Signs characteristic of drowning in water (compendium). "Pale" drowning What types of drowning do you know?

Drowning is a life-threatening condition that 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 are filled with water.
2. Upper respiratory tract spasm- "dry" drowning when water does not fill the lungs. This is possible with a sharp hit in cold water, with fright, head injuries while falling into the water. In some people, as a protective reflex in response to a small amount of water entering the glottis.
3. Syncope, "pale" drowning- drowning is preceded by cardiac arrest, for example, with a sudden temperature drop, etc. No water intake occurs.

Most often, the drowning mechanism is mixed, so it is extremely difficult to accurately establish it by external signs during the rescue of a drowning man. Sometimes death occurs from injury, cardiovascular disease, and other conditions not associated with drowning.

Drowning person transportation rules:

• It is desirable to transport a drowning person to the shore or a watercraft with the efforts of two people using life-saving equipment (lifebuoy or any object with good buoyancy).
• If a drowning person actively moves in the water, rescuers should be careful, as the victim can reflexively harm those who come to the rescue.
• The drowning man 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, it is necessary to draw air and dive under the water. The drowning man, having lost his support, will loosen his grip.
• The sooner it is possible to deliver the victim to the 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, and even disturbance of consciousness may occur;
• in the first minutes breathing and heartbeat are quickened, then cut back;
• chills are observed;
• the stomach is swollen, vomiting of water and stomach contents, cough often develops;
• the skin is bluish.

Drowning symptoms gradually fade away, 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 is significantly expressed only with true drowning, however, the efficiency of resuscitation in this case is higher. With other types of drowning, clinical death develops very quickly.

Clinical death stage:

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

Why is drowning dangerous?

As a result of drowning, severe pathological changes develop in the body. 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 dozens of minutes spent in the water. Big role here the individual characteristics of a person, the circumstances of the accident and the temperature of the water play.

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

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

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

• In the first case, a large amount of water is poured out of the mouth, a gag reflex, coughing and respiratory movements occur, a person regains consciousness.
• In the second case, water does not flow from the respiratory tract, there is no gag reflex. Without wasting a second, turn the victim onto his back and start artificial respiration.
• If there is no heartbeat, alternate artificial respiration with chest compressions.
• Signs of revitalization will be pinking of the skin, the appearance of a cough reflex, attempts to spontaneously breathe, pulse and movements.

What shouldn't be done?

• Begin resuscitation without making sure there is no water in the airways. If the lungs are filled with water, artificial respiration will be ineffective.
• Waste time trying to revive with loud shouts, punches to the face, etc.
• Warm the victim with alcoholic beverages.
• Leave the rescued person unattended after regaining consciousness. The human condition after drowning is very unstable. It is necessary to constantly monitor the pulse and breathing.
• Disregard medical care and supervision even if the victim is successfully rescued and the victim is in good health.

Nota Bene!

One should never lose hope of salvation, even if a person has spent in water. long time and shows no signs of life. By properly 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 probability of salvation is especially high in cold water, which slows down metabolism, a kind of preservation of the body.

Created based on materials:

1. Vertkin A.L., Bagnenko S.F. - M .: GEOTAR-Media, 2007.
2. A. A. Kostrub Medical reference tourist. - M .: Profizdat, 1990. 2nd edition, revised and enlarged.
3. Primary Health Care Guide. - M .: GEOTAR-Media, 2006.
4. Medical assistant's guide / ed. prof. A. N. Shabanova. - M .: Medicine, 1976.
5. Schwartz L.S. emergency care... - Saratov, 1968.

Drowning should be understood as a separate type of violent death, which is caused by a complex of external influences on the human body when its body is immersed in a liquid. At a certain stage in the development of a complex pathophysiological process of dying, phenomena determined by aspiration of fluid join.
Drowning in water is most common. 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 in liquid. The closure of the airways and cavities with fluid and the subsequent asphyxia should be considered as a special case of obstructive asphyxia. For example, immersion of only the face in a shallow stream or puddle can be fatal due to aspiration asphyxiation, but not drowning.
With a sudden and rapid immersion of a person in water or other liquid, accompanied by the closure of the respiratory tract, a complex and not always unambiguous complex of pathophysiological changes develops in the body. This complex is based on several factors: low (compared to the body and the surrounding air) water temperature, hydrostatic pressure, which varies with the depth of diving, psychoemotional stress caused by fear. The latter can deprive (even someone who knows how to swim well) a person of the ability to stay on the surface of the water.
The genesis of drowning death can be different:
1) water at a temperature of about 20 ° C, getting into upper sections respiratory tract, can irritate the mucous membranes and endings of the superior laryngeal nerve, leading to spasm vocal cords and reflex cardiac arrest. This mechanism of death is called asphytic (or dry) drowning;
2) penetrating into the upper respiratory tract, water closes them. This type of drowning has been called "true" or "wet" drowning. There is a typical asphyxia from the closure of the upper respiratory tract, which proceeds, like mechanical asphyxia, in several phases.
Initially, there is a reflex delay (arrest) of breathing, lasting 30-60 s. After this, the phase of inspiratory dyspnea begins (up to 1 min), water begins to penetrate the respiratory tract and lungs. Inspiratory dyspnea is replaced by expiratory dyspnea, at the beginning of which consciousness is lost, convulsions develop, and reflexes are lost. Water continues to penetrate into the lungs and blood vessels of the small, and then large circle blood circulation, significantly diluting the blood (hemodilution) and hemolyzing it.
It has been established that water can penetrate into the blood in a volume approximately equal to the volume of circulating blood. After expiratory dyspnea, breathing stops for a short time, after which several deep respiratory movements(terminal breathing), during which water continues to enter the lungs. Then there is a persistent cessation of breathing due to paralysis of the respiratory center and after 5-10 minutes, persistent cardiac arrest. Death is coming. It is not uncommon for drowning to develop at first as an asphytic type, and ends as a true drowning (laryngospasm is resolved, water enters the respiratory tract and lungs);
3) under the action of cold water on the body, a spasm of the vessels of the skin and lungs develops, the respiratory muscles contract, which results in sharp disturbances in breathing and cardiac activity, brain hypoxia, leading to a rapid onset of death, even before the development of drowning itself.
The different genesis of death determines the difference in the severity and nature of morphological changes found in the forensic medical examination of corpses.
The entire drowning period lasts 5-6 minutes. The rate of development of asphyxia during drowning is affected by the temperature of the water. In cold water, the onset of drowning death is accelerated due to the cold effect on the reflex zones. When drowning, water is usually swallowed, entering the stomach and the beginning of the small intestine.
The mechanism of death from drowning in other fluids is essentially the same as drowning in water.
Diagnosis of drowning death is often difficult, only a set of signs and use laboratory methods research allows you to correctly establish the cause of death.
When a corpse is examined externally, the following signs are important, which make it possible to suspect drowning: the skin as a result of spasm of the skin capillaries is paler than usual; cadaveric spots of purple with a gray tint and pinkish coloration along their periphery. Often there is the so-called goose bumps, which is a consequence of the contraction of the muscles that lift the hair. Around the openings of the mouth and nose, as a rule, a pinkish-white, persistent, fine-bubble foam is determined. Foam around the respiratory openings lasts up to two days after removing the corpse from the water, then it dries up and a mesh film of a dirty gray color is visible on the skin.

Foam around the mouth and nose openings
drowning

At internal research a number of characteristic features... When opening the chest, there is a pronounced emphysema of the lungs, the latter completely fill the chest cavity, covering the heart. On the posterolateral surfaces of the lungs, rib prints are almost always visible. Light to the touch with a doughy consistency due to significant edema of the lung tissue. The increase in lung volume during the period when the corpse is in the water gradually disappears by the end of the week. Lukomsky-Rasskazov spots are observed under the visceral pleura. These spots are hemorrhages of a reddish-pink color, much larger in comparison with the Tardier spots, located only under the visceral pleura: Their color and size depend on the amount of water that has entered the systemic circulation through the ruptured and gaping capillaries of the interalveolar septa. Diluted and hemolyzed blood becomes lighter, its viscosity decreases, and therefore hemorrhages become vague. The spots of Lukomsky-Rasskazov disappear after the corpse has been in the water for more than two weeks. Thus, the absence of Lukomsky-Rasskazov spots during the long stay of the corpse in the water does not yet indicate that they were not there at all. The visceral pleura is unclear. When examining the respiratory tract, a grayish-pink, fine-bubble foam is found in them, in which, during microscopic examination, foreign inclusions (sand, small algae, etc.) can often be found. The mucous membrane of the trachea and bronchi is edematous, unclear. From the surface of the incisions of the lungs, a bloody, frothy liquid flows abundantly. The stomach usually contains a lot of fluid. The liver capsule is also somewhat unclear. The bed of the gallbladder and its wall with pronounced edema. V serous cavities you can see a significant amount of transudate, which, according to a number of authors, is formed 6-9 hours after the stay of the corpse in water and essentially refers to signs indicating the presence of a corpse in water. The detection of fluid in the tympanic cavities of the middle ear is of the same importance. As a result of laryngospasm, the pressure in the nasopharynx decreases, in connection with this, water enters the sinuses of the main bone of the skull through the pear-shaped fissures. The volume of water in the sinuses can reach 5 ml (Sveshnikov's sign). When drowning, hemorrhages are found in tympanic cavity, mastoid cells and mastoid caves, which have the appearance of free accumulations of blood or abundant soaking of the mucous membranes. The occurrence of this phenomenon is associated with an increase in pressure in the nasopharynx, circulatory vascular disorders, which, in combination with pronounced hypoxia, lead to an increase in the permeability of the vascular walls with the formation of these hemorrhages. Laboratory tests, especially plankton detection, are important for the diagnosis of drowning. Plankton are the smallest organisms of plant and animal origin that live in lakes, rivers, seas, etc. For each reservoir, certain types of plankton are characteristic, which have specific differences. To diagnose drowning greatest value has plankton of plant origin - phytoplankton, especially diatoms. Diatoms have a shell composed of inorganic compounds - silicon. Such a shell withstands the action high temperatures, strong acids and alkalis. Diatom phytoplankton has different shape and is found in the form of rods, asterisks, boats, etc. Diatoms up to 200 microns in size, together with water through the ruptured capillaries of the alveoli, penetrate into the system of the systemic circulation and with the blood flow are carried throughout the body, lingering in the parenchymal organs and bone marrow. The detection of this type of plankton in internal organs and bone marrow is objective method evidence of drowning death. Plankton persists for a long time in the sinus of the main bone and can be detected by microscopic examination in scrapings from the walls that form the named cavity. When examining a corpse, if death from drowning is expected, the use of tap water is strictly prohibited, since the plankton in it can be introduced into the tissue of organs sent for special research. The method for detecting plankton in the blood, parenchymal organs, bone marrow of long tubular bones is quite complicated and consists in the following: liver, brain, kidney, bone marrow (they should be taken about 200 g each), after grinding, they are placed in a flask and poured with perhydrol, boiled in concentrated sulfuric acid (it is possible in hydrochloric acid with the addition of glacial acetic acid), then treated with nitric acid. At the last stage, a small amount of perhydrol is added again to clarify. After these manipulations, all the organic constituent parts of the tissues are completely destroyed and only inorganic compounds remain, including the silicon shells of plankton. The transparent contents of the flask are subjected to repeated centrifugation. From the sediment obtained, preparations are made on glass slides, which are examined under a microscope. It is advisable to photograph the discovered diatoms. A micrograph is a document confirming the reliability of the results of the study. For a comparative study of the features of the plankton found in the corpse, it is necessary to simultaneously examine the water from which the corpse was extracted. Together with water, grains of sand, starch grains, etc., the so-called pseudoplankton, suspended in water, can enter the blood from the lungs. Due to the fact that the blood in the left half of the heart is diluted with water, its amount is greater than in the right half, the freezing point of blood in the left and right halves of the heart will be different, which is determined by cryoscopy. Methods for studying the electrical conductivity of blood, the resistance of erythrocytes, refractometry, and others are also proposed. All these methods help to establish with greater objectivity the fact of death from drowning. Establishing the fact of death from drowning is difficult in cases where the corpse is in a state of pronounced putrefaction, in which all the generally accepted signs indicating drowning are practically absent. In this case, invaluable help is provided by the use of laboratory research to detect plankton. Some features are observed when drowning in seawater, which is a hypertonic environment in relation to blood. As a result, blood plasma is released into the alveoli, which leads to the rapid onset of pulmonary edema, followed by pronounced pulmonary insufficiency. With this type of drowning, the blood does not liquefy, but, on the contrary, an increase in the coefficient of its viscosity is observed. As a rule, there is no erythrocyte hemolysis. Studies of corpse organs to detect plankton almost always give a negative result. Drowning in fluids other than water, such as oil, is usually easily identified by the nature of the fluid, and diagnosis of the cause of death is usually straightforward. The death of a person in water can sometimes occur not from drowning, but from other causes. It occurs in individuals with coronary artery disease from ventricular fibrillation, in individuals with hypertension from hemorrhage in the brain. There were cases of sudden death of young people practically healthy people jumping into water after being overheated in the sun. In such cases, morphological signs of a rapidly occurring death are found. No signs of drowning are found. When examining corpses removed from the water, it is necessary to establish whether death has occurred in water (from drowning or from other reasons) or whether a corpse has already been thrown into the water. Therefore, they differ: signs of drowning (which were mentioned above) and signs of a corpse being in the water, which are more pronounced the more time the corpse was in the water, and can be found both on the corpses of persons who died from drowning, and on corpses who died from other reasons and then got into water bodies. As practice shows, when diving into water upside down in a shallow place, fractures of the cervical vertebrae may occur, accompanied by damage to the spinal cord. Tetraplegia arises, the person cannot swim out and dies. In all cases of autopsy of a corpse removed from the water, it is necessary to examine cervical spine the spine and spinal cord, which makes it possible to establish the presence and the nature of fractures typical for this drowning mechanism.

Signs of a corpse in the water

Rapid cooling of the body.
In water, especially cold water, the body temperature of a corpse decreases much faster than when it is exposed to air, and depends primarily on the temperature of the water. The time spent by the corpse in the water and the prescription of death due to the decrease in body temperature is difficult to determine, since the patterns have not been established.
Sharp pallor of the skin.
When exposed to water with a temperature below the body temperature of the corpse, the skin vessels contract, which causes the pallor of the skin. At the same time, there is a contraction of the muscles that straighten the hair, which leads to the so-called goose bumps. The skin of the scrotum and the skin of the nipples also contract. These signs can occur both when drowning in cold water, and when a corpse falls into the water shortly after death.
The gray tint of purple cadaveric spots is determined by the amount of hemolyzed blood.
The pink color of the skin along the edges of cadaveric spots occurs due to the fact that, under the influence of water, the epidermis loosens, which facilitates the penetration of oxygen through it, which oxidizes hemoglobin.
Maceration.
Already a few hours after the stay of the corpse in the water, a pearly-white coloration of the face, palmar surface of the hands and the plantar surface of the feet is noted. Within 1-3 days, the skin of the entire palm of the “laundry woman’s hand” wrinkles (Fig. 13), and after 5-6 days - the feet.

Maceration of the skin of the hands, depending on
from the time spent in the water

By the end of the week, separation of the epidermis begins, and by the end of the 3rd week, the swollen, loosened and wrinkled epidermis can be removed in the form of a glove (hence the name “gloves of death”). The mineral composition of the aquatic environment (fresh, salty, marine) also has a certain influence on the dynamics of the development of maceration. Clothes on the corpse, gloves on hands and shoes delay the development of maceration. In practice (when deciding on the duration of the stay of the corpse in water, taking into account the increase in the maceration process), you can use the data given in the table.

The timing of the development of skin maceration, depending on the temperature of the water

In the water, rotting of corpses develops with the formation of putrefactive gases, under the influence of which the corpse can float, even if a load weighing up to 30 kg was tied to it.
As a result of loosening of the skin (after about two weeks), hair loss begins and by the end of the month, especially in warm water, complete baldness may occur. Moreover, in contrast to intravital baldness on the scalp of a corpse, the holes from the hair that have fallen out are well defined. The possibility of hair loss during prolonged exposure of a corpse to water must be taken into account when it becomes necessary to identify a corpse.
It should be borne in mind that a human corpse can be placed in the water after inflicting fatal mechanical damage to cover up the crime. On the corpse, damage from the action of blunt and sharp objects is usually clearly visible, firearms, signs of poisoning with some poisons, etc.
The main issue when mechanical damage is found on a corpse is to establish their origin (intravital, posthumous). Damage in water of lifetime origin in the form of abrasions, bruised wounds, damage to the bones of the vault and base of the skull can occur when jumping into the water from impacts against stones, piles and other objects. Injuries in the form of compression fractures of the cervical vertebrae usually occur when jumping into the water upside down into shallow bodies of water. Therefore, in all cases of drowning, it is necessary to make control incisions in the back of the neck to examine the soft tissues and vertebrae. The human body in water can be exposed during life to the action of propellers and hydrofoils of river and sea vessels, etc.
Posthumous injuries can be caused by hooks, poles, and other items used to locate a corpse in water. When examining a corpse, injuries in the chest, abdomen, extremities, as well as rib fractures resulting from artificial respiration, can be detected.
Corpses in water can be damaged by animals inhabiting water bodies: crayfish, water rats, stingrays, crabs, etc. Typical injuries are caused by leeches, forming multiple T-shaped superficial wounds on the skin of the corpse.
Some types of algae can settle on a corpse. According to the development cycle of these algae, with the help of forensic botanical examination, it is possible to establish the approximate residence time of a corpse in a certain area of ​​the reservoir.
When examining the corpse at the scene (after removing the corpse from the reservoir), attention is drawn to the presence of foam around the mouth and nose, maceration of the integument, injuries are noted that can occur intravital or posthumously and be of different origins, including when providing first aid for artificial respiration (bruising on the forearms, sedimentation on the anterolateral surfaces of the chest). Together with the corpse, a water sample is sent to the morgue from the reservoir from which the corpse was removed (at least 1 liter) for further detection of plankton in order to compare it with plankton, which can be detected when examining the corpse in the morgue. The presence of objects that hold the body on the surface of the water (life belts, etc.) or, conversely, contribute to immersion (stones, objects tied to the body or in pockets of clothing) is noted. The condition of the clothes, the presence of sand particles or algae are described.
When a corpse moves in running waters, especially in mountain rivers, the corpse may show signs of wear on shoes, clothes, skin, nails, and even on the bones of the skeleton. Depending on the relief and features of the bottom (sharp stones, snags, etc.), when a corpse is moved by the current of water, clothes can be mechanically removed from it, and the corpse can be seriously damaged, up to dismemberment.

Content

Relaxing by the pond is not always pleasant. Improper behavior in water or emergencies can lead to drowning. Young children are especially at risk, but even adults who are good at swimming can become victims of strong currents, seizures, and whirlpools. The sooner the victim is removed from the water, and first aid is provided for drowning (removal of fluid from the respiratory tract), the higher the chance to save a person's life.

What is drowning

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

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

• injuries from diving in shallow water, in unexplored places;
• alcoholic intoxication;
• emergencies (seizures, heart attack, diabetic or hypoglycemic coma, stroke);
• inability to swim;
• negligence towards the child (when children drown);
• getting into whirlpools, storm.

Signs of drowning

Drowning symptoms are easy to spot. The victim begins to flounder, or swallows air through his mouth like a fish. Often, a person spends all his energy to keep his head above water and breathe, so he cannot cry for help. A spasm of the vocal cords may also occur. A drowning man is seized with panic, he is lost, which reduces his chances of self-salvation. When the victim was already pulled out of the water, the fact that he was drowning can be determined by the following symptoms:

• bloating;
• chest pain;
• blue or bluish tint skin;
• cough;
• shortness of breath or shortness of breath;
• vomit.

Types of drowning

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

1. "Dry" (asphyxial) drowning. A person submerges under water and loses orientation. Often there is a spasm of the larynx, water fills the stomach. The upper airways are blocked and the drowning man begins to choke. Asphyxia sets in.
2. "Wet" (true). Plunging into water, a person does not lose the respiratory instinct. The lungs and bronchi are filled with fluid, foam can be released from the mouth, and cyanosis of the skin manifests itself.
3. Fainting (syncope). Another name is pale drowning. The skin acquires a characteristic white, gray-white, bluish color. A lethal outcome occurs as a result of a reflex cessation of the work of the lungs and heart. Often this happens due to temperature differences (when a drowning person is immersed in ice water), hitting the surface. Fainting, loss of consciousness, arrhythmia, epilepsy, heart attack, clinical death occurs.

Rescue of a drowning man

Anyone can notice the victim, but it is important to provide first aid in a short time, because someone's life depends on it. While on the shore, the first thing to do is call a rescuer for help. The specialist knows exactly how to act. If he is not around, you can try to pull the person out on your own, but you need to remember the danger. The drowning person is in a stressful state, his coordination is impaired, so he can involuntarily grab onto the rescuer, not allowing him to grab himself. There is a high probability of drowning together (with improper behavior in the water).

Drowning emergency

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

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

Difference between sea water and fresh water when drowning

An accident can occur in various water sources (sea, river, pool), but drowning in fresh water is different from immersion in a salty environment. What is the difference? Inhalation of sea fluid is less dangerous and has a better prognosis. The high concentration of salt prevents water from entering lung tissue... However, the blood thickens, there is pressure on the circulatory system. Within 8-10 minutes, a complete cardiac arrest occurs, but during this time you can manage to reanimate a drowning person.

When it comes to fresh water drowning, the process is more complicated. When fluid enters the cells of the lungs, they swell, some of the cells burst. Fresh water can be absorbed into the blood, making it more liquid. Capillaries rupture, which interferes with cardiac activity. Ventricular fibrillation, cardiac arrest occurs. This whole process takes several minutes, so death in fresh water occurs much faster.

First aid on the water

A specially trained person should be involved in the rescue of a drowning person. However, he is not always nearby, or several people may drown in the water. Any vacationer who can swim well can provide first aid. To save someone's life, the following algorithm should be used:

1. It is necessary to gradually approach the victim from behind, dive in and cover the solar plexus, taking the drowning person by the right hand.
2. Swim to the shore on your back, paddle with your right hand.
3. It is important to ensure that the victim's head is above the water and does not swallow the liquid.
4. On the shore, you should put a person on his stomach, provide first aid.

First aid rules

The desire to help a drowning person is not always beneficial. Inappropriate behavior by a stranger often only exacerbates the problem. For this reason, first aid for drowning must be competent. What is the mechanism of PMP:

1. After the person is pulled out of the water and covered with a blanket, symptoms of hypothermia (hypothermia) should be checked.
2. Call an ambulance.
3. Avoid deformation of the spine or neck, do not cause damage.
4. Secure the cervical spine with a rolled-up towel.
5. If the victim is not breathing, you should start performing artificial respiration, heart massage

With true drowning

In about 70 percent of cases, water enters the lungs directly, causing true or "wet" drowning. This can happen to a child or a person who cannot swim. The first health care when drowning, includes the following steps:

• probing the pulse, examining the pupils;
• warming the victim;
• maintaining blood circulation (raising the legs, tilting the body);
• the production of ventilation of the lungs with breathing apparatus;
• if the person is not breathing, artificial respiration should be given.

With asphyxial drowning

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

• immediately carry out cardiopulmonary resuscitation;
• call an ambulance;
• when the victim recovers, warm him up.

Artificial respiration and heart massage

In most cases, when drowning, the person stops breathing. To bring him back to life, you should immediately start taking active steps: massage the heart, do artificial respiration. You need to follow a clear sequence of actions. How to do mouth-to-mouth breathing:

1. The victim's lips should be parted, mucus, algae should be removed with a finger wrapped in a cloth. Allow the liquid to drain from the oral cavity.
2. Grasp your cheeks so that your mouth does not close, tilt your head back, raise your chin.
3. Pinch the nose of the rescued person, breathe air directly into his mouth. The process takes a split second. Number of repetitions: 12 times per minute.
4. Check the pulse in the neck.
5. After a while, the chest will lift (the lungs will begin to function).

Mouth-to-mouth breathing is often accompanied by a heart massage. This procedure should be done very carefully so as not to damage the ribs. How to proceed:

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

Actions after first aid

Even if a person has come to his senses, this does not mean that he does not need medical attention. You should stay with the victim, call an ambulance or seek medical help. It is worth knowing that when drowning in fresh water, death can occur even after a few hours (secondary drowning), so you should keep the situation under control. With prolonged unconsciousness and oxygen, the following problems may arise:

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

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

• learn to swim;
• avoid drinking and bathing;
• do not go into too cold water;
• do not swim during a storm or at great depths;
• do not walk on thin ice.

Video

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment... Only a qualified doctor can diagnose and give recommendations for treatment, based on the individual characteristics of a particular patient.

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

Rest near a reservoir, 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 while the brigade arrives, it may come biological death... 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 are that they allocate different kinds drowning. Before you indicate the sequence of the implementation of assistance, you need to disassemble the causes and mechanisms of development different types drowning.

There are 3 types:

True drowning

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

Asphyxia 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 swim poorly or are intoxicated usually drown.

Syncope drowning is when, upon falling from a height, upon contact with cold water there is a reflex cardiac arrest and respiration. 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. Appearance 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 loss of consciousness, due to oxygen starvation of the brain. After that, the water in a large number fills the lungs and stomach.

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

Important! A drowning person can only be helped by someone who has 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, you must immediately call an ambulance. It should be borne in mind that water bodies are usually located far from the city and emergency stations.

After the victim is delivered to the shore, it is necessary to immediately begin providing first aid emergency aid. In rescuing a drowning man, the main thing 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 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 will resuscitate 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,
	You can not leave the victim unattended. Repeated 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 v crustacean.

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 that comes off easily;
• 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.

Action	Description
	If a drowning person is identified, you must immediately call the emergency team.
	Deliver the victim to the shore.
	In winter, you should 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 carry the person to the warmth, change his clothes and give him a warm drink.

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

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

This means that in winter, even after half an hour in the water, a drowned person 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:

Action	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.
	You need to revive the child for at least 40 minutes, especially after removing it 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 care skills are a guarantee of saving a person from death.

Table of contents of the subject "Acute respiratory failure (ARF) with airway obstruction. Foreign bodies of the upper respiratory tract. Thromboembolism pulmonary artery(TELA). ":
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.
8. Pulmonary embolism (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 care for pulmonary embolism (PE). Urgent care.

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

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 the 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, 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).

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

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

Syncopal 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 is suddenly immersed in cold water.

Clinic... At 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. There is cyanosis, chills, goose bumps. 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 complete this manual, it is recommended to lay the victim with his stomach on the bent knee of the person providing resuscitation assistance 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 treatment is syndromic in nature and consists of the following areas:
1. Carrying out 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 chart