year. Mostly young men and children are targeted.

Reasons for drowning

Risk factors are alcohol intoxication, the presence of heart disease in a person, damage to the spine when diving upside down. Also, the reasons for drowning can be a sharp fluctuation in temperature, fatigue, and various injuries during diving.

The risk of drowning is increased in the case of a whirlpool, a high speed of water flow, and the presence of key sources. Being calm in an emergency and not panicking can significantly reduce the risk of drowning.

Types of drowning

There are three types of drowning.

The true form of drowning is characterized by the filling of the airways with liquid to the smallest branches - the alveoli. In the alveolar septa, capillaries burst under fluid pressure, and water or other fluid enters the bloodstream. As a result, there is a violation of the water and salt balance and the breakdown of erythrocytes.

Asphytic drowning is characterized by spasm of the airways, which ultimately leads to suffocation from lack of oxygen. When water or liquid enters the respiratory tract, laryngospasm occurs, which leads to hypoxia. In the last stages of drowning, the airways relax and fluid enters the lungs.

The syncope type of drowning is characterized by the onset of death from reflex cardiac arrest and respiration. This type of drowning occurs from hypothermia or severe emotional distress. It accounts for 10-14% of all drowning cases.

Signs of drowning

The main symptoms and signs of drowning depend on the type of drowning.

With true drowning, there is a sharp cyanosis of the skin and mucous membranes, pink foam is emitted from the respiratory tract, the veins on the neck and limbs are very swollen.

In asphytic drowning, the skin is not as blue as in true drowning. From the lungs of the victim, pink fine-bubble foam is released.

In syncope drowning, the skin is pale in color due to spasm of the capillaries, such victims are also called "pale". This type of drowning has the most favorable prognosis. It is known that with syncope drowning, even after 10 or more minutes of being under water, revival is possible.

It should be noted that the prognosis for drowning in sea waters is more favorable than in fresh water.

Drowning aid

Drowning assistance consists of resuscitation. It must be remembered that the sooner recovery measures are taken, the better the prognosis will be, and the higher the victim's chances of recovery.

The main care for drowning is artificial ventilation and chest compressions.

It is advisable to carry out artificial respiration as early as possible, even during transportation to the shore. First, it is necessary to free the oral cavity from foreign bodies. To do this, a finger wrapped in a bandage (or any clean rag) is inserted into the mouth and all excess is removed. If there is a spasm of the masticatory muscles, due to which it is impossible to open the mouth, then it is necessary to insert a mouth dilator or any metal object.

To free the lungs from water and foam, special suction can be used. If they are not there, then it is necessary to lay the victim with his stomach down on the knee of the rescuer and vigorously squeeze the chest. If for several seconds the water does not leave, you need to start artificial ventilation. To do this, the victim is put on the ground, his head is thrown back, the rescuer puts one hand under the neck, and the other on the patient's forehead. It is necessary to extend the lower jaw so that the lower teeth protrude forward. The rescuer then inhales deeply and, pressing his mouth over the victim's mouth or nose, exhales. When respiratory activity appears in the victim, artificial ventilation of the lungs cannot be stopped, unless consciousness is restored and the breathing rhythm is disturbed.

If cardiac activity is absent, then simultaneously with artificial respiration, it is necessary to perform an indirect heart massage. The hands of the rescuer should be placed perpendicular to the patient's sternum in its lower third. The massage is performed in the form of sharp jerks with relaxation intervals. The frequency of shocks is from 60 to 70 per minute. With the correct implementation of chest compressions, blood from the ventricles enters the circulatory system.

If the rescuer resuscitates alone, alternate cardiac muscle massage and artificial ventilation. For 4-5 pushes, one blow of air into the lungs should fall on the sternum.

The optimal time for resuscitation is 4-6 minutes after rescuing a person. When drowning in ice water, revival is possible even half an hour after being removed from the water.

In any case, as soon as possible, even with the restoration of all vital functions, it is imperative to deliver the victim to the hospital.

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