Table of contents of the topic "Acute respiratory failure (ODN) in the obstruction of the respiratory tract. Non-road bodies of the upper respiratory tract. Thromboembolia pulmonary artery (Tel). ":
1. Acute respiratory failure (ODN) when obstruction of the respiratory tract. Laryngospasm. Causes (etiology), pathogenesis of laryngospasm. Emergency assistance during larying pump.
2. Bronchiolospasm (bronchial asthma). Causes (etiology), pathogenesis of bronchiolesmospasm. Emergency care for bronchio-poise (bronchial asthma).
3. Astmatic state. Asthmatic status. Causes (etiology), pathogenesis of asthmatic status. Stages of asthmatic status.
4. Principles of treatment of asthmatic status. Treatment of asthmatic status of stage 1.
5. Treatment of asthmatic status 3 (thirds) stage. Signs of relief of asthmatic status. Hospitalization issues.
6. Foreign body. Foreign bodies of the upper respiratory tract. Emergency care for foreign bodies.
7. Drowning. True (wet) drowning. Asphisic (dry) drowning. Syncopal type of drowning (death in water). Emergency care when drowning.
8. Long artery thromboembol (TEL). Etiology (reasons) thromboembolism. Pathogenesis of pulmonary artery thrombembolism (TEL).
9. Anatomical variants of pulmonary artery thromboembolism (TEL) on localization. Tel clinical forms. Clinic thromboembolism of the pulmonary artery (TEL).
10. ECG (ECG, electrocardiogram) of pulmonary artery thromboembolism (TEL). Radiological data of TEL. The principles of intensive therapy of pulmonary artery thrombomembolism (TEL). Urgent Care.

Drowning. True (wet) drowning. Asphisic (dry) drowning. Syncopal type of drowning (death in water). Emergency care when drowning.

Drowning - acute pathological condition, developing in a random or deliberate immersion in the liquid, followed by the development of signs of ODN and OSN, the cause of which is the falling fluid to the respiratory tract.

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

Etiology. True drowning. It is based on the population of water in Alveola. Depending on what water was drowning (fresh or marine), there will be a different pathogenesis. Fresh water, due to the difference of an osmotic gradient with blood, quickly leaves the alveoli and penetrates into the vascular channel (see fig. 10a). This leads to an increase in the BCC and hemodilution, elderocyte edema, the hemolysis of red blood cells, a decrease in the concentration of sodium ions, chlorine and plasma calcium, as well as plasma proteins. When drowning in seawater as a result of the difference in the osmotic gradient between blood and sea water, and here there is a clear predominance of the gradient of sea water over blood, part of the plasma comes out of the vascular bed. In this connection, the mass of circulating blood decreases (up to 45 ml / kg), the hematocrit (V. A. Neochsky, 1977) is increasing.

Fig. 10. Pathogenesis of drowning in fresh (a) and sea (b) water.

Asphisic drowning It occurs without aspiration of water. The basis of this pathology is the reflex laryngospasm. The voice gap does not let the water, but it does not let and air. Death comes from mechanical asphyxia.

Syncopal type of drowning (death in water) It comes as a result of a reflex stop of cardiac activity and respiration. The most common version of this type of drowning is marked with a sudden immersion of the victim in cold water.

Clinic. For true drowning is distinguished 3 periods: initial, agonal and clinical death. The state of consciousness depends on the period of drowning and its type. Breathing disorder is possible from noisy to the attrane. Cyanosis, chills, goose skin are observed. When drowning in fresh water, there is a clinic of edema, arterial and venous hypertension, tachycardia, arrhythmia. Foam can be released from the upper respiratory tract, sometimes with a pink tint, as a result of the hemolysis of red blood cells. When drowning in seawater, arterial hypotension, bradycardia is more characteristic.

Urgent Care. Regardless of which water, drowning, when stopping the respiration and cardiac activity, the victim must be carried out by a complex of resuscitation activities. Before carrying out artificial respiration, the upper respiratory tract (VDP) from water and foreign bodies (river sand, algae, il, etc.) should be released. The optimal way of liberating the VDP, especially in children, is the rise of the victims of the legs. If it is impossible to complete this manual, it is recommended to put the victim of the stomach on a bent knee of a person who has resuscitation assistance, and wait for the leakage of the fluid from the VDP (see Fig. 11). This procedure should occupy no more than 5-10 seconds., After which it is necessary to proceed with the resuscitation manual.

In hospital conditions treatmentit is syndromic and consists of the following directions:
1. Conduct a complex of resuscitation activities and translation of the patient to the IVL (according to indications).
2. Sanitation of the tracheobronchial tree, therapy of bronchiolesmospasm, pulmonary edema.
3. Saving OSSN.
4. Correction of KSHC and electrolytes.
5. Prevention of pneumonia and renal failure.

Video of first aid when drowning the patient

Emergency Preparation Scheme when drowning

Under the drowning, it is necessary to understand a separate type of violent death, which is due to the complex of external influences on the human body when its body immerses fluid. At a certain stage of the development of the complex pathophysiological process of dying, phenomena defined by the aspiration of the liquid are joined.
Most often occurs drowning in water. By the nature of death, this is usually an accident, rarely - suicide and even less often - murder.
An indispensable condition for drowning is the immersion of the body into the liquid. Closing the respiratory tract and cavities with liquid and the subsequent asphyge state should be considered as a special case of obtuctive asphyxia. For example, the immersion of only faces in the small stream or puddle can lead to a death rate due to aspiration asphyxia, but not drowning.
With a sudden and fast immersion of a person in water or other liquid, accompanied by the closure of the respiratory tract, in the body develops a complex and not always unambiguous complex of pathophysiological changes. This complex is based on several factors: low (compared with the body and ambient air) water temperature, hydrostatic pressure, varying from dive depth, psycho-emotional stress due to fear. The latter can deprive (even who knows how to swim well) the person is able to resist on the surface of the water.
The genesis of death when drowning may be different:
1) water at a temperature of about 20 ° C, falling into top departments The respiratory tract can cause irritation of the mucous membranes and the endings of the upper gear nerve, which leads to the spasm of voice ligaments and the reflex stop of the heart. This death mechanism was called asphy (or dry) drowning;
2) penetrating into the upper respiratory tract, water closes them. This type of drowning was called "true", or "wet", drowning. A typical asphyxia occurs from the closure of the upper respiratory tract, which flows, as well as mechanical asphyxia, in several phases.
Initially, there is a reflector delay (stop) of breathing, lasting 30-60 s. After that, the phase of inspiratory dyspnea occurs (up to 1 min), water begins to penetrate the respiratory tract and the lungs. Inspiratory shortness reduction is replaced by expiratory, at the beginning of which consciousness is lost, convulsions are developing, reflexes are lost. Water continues to penetrate into the lungs and in the small vessels and then big Circle blood circulation, significantly diluting blood (hemodilution) and hemolysizing it.
It has been established that water can penetrate into the blood in the amount of approximately equal volume of circulating blood. After expiratory shortness of breath, breathing stops for a short time, after which there are several deep respiratory movements (terminal breathing), during which water penetration continues into the lungs. Then there is a persistent respiratory stop due to the paralysis of the respiratory center and after 5-10 min, a resistant stop of the heart. Death comes. There are no cases when drowning first develops on an asphyicid type, and ends in the type of true drowning (laryngospasm is allowed, water penetrates the respiratory tract and light);
3) With the action of cold water on the body, the spasm of the vessels of the skin and lungs develops, the respiratory muscles are reduced, the result of which is sharp disorders of breathing and cardiac activity, the hypoxia of the brain, leading to the rapid onset of death, even before the development of drowning itself.
Different genesis of death determines the difference in the degree of severity and the nature of morphological changes, are discovered at the forensic study of the corpses.
The entire period of drowning continues 5-6 minutes. At the rate of asphyxia, the water temperature is affected by drowning. In cold water, the occurrence of death from drowning is accelerated due to cold exposure to reflex zones. When drowning, water is usually swallowed, enters the stomach and the initial part of the small intestine.
The mechanism of the occurrence of death from drowning in other liquids is essentially not different from drowning in water.
Diagnosis of death from drowning is often difficult, only a complex of signs and use laboratory methods Research allows you to correctly establish the cause of death.
In external examination of the corpse, the following features are important, allowing to suspect drowning: skin cover as a result of spasm of capillaries of the skin pale usual; Purple spots with a gray tint and pinkish staining along their periphery. Often there is a so-called goose skin, which is a consequence of cutting muscles lifting hair. Around the holes of the mouth and the nose, as a rule, it is determined by a pinkish-white, resistant, fine-tubed foam. The foam around the respiratory holes is preserved up to two days after removing the corpse from the water, then it dries and the mesh film of the dirty gray can be visible on the skin.

Foam around the mouth and nose holes
when drowning

For domestic study Acts attention to the row characteristic signs. At the opening chest There is a sharply pronounced emphysema of the lungs, the latter completely fill the infant cavity, covering the heart. On the posterior surfaces of the lungs are almost always visible fingerprints of ribs. Light to the touch test consistency due to a significant swelling of the pulmonary fabric. Increasing the volume of lungs during the stay of the corpse in the water gradually disappears by the end of the week. Under Visceral Pleverra, the stains of the Lukomsky-story story are observed. These stains are the hemorrhages of reddish-pink color, significantly larger compared to Tardier stains, located only under visceral pleural: color and magnitude depend on the amount of water in a large circle of blood circulation through the broken and gaping capillaries of inter-vololar partitions. Diluted and hemolyzed blood becomes brighter, its viscosity decreases, in connection with this, hemorrhages become blurry. The stains of the Lukomsky-story storing disappear after staying the corpse in the water over two weeks. Thus, the absence of the stains of the Lukomsky-story, with a long stay of the corpse in water, does not yet indicate that they were not at all. Visceral pleura purple. In the study of the respiratory tract, a grayish-pink, fine foam foam is found in them, as part of which, with a microscopic examination, it is often possible to detect foreign inclusions (sand, fine algae, etc.). The mucous membrane of the trachea and bronchi edema, turbid. From the surface of the cuts of the lungs is abundantly flowing roofing foam liquid. The stomach usually contains a large amount of fluid. The liver capsule is also somewhat lunned. The bed of the gallbladder and its wall with severe edema. IN serous cavities You can see a significant amount of transudate, which, according to a number of authors, is formed after 6-9 hours after staying the corpse in water and essentially refers to the signs pointing to the stay of the corpse in water. The detection of fluid in the drum cavities of the middle ear has the same meaning. As a result of Laringospa, the pressure in the nasopharynk decreases, in connection with this, water through the pear-shaped cracks enters the sinus of the main bone of the skull. The volume of water in the sinuses can reach 5 ml (Snakhnikov sign). When drowning, hemorrhages are found in drum cavity, deputyid cells and preserved caves that have the kind of free blood clusters or abundant impregnation of mucous membranes. The occurrence of this phenomenon is associated with an increase in pressure in the nasopharynx, circulatory vascular disorders, which, in combination with sharply pronounced hypoxia, lead to an increase in the permeability of vascular walls to form these hemorrhages. Laboratory studies have important for the diagnosis of drowning, in particular the plankton detection method. Plankton is the smallest organisms of plant and animal origin, inhabitants in lakes, rivers, seas, etc. For each reservoir, certain types of plankton are characterized, which have specific differences. For the diagnosis of drowning, Plankton of plant origin is the greatest value - phytoplankton, in particular diatoms. The diatoms have a shell consisting of inorganic compounds - silicon. Such a shell withstands action high temperatures, strong acids and alkalis. Diatom phytoplankton has various shapes And it is found in the form of sticks, asterisks, boats, etc. diatoms up to 200 microns, along with water through torn capillaries, the alveoli penetrate into the row of a large circle of blood circulation and with blood current are spread throughout the body, lingering in parenchymal organs and bone marrow. The detection of this type of plankton in the internal organs and the bone marrow is an objective method Evidence of death from drowning. Plankton has long been preserved in the basic bone sinus and can be detected in a microscopic examination in the scraping from the walls forming the named cavity. In the study of the corpse, if the occurrence of death from drowning is supposed, it is strictly forbidden to use water water, since the plankton existing in it can be entered into the tissue of organs sent to special research. The method of detection of plankton in the blood, parenchymathous organs, bone marrow of long tubular bones is quite complicated and is as follows: liver, brain, kidney, bone marrow (they should be taken about 200 g) after grinding are placed in the flask and poured with perhydrol, subjected to boiling in concentrated sulfuric acid (can be in salt with the addition of ice acetic), then treated with nitric acid. At the last stage, a small amount of perhydron is added to enlighten. After these manipulations, all organic components of the tissues are completely destroyed and only inorganic compounds remain, including silicon plants of plankton. Transparent flask contents are subjected to multiple centrifugation. Preparations are manufactured from the resulting precipitate, which are studied under the microscope. The detected diatoms are advisable to photograph. Microfotography is a document confirming the accuracy of the results of the study. For a comparative study of the characteristics of the plankton detected in the corpse, it is necessary to simultaneously explore the water from which the corpse was removed. Together with the water from the lungs in the blood, the grains of starch, etc., the so-called pseudoplankton can fall into the blood. Due to the fact that in the left half of the heart, blood is diluted with water, its quantity is greater than in the right half, the blood freezing point in the left and right half of the heart will be different, which is determined by cryoscopy. The methods of studying the blood cells, resistance of erythrocytes, refractometry, etc. are also proposed. All of these methods help with greater objectivity to establish the fact of the occurrence of death from drowning. The establishment of the fact of the occurrence of death from drowning is difficult in cases where the corpse is in a state of severe rotting, in which all generally accepted signs indicating intimating is practically absent. In this case, the use of invaluable assistance laboratory studies To detect plankton. Some features are observed when drowning in seawater, which is a hypertensive medium in relation to blood. As a consequence, blood plasma is released in Alveola, which leads to a rapid occurrence of pulmonary edema, followed by severely pronounced pulmonary failure. In this form of drowning, blood does not dilute, but, on the contrary, it is observed an increase in its viscosity coefficient. As a rule, there is no hemolysis of red blood cells. The study of the body of the corpse to detect plankton almost always give a negative result. Drilling is not in water, and in other liquids, for example, in oil, is usually easily determined by the nature of the fluid, and the diagnosis of the cause of death, as a rule, does not represent much difficulty. The death of a person in water can sometimes come not from drowning, but from other reasons. This happens in persons suffering ischemic disease Hearts from ventricular fibrillation, in persons suffering hypertensive disease From hemorrhage to the brain. There were cases of sudden death of young practically healthy peoplejumping into the water after overheating in the sun. In such cases, the morphological signs of the rapidly coming death are found. Signs of drowning are not detected. In the study of corpses extracted from the water, it is necessary to establish: whether death has occurred in water (from drowning or from other reasons) or the corpse is already abandoned. Therefore, there are differences: signs of drowning (about which was mentioned above) and signs of staying the corpse in water, which are expressed as sharper, the more time the corpse was in water, and can be found both on the corpses of those who died from drowning and on the corpses other reasons and then fell into reservoirs. As practice shows, when diving into the water, the cervical vertebrae may occur on a shallow vertex, accompanied by damage to the spinal cord. There is a tetraplegy, a person cannot swim and dies. In all cases of opening the corpse extracted from the water, it is necessary to investigate cervical The spine and the spinal cord, which makes it possible to establish the presence and typical mechanism for this mechanism of drowning the character of fractures.

Signs of a corpse stay in water

Fast body cooling.
In water, especially cold, the body temperature of the corpse is reduced much faster than when it is in air, and depends on the water temperature. The time of staying the corpse in the water and the advance of the occurrence of death to reduce body temperature is difficult to determine, since the patterns are not established.
Sharp skin pallor.
If the temperature of the body of the corpse is reduced to the water with a temperature below, the skin vessels are reduced, which causes pallor skin Pokrov. At the same time, there is a reduction in the muscles, straightening the hair, which leads to the occurrence of the so-called goose skin. The scrotum and skin of chest nipples are also reduced. These signs may occur both when drowning in cold water and when the corpse gets into the water shortly after the occurrence of death.
Gray shade purple potted spots Determined by the amount of hemolyzed blood.
The pink color of the skin along the edges of the body spots arises due to the fact that under the influence of water, the epidermis is breaking down, which facilitates the penetration of oxygen through it, which oxidizes hemoglobin.
Maceration.
Already a few hours after staying the corpse in the water, the pearl-white painting of the face, the palm surface of the brushes and the plantar surface of the feet. For 1-3 days, the skin is wrinkled with the whole palm "Hands of Luchk" (Fig. 13), and after 5-6 days - stop.

Maceration of skin brushes depending
from time staying in water

By the end of the week, the epidermis branch begins, and by the end of the 3rd week the swollen, loose and wrinkled epidermis can be removed in the form of a glove (hence the name "death gloves"). The mineral composition of the aquatic environment (fresh, salt, marine) also has a certain effect on the dynamics of maceration. Clothing on the corpse, gloves on hands and shoes detains the development of maceration. In practice (when solving the question of the period of stay of the corpse in water, taking into account the increase in the maceration process), you can use the data given in the table.

Terms of development of skin maceration depending on the temperature of the water

In the water, the rotten rotation of corpses is developing with the formation of rotor gases, under the influence of which the corpse can emerge, even if the load is tied to it with a mass of up to 30 kg.
Due to the breaking of the skin (approximately two weeks later), hair loss begins and by the end of the month, especially in warm water, can come full "baldness". At the same time, unlike the lifetime baldness on the skin of the head of the corpse, wells are well defined by the wells. The possibility of hair loss during long-term stay of the corpse in water must be taken into account when there is a need to identify the corpse.
It should be borne in mind that a human corpse can be placed in water after death mechanical damage To conceal the crime. The corpse is usually clearly visible damage from the action of stupid and acute items, firearms, signs of poisoning by some poisons, etc.
The main issue when the mechanical damage is detected on the corpse is the establishment of their origin (lifetime, posthumous). Damage to the water of a lifetime origin in the form of abrasions of bruised wounds, damage to the bones of the arch and base of the skull can occur when jumping into water from stones, piles and other objects. Damage in the form of compression fractures of cervical vertebrae usually occur when jumping down the water head in shallow reservoirs. Therefore, in all cases of drowning it is necessary to produce control cuts of the rear surface of the neck for the study of soft tissues and vertebrae. The human body in water may be subject to the effect of rowing screws and underwater wings of river and sea ships, etc.
Posthumous damage can be caused by barrams, poles and other objects used to detect the corpse in water. In the study of the corpse, damage in the chest, abdomen, limbs, as well as fractures of ribs arising from artificial respiration may be detected.
The corpses in water can cause various injuries of animals, inhabiting reservoirs: crayfish, water rats, sea rods, crabs, etc. Typical damage cause leeches, forming multiple T-shaped surface wounds on the skin of the corpse.
Some types of algae can settle on the corpse. According to the development cycle of these algae, with the help of a forensic examination, an approximate period of stay of the corpse can be established in a certain area of \u200b\u200bthe reservoir.
When inspecting the corpse at the scene (after removing the corpse of the water branch), attention is drawn to the presence of foam around the mouth and nose, the materactions of the cover, there are damage, which may arise in a great or posthumously and be of different origin, including when providing the first medical care In case of artificial respiration (bruises on forearm, sedimentation on the front surfaces of the chest). Together with the corpse in the morgue, the test of water from the reservoir, from which the corpse (at least 1 l) is extracted to further detect plankton in order to compare it with plankton, which can be detected in the study of the corpse in the morgue. The presence of objects holding the body on the surface of the water (rescue belt, etc.) or, on the contrary, contributing to the immersion (stones, objects attached to the body or in the pockets of clothing). Describes the condition of clothing, the presence of particles of sand or algae.
When moving the corpse in flowing waters, especially in mountain rivers, signs of womb on shoes, clothing, skin, nails and even on the bones of the skeleton can be revealed on the corpse. Depending on the relief and features of the bottom (sharp stones, Koryagi, etc.) when moving the corpse of water with the flow of water from it, clothing can be mechanically removed and significant damage caused to dismemberment.

Drowning - This is a deadly dangerous state that occurs when water or other liquids in the respiratory tract.

Several direct causes, or types, drowning:

1. True, "wet", "blue" drowning - A person dies, choking water. The most frequent type of drowning. During the struggle for life, a person performs respiratory and swallowing movements, as a result of which the lungs and stomach are filled with water.
2. Spasm of the upper respiratory tract - "Dry" drowning when water does not fill the lungs. This is possible with a sharp hit in cold water, in fright, head injuries during falling into the water. In some people - as a protective reflex in response to entering a small amount of water into the voice gap.
3. Syncopal, "pale" drowning - drowning is preceded by a heart stop, for example, with a sudden drop of temperature and so on. The flow of water in the body does not occur.

Most often, the mechanism of drowning is mixed, so you exactly install it on external signs during the salvation of the immentable is extremely difficult. Sometimes death comes from injuries, cardiovascular pathology and other states that are not confused.

Rules for transporting drowning:

• It is desirable to transport the efforts of two people with the use of rescue tools (rescue circle or any item with good buoyancy).
• If the drowning is actively moving in water, the rescuers should be caution, since the affected reflex can harm those who came to the rescue.
• The drowning captures behind the frills behind, turn the face up and in such a position transport to the shore.
• If the victim grabbed the rescuer and interferes with movement, it is necessary to dial air and dive into water. Imaginary, having lost support, weaken the grip.
• The faster it will be possible to deliver the victim to the shore, the higher the chances of salvation.

Signs of drowning

Signs of the initial stage of drowning:

• the victims retain consciousness, but not always able to adequately respond to what is happening;
• excited, can break out, run away, to abandon medical care, then the phase of braking, apathy, and inhibition up to the violation of consciousness may occur;
• in the first minutes, breathing and heartbeat are rapidly, then peaked;
• obbovob is observed;
• belly will break, often develops vomiting with water and gastric content, cough;
• skin skin.

Signs of drowning are gradually going to no, but for several days residual phenomena can be maintained: weakness, apathy, headaches.

Stage of Agony:

• victim unconscious;
• breath and heartbeat weak, arrhythmical;
• skin leather, cold;
• pink foam can be released from the respiratory tract.

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

Stage of clinical death:

• there are no consciousness, breathing and heartbeat;
• pupil does not respond to light;
• there is no vomit reflex.

What is dangerous drowning?

As a result of drowning in the body, severe pathological changes are developing. In the stage of agony and clinical death, the chances of salvation of the victim are very small. However, there are cases of returning to the life of heaven after dozens of minutes spent in water. Big role Here they play individual features of a person, the circumstances of the accident and the temperature of the water.

Even after the successful rescue of the victim, it is necessary to urgently deliver to medical institutionSince the consequences of drowning can manifest after some time.

First Aid when drowning

1. As soon as the victim turned out to be on the shore or board of the swimming agent, proceed to help. Regardless of the severity of the war of the victim need to cause ambulance.
2. If you managed to remove a person from the water consciousness, the first aid is to most effectively remove water from the respiratory tract and stomach, calm and warm the victim. For this, the rescuer helps a person to turn over his stomach, drives him through his thigh, tapping on his back, helping to flip. A person is freed from wet clothes, wipe dry, wrapped. They give warm drink and send to the hospital as soon as possible.
3. If the drowning is unconscious, do not waste time to determine the stage and type of drowning, calculating the time spent under water. Efficiency rescue measures largely depends on the efficiency of your actions. First aid in this case turns out to be in a single algorithm:

• Quickly turn the person on the belly, face down, under the stomach substitute your own thigh or knee. Try to open your mouth to the victim and put pressure on the root of the tongue. So in one action you seek three effects at once:

1. contribute to the release of respiratory tract from water, sand and other foreign objects;
2. stimulate the respiratory center;
3. assess the state of the rescue.

• In the first case, a large amount of water is poured out of the mouth, a vomit reflex, cough and respiratory movements arise, a person comes into consciousness.
• In the second case, water from the respiratory tract does not come, there is no vomit reflex. Without losing a second, turn the victim to the back and proceed to artificial respiration.
• If there is no heartbeat, alternate artificial respiration with an indirect heart massage.
• Symptoms of revival will be peppering the skin, the appearance of a cough reflex, attempts of self-breathing, pulse and movements.

What can not be done?

• Start resuscitation, without making sure the absence of water in the respiratory tract. If the lungs are filled with water, artificial respiration will be inefficient.
• Would spend time on trying to make loud swords, shocks in the face and so on.
• Warming victims of alcohol drinks.
• Leave saved unattended after returning to consciousness. The state of a person after drowning is very unstable. It is necessary to constantly control the pulse and breathing.
• Neglect medical care and supervision even with successful salvation and satisfactory well-being of the victim.

NOTA BENE!

Never lose hope for salvation, even if a person spent in water for a long time And does not show signs of life. Correctly carrying out a heart massage and artificial respiration, you support the viability of the central nervous system and other injured bodies. There are cases of successful rescue people who were under water up to 30-40 minutes. Especially high likely to save in cold water, which provides a slowdown in metabolism, a kind of conservation of the body.

Created by materials:

1. Veltkin A. L., Bagnenko S. F. Guidelines for emergency medical care. - M.: Gootar Media, 2007.
2. Kostuzova A. A. Medical directory of tourist. - M.: ProfiSdat, 1990. 2nd Edition, recycled and supplemented.
3. Guide to primary health care. - M.: Goeotar Media, 2006.
4. Handbook of Feldscher / Ed. prof. A. N. Shabanova. - M.: Medicine, 1976.
5. Schwartz L. S. Directory of the doctor of emergency and emergency care. - Saratov, 1968.

Content

Rest at the reservoir is not always enjoyable. Incorrect behavior in water or emergency situations can lead to drowning. These risks are especially susceptible to small children, but even adults who know how to swim well, can become victims of a strong current, the occurrence of convulsions, water films. The sooner the victim is removed from the water, and the first aid will be provided with drowning (eliminating the fluid from the respiratory tract), the higher the chance to save the human life.

What is drowning

The World Health Organization (WHO) determines the drowning as respiratory disorders caused by immersion or long stay under water. As a result, a respiratory disorder may occur, asphyxia. If the first help is immentable not been rendered on time, death comes. How long can a person do without air? The brain is able to function only 5-6 minutes in hypoxia, so it is necessary to act very quickly, without waiting for an ambulance brigade.

There are several reasons for such a situation, but not all of them are random. Sometimes the wrong behavior of the person on the surface of the water leads to undesirable consequences. The main factors include:

• injuries from immersion in shallow water, in the unexplored places;
• alcoholic intoxication;
• emergency situations (cramps, heart attack, diabetic or hypoglycemic coma, stroke);
• inability to float;
• negligent attitude towards the child (when children are drown);
• getting into the waterproofs, storm.

Signs of drowning

Symptoms of drowning to notice easily. The victim begins to flounder, or swallows the mouth of the air as a fish. Often, a person spends all his energy to keep his head over water and breathe, so can't shout about help. There may also be spasm of voice ligaments. Importing covers panic, it is lost, which reduces his chances of self-esteem. When the victim has already been pulled out of the water, the fact that it is silent can be determined by the following symptoms:

• bloating;
• breast pain;
• blue or bluish tint of the skin;
• cough;
• shortness of breath or shortness of breathing;
• vomit.

Types of drowning

There are several types of drowning, each of which is characterized by its peculiarities. They include:

1. "Dry" (asphisical) drowning. A person is immersed under water and loses orientation. Often there is a spasm of larynx, the water fills the stomach. The upper respiratory tract is blocked, and the drowning begins to choke. Asfix occurs.
2. "Wet" (true). Immersing into the water, a person does not lose their breathing instinct. Lightweight and bronchi are filled with liquid, foam can be released from the mouth, cyanosis of the skin is manifested.
3. Fund (syncopal). Another name is pale drowning. The skin acquires a characteristic white, white-gray, bluish color. Female outcome occurs as a result of reflex cessation of light, hearts. It often happens due to the temperature difference (when the drowning is immersed in the ice water), the impact of the surface. Syncnich arises, loss of consciousness, arrhythmia, epilepsy, heart attack, clinical death.

Salvation of drowning

Anyone can notice the victim, but it is important to provide first aid in a short time, because someone's life depends on it. Being on the shore, the first thing to do is call for helping the rescue. The specialist knows exactly how to act. If it is not near, you can try to pull out a person yourself, but you need to remember the danger. The drowning is in a stressful state, it has a coordination, so he may involuntarily cling to the rescuer, not allowing him to grasp himself. The likelihood of drowning together (with incorrect behavior in water).

Emergency care when drowning

When an accident occurs, you need to act quickly. If there was no professional rescuer or a medical worker nearby, then the first assistance in drowning should be provided to others. The following steps should be performed:

1. Wrap your finger soft cloth, Clear them purph cavity saved.
2. If there is a liquid in the lungs, you need to put a person on your knee abdomen down, lower his head, make a few blows between the blades.
3. If necessary, make artificial respiration, heart massage. It is very important not to put on the chest too much so as not to break the ribs.
4. When a person woke up, he should be released him from wet clothes, wrap a towel, let it warm up.

The difference between sea and fresh water when drowning

The accident may occur in various water sources (sea, river, pool), but the drowning in fresh water differs from the immersion in the salt environment. What is the difference? Inhalation of sea fluid is not as dangerous and has a more favorable forecast. High salt concentration prevents water from entering light fabric. However, blood is thickened, pressure occurs on the circulatory system. Within 8-10 minutes, a complete stop of the heart occurs, but during this time you can have time to reanimate the drowning.

As for drowning in fresh water, the process is more complicated. When the liquid enters the lung cells, their swelling occurs, some cells are bursting. Freshwater can be bored in blood, make it more liquid. Capillaries break out, which violates heart activities. The ventricular fibrillation occurs, stop the heart. This whole process takes a few minutes, so death in fresh water comes much faster.

First Aid on Water

A specially trained person should be saved by the drowning person. However, it is not always near, or several people may suffer in water. Any holidaymaker can provide first help. To save someone's life, it is worth using the following algorithm:

1. It is necessary to gradually approach the victim behind the rear, to dive and produce the coverage of solar plexus, taking a sinking person behind my right hand.
2. Swear to the shore on the back, row your right hand.
3. It is important to ensure that the head of the victim was over the water, and it does not swallow the liquid.
4. On the shore should put a person on the stomach, to provide first aid.

First Aid Rules

The desire to help the drowning does not always benefit. Incorrect persecution behavior often only aggravates the problem. For this reason, first aid for drowning should be competent. What is the mechanism of PMP:

1. After the person was pulled out of the water and covered the blanket, you need to check the symptoms of hypothermia (supercooling).
2. Call an ambulance.
3. Avoid deformation of the spine or neck, not damage.
4. Fix the cervical department by laying a rolled towel.
5. If the victim does not breathe, you should proceed to the performance of artificial respiration, the heart massage

With true drowning

About 70 percent cases, water falls directly into the lungs, a true or "wet" drowning occurs. It can happen to a child or a man who does not know how to swim. The first medical care during drowning includes the following steps:

• turning the pulse, inspection of pupils;
• warming the victim;
• maintenance of blood circulation (raising legs, tilting of the body);
• production of light ventilation using breathing apparatus;
• if a person does not breathe, it is necessary to make artificial respiration.

With asphisic drowning

Dry drowning is somewhat atypical. Water never reaches the lungs, but instead there is a spasm of voice ligaments. Death may come due to hypoxia. How to give first aid to a person in this case:

• immediately hold cardiovascular resuscitation;
• call an ambulance;
• when the victim came to himself, he warm him.

Artificial Breathing and Heart Massage

In most cases, when drowning, a person stops breathing. To return it to life, you should immediately begin active steps: make a heart massage, make artificial respiration. It is necessary to observe a clear sequence of actions. How to perform the breath "mouth in the mouth":

1. It is necessary to push the lips of the victim, remove the mucus, algae with a finger wrapped with a cloth. Give a track of the fluid from the oral cavity.
2. Cook your cheeks so that the mouth does not close, tilt the head back, raise the chin.
3. Click the nose of saved, breathe the air directly into his mouth. The process takes the split second. The amounts of repetition: 12 times per minute.
4. Check the pulse on the neck.
5. After some time, the chest will be lifted (the lungs will start functioning).

The breath of "mouth in the mouth" is often accompanied by a heart massage. This procedure should be performed very carefully not to damage the ribs. How to act:

1. Place the patient on a flat surface (floor, sand, ground).
2. Put one hand on the chest, cover the second hand at an angle of about 90 degrees.
3. Rhythmically pressed on the body (approximately one pressure per second).
4. To start the child's heart, the chest should be pressed with 2 fingers (due to the small growth and weight of the baby).
5. If the rescuers two, artificial respiration and heart massage are performed simultaneously. If the rescuer is one, then every 30 seconds you need to alternate these two processes.

Actions after first aid

Even if a person came to himself, it does not mean that he does not need health care. It should be left with the victims, call the urgent or seek help to the doctor. It is worthwhile that when drowning in fresh water, death can come even after a few hours (secondary drowning), so they should keep the situation under control. With long stay without consciousness and oxygen, the following problems may arise:

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

In order not to have a complication, it should be health care as quickly as possible. The following precautions should be observed in drowning:

• learn to swim;
• avoid swimming in a drunk;
• do not go into too cold water;
• do not swim during the storm or at great depth;
• do not walk on thin ice.

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Attention! The information presented in the article is familiarized. Articles do not call for independent treatment. Only a qualified doctor may diagnose and give recommendations on treatment, based on the individual characteristics of a particular patient.

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There are three varieties of drowning. Drowning can be primary wet, dry and secondary. In addition to drowning, sometimes death occurs in water caused by various injuries, heart diseases, brain violations and so on.

Drowning is possible with a variety of circumstances:

1. From injury obtained in water.
2. With a sudden stop of the heart.
3. With violation of cerebral circulation.
4. Spasm of the larynx and the impossibility of inhalation and exhalation:
- out of fear;
- Sharp with sudden getting into very cold water.

Types of drowning.

Primary (true) drowning.

This is the most frequent type of drowning. The drowning is not immediately immersed in the water, but trying to keep on the surface, in a panic he begins to make feverish and random movements with his hands and legs. It is the most frequent variety of accidents on water.

With it, the liquid enters the respiratory tract and lungs, and then enters the blood. When inhaling, the drowning swallows a large amount of water that overwhelms the stomach, falling into the lungs. A person loses consciousness and plunges on the bottom. Oxygen fasting - hypoxia - gives the skin a blue color, so this type of drowning is also called "blue".

When the victims are drowning in fresh water, the blood dilution quickly increases with water, the total amount of circulating blood increases, erythrocytes are destroyed, the balance of salts in the body is disturbed. As a result, the oxygen content in the blood is dramatically reduced. After the rescue of the drowning and first aid, the phenomena of the pulmonary edema often noted, in which bloody foam goes from the mouth.

Drowning in seawater on the effect on the body of the victim is very different from drowning in fresh. In seaside water, the concentration of salts is higher than that of the plasma of human blood. As a result of seaside water to the human body, the number of salts in the blood increases and its concentration is developing. With true drowning in seawater, swelling of the lungs is rapidly developing, and a white "fluffy" foam is distinguished.

"Dry" drowning.

Also found quite often. With this variety of drowning, the reflex spasm of the voice gap occurs. Water does not fall into the lower respiratory tract, but the suffocation comes. This usually occurs in children and women, as well as when the victim enters dirty or chlorinated water. With this drowning, water in large quantities falls into the stomach.

Secondary or "pale" drowning.

It happens because of the cardiac arrest, when the victim enters cold water, which is called ice. This is based on the reflex reaction of the body to enter the water in the respiratory throat or in the ear, when there is damage to the eardrum. For secondary drowning, a pronounced spasm of peripheral blood vessels. Elevation of the lungs, as a rule, does not develop. Such drowning occurs when a person is not trying or cannot fight for his life and quickly goes to the bottom.

It often happens during shipwrecks on the sea, the coup of boats, rafts, when a person is immersed in water in a state panic fear. If the water is also cold, it can cause strokes and larynx, which in turn often leads to a sudden stop of the heart and breathing. Such a type of drowning can occur in the event that a person who is in water has occurred head injury or he has already fallen into the water with her. In this case, there is a quick loss of consciousness. Skin covers are distinguished by an increased pallor, from here and type name.

Rescue drowning.

When salivation of the drowning can not be enough for his hair or head. The most reliable and safe way is to capture it under the mouse, turn your back and swim to the shore, trying to the head of the victim was over the water.

The state of victims during drowning.

It is associated with the duration of water under water, with a type of drowning and the degree of cooling the body. In light cases, consciousness is preserved, but the excitement is noted, trembling, repeated vomiting. With a long stay in the water, with a true or "dry" drowning, consciousness is broken or absent in general, the victims are very excited, there may be cramps, and the skin is blue. With secondary drowning, there is a pronounced pallor of the skin, the pupils are expanded. At the victims bubbling rapid breathing.

When drowning in seawater, swelling of the lungs is rapidly developing, heartbeat is rapidly developed. When drowning is long and secondary, the victim can be removed from the water in a state of clinical or biological death. True drowning in fresh water can be complicated by a violation of the work of the kidneys in the form of blood appearance in the urine. During the first day there may be inflammation of the lungs. With a pronounced decay of erythrocytes in the body, an acute renal failure is developing.

Emergency care when drowning.

Regardless of the type of drowning, assistance must be rendered immediately, otherwise the irreversible changes in the brain are occurring. With true drowning, this happens within 4-5 minutes, in other cases after 10-12 minutes. First aid on the shore will be different with blue and pale drowning. In the first case, it is necessary first of all to quickly remove water from the respiratory tract. For this, standing on one knee, lay the victim to the bent the second leg so that it rests bottom part chest, and top part The torso and head fused down.

After that, it is necessary to open the mouth of the victim with one hand, and the other patted it on the back or smoothly pressed on the ribs on the back side. You must repeat these actions before the cessation of the turbulent water flow. Then make an artificial respiration and a closed heart massage. With a pale type of drowning, artificial respiration is immediately needed, and when the heart is stopped - a closed massage. Sometimes in the respiratory tract of drowning are large foreign bodieswho get stuck in the larynx, as a result of which the respiratory tract becomes impassable or developing a resistant spasm of the voice gap. In this case, produce tracheostomy.

With any type of drowning, it is categorically impossible to turn the head of the victim, as this can apply additional injury with a possible spinal fracture. To make the head did not move, put the rollers from tightly twisted clothes on both sides, and if necessary, turn the victim, while one of the help suppose should support the head, not letting it move on their own.

Resuscitation, in particular, artificial respiration, it is necessary to continue, even if the victim has independent breathing, but there are signs of edema of the lungs. Artificial respiration is carried out and then when the victim has a disruption of breathing (i.e. its frequency - more than 40 in 1 minute, nehydramnichny breathing and a sharp formation of skin). If the breath is saved, then the patient needs to make ride in pairs of ammonia alcohol. If the savings of the victim passed successfully, but his chills beats, it is necessary to confuse the skin, wrap it with warm dry blankets. It is impossible to apply heights in the absence or impairment of consciousness.

With severe types of drowning the victim, it is required to deliver to the resuscitation department. During transportation, artificial ventilation of the lungs should be continued. The "emergency medical care" or the resuscitation hospital department with impaired breathing and the ead of the lungs in the victim produces the introduction of the breathing tube into the trachea and its connection to the device or the device of artificial ventilation of the lungs.

Previously in the stomach of the victim introduced a probe. This will prevent the content of the contents of the stomach into the respiratory tract. It is necessary to transport a patient in the position lying on the side, with the head restraint of the stretcher. It is dangerous to prematurely stop artificial ventilation of the lungs. Even if a person has independent respiratory movements, it does not mean the restoration of normal respiration, especially when the edema of the lungs.

When drowning in fresh water, the victim in hospital conditions with a sharp formation, the swelling of the cervical veins sometimes produce bloodletting. With a pronounced decay of erythrocytes, the sodium hydrocarbonate solution, the erythrocytic mass, a blood plasma is transfused intravenously. A diuretics are introduced to reduce edema, such as furosemide. Reducing the level of protein in the body is an indication for transfusion of concentrated albumin.

With the development of pulmonary edema against the background of arterial hypertension, a 2.5% solution of benzenexium or 5% solution of pentamine, glucose solutions are introduced intravenously. Big doses of hormones are used: hydrocortisone or prednisone. Antibiotics are prescribed to prevent pneumonia. 20% sodium oxybutirate solutions, 0.005% solution of fentanyl, or 0,25% Droperidol solution are administered intravenously.

According to the materials of the book " Fast help in emergency situations. "
Kashin S.P.