It is not typical for true drowning. Drowning

Water is a serious element with which no one jokes. In it, a person gets food, with its help he waters the planted plants and gives water to animals, and also uses it for entertainment: swimming, diving, and doing various sports. All of this carries with it the potential danger of drowning in water. Moreover, children are at greater risk of drowning and, oddly enough, good swimmers: both neglect the danger and dive, jump into the water from a height, go swimming in a storm.

Drowning is an insidious state. Firstly, almost the entire body of a person is hidden by water, and even those floating nearby do not see how bad he is. Secondly, a drowning person never stretches out his hands and does not call for help: he is fighting for his life and is busy only with breathing in a little more air. From the side - especially if a child is drowning - it looks as if he is being played: he jumps over the water and dives again. Third, there is such a condition as secondary drowning. In this case, a person has been on land for a long time, but the water that has entered his respiratory tract continues its destructive effect and can kill him if treatment is not started in time.

Why do people drown?

Drowning of people is a life-threatening condition associated with a person getting into water. It arises as a result of:

• panic when swept by a wave at depth
• emergency situations: floods, ship sinking;
• swimming in a storm;
• violations of swimming rules, including diving;
• swimming in a strong current area;
• the purchase of faulty diving equipment;
• getting into swamps and swamps;
• the occurrence or exacerbation of diseases while swimming. These are fainting, epileptic seizure, acute cerebrovascular accident (stroke), heart attack, hypothermia, due to which the muscles of the legs are reduced;
• suicide, when a person either swims very deeply, or dives to a depth, or jumps into the water from a height. In the latter case, death can be triggered by three mechanisms:
  1. loss of consciousness due to brain injury;
  2. paralysis of all limbs due to fracture of the cervical vertebrae;
  3. reflex cardiac arrest, provoked either by a sudden immersion in cold water, or by pain from hitting the water;
• murder.

Not all people die as a result of the ingress of water into the respiratory tract: there is a type of it when air stops passing into the lungs due to the fact that a person has a reflex spasm of the larynx in the water. This type of drowning is called "dry".

Who is most at risk of drowning

Of course, young and healthy people who practice extreme water sports are at risk of drowning. But such activities increase the risk in only a small number of people. In most cases, drowning occurs:

• after taking a large amount of alcohol, which dulls a person's reactions and "instills" in him fearlessness. In addition, when alcoholic drinks "push" a person into the water, they contribute to hypothermia of the body, which increases the chance of drowning even more (with strong cooling, the body "throws" all the blood to the internal organs, leaving working muscles with minimal blood supply);
• when hitting a strong or rebound (reverse) current: it does not allow a person to reach the shore;
• when overwhelmed by a wave, when water enters the respiratory tract, and, in addition, causes a person to panic;
• if the person suffers from epilepsy or faints. In this case, loss of consciousness leads to the ingress of water into the respiratory tract;
• when bathing alone: \u200b\u200bin this case, the chance of first aid is reduced if a person gets injured under water, falls into the flow area or gets his leg pulled together from cold water;
• when swimming on a full stomach. In this case, the deterioration of a person's condition, which can lead to drowning, occurs according to one of three mechanisms:
  1. the main amount of blood after eating rushes to the stomach and intestines. In these conditions, the heart itself begins to be less supplied with blood - its work deteriorates, a heart attack may develop;
  2. the water compresses the full stomach, as a result its contents rises up the esophagus. At the moment of inhalation, food mixed with gastric juice can enter the respiratory tract (this is especially at risk for people who are intoxicated). This is how inflammation of the lung tissue develops, which is difficult to treat - pneumonitis;
  3. worsening of the condition can develop according to the previous scenario, only the airways (bronchi or trachea) can be clogged with a large piece of food. Even if this food can not completely block the diameter of the bronchus or trachea, it is still dangerous: it will cause a coughing attack, and in water it can end up with liquid entering the respiratory tract;
• with existing heart diseases: muscle work in the water makes the heart work harder, which can worsen its condition. If bathing takes place in cold water, then the load on the heart increases even more: it has to process a larger volume of blood due to narrowing of the skin vessels.

Types of drowning

The division of drowning into types is due to the fact that in each case different mechanisms lead to death and you can get rid of them in different ways.

There are 4 main types of drowning:

1. "Wet" or true drowning. It develops as a result of the ingress of water - sea or fresh - into the respiratory tract; occurs in 30-80% of cases. The true form of drowning suggests that the person resisted the action of water for some time. Skin color for this type of drowning is blue. This is due to venous congestion in the skin. Very seriously, the condition worsens when 10 ml of water gets into the lungs for every kg of body weight. A lethal hit is more than 22 ml / kg.
2. "Dry" drowning. It occurs when, when a person enters water, the glottis reflexively spasms (contracts), as a result of which neither water nor air enters the lungs. This type of drowning occurs in every third person who drowns. The color of the skin with this drowning is white, associated with a spasm of the vessels of the skin.
3. Syncope-type drowning occurs when a person's heart reflexively stops when they enter water (usually from a height and into cold water). Then he does not flounder and does not swallow water, but immediately goes to the bottom. Syncope drowning is the least common - in every 10 cases, more typical for people with heart disease.
4. Mixed drowning. In this case, water first enters the respiratory tract, as in true drowning, and because of this, the glottis spasms (as in its "dry" form). Then, when consciousness is already lost, the larynx relaxes, and water flows back into the lungs. This type is found in every fifth drowned person.

The mechanisms leading to death in "wet" drowning depend on whether the water got into the lungs - sea or fresh.

So, when drowning occurs in fresh water, processes occur associated with the fact that the water, in comparison with the fluids of our body, is hypotonic. This means that fewer salts are dissolved in it, and because of this, it penetrates into areas where biological fluids are contained and dilutes them. As a result, water trapped in the respiratory tract:

• first, it fills the alveoli - those structures of the lungs in which the exchange of gases - oxygen and carbon dioxide - between the blood and the respiratory tract takes place. These are respiratory "sacs", which normally always remain unclosed and contain air, which is due to the presence in them of a substance called "surfactant";
• being hypotonic, fresh water (and with it bacteria and plankton) quickly passes from the alveoli into the blood: the vessel is located on the outside of each alveoli;
• fresh water destroys surfactant;
• there is a lot of fluid in the vessels, and it goes back to the alveoli, causing pulmonary edema. Since erythrocytes burst from fresh water, the fluid in the alveoli becomes saturated with their "debris". This makes the foam that comes out of the respiratory tract red;
• when water dilutes the blood, the concentration of electrolytes (potassium, sodium, chlorine, magnesium) decreases in it. This disrupts the work of internal organs.

If the drowning occurred in seawater, which, on the contrary, is saturated with sodium salts, the picture will be different:

• seawater entering the alveoli "attracts" fluid from the lung tissue and blood to the alveoli;
• due to oversaturation of the alveoli with fluid, pulmonary edema develops. The released foam (it is obtained from the surfactant) is white. Moreover, each breath "whips up" the foam even more;
• since some of the fluid has left the blood, the blood becomes more concentrated;
• it is difficult for the heart to pump thick blood;
• thick blood cannot reach the small capillaries, since here it is not the force of the heart that pushes it, but the wave that was formed at the previous stage by the arteries of medium caliber;
• such blood has a high concentration of potassium, which causes cardiac arrest.

Who is more likely to survive drowning

When rescuing a drowning person, a huge factor is the time that has passed since the moment of falling into the water. The sooner assistance is started, the more chances you have to save a person.

The chances of saving a person increase if:

• the drowning occurred in icy water. Although such drowning is most likely "dry" in nature, when exposed to low temperatures, all biochemical processes in the body are greatly slowed down. This gives a chance to even restore the body's work when the heart has not been beating for some time (up to 10-20 minutes, depending on the water temperature);
• this is a child or young person without chronic diseases: their ability to regenerate, including brain tissue, is higher.

How to suspect that a person is drowning

It is only in films that they show that the signs of drowning are when the victim shouts "Drowning!" or "Save!" In fact, a drowning person does not have the strength and time for this - he is trying to survive. Therefore, you can see how:

• he then rises above the water, then plunges into it again;
• his head rises above the water, thrown back, eyes are closed;
• arms and legs move erratically, making attempts to swim;
• the drowning man coughs, spits out water.

Symptoms of drowning children look like a game: the child jumps over the water (each time it gets lower), convulsively swallowing air, and from the side it seems that everything is all right with him.

Calling for help and purposefully waving your arms is what precedes drowning. When a person feels that he is drowning, he develops a panic state associated with a feeling of lack of air. At this moment, he is unable to think critically.

The following signs indicate that a person has experienced drowning:

• severe cough, cough with foam or foamy sputum - white or reddish;
• rapid breathing;
• muscle tremors;
• fast pulse;
• pale or bluish skin;
• wheezing when breathing;
• vomiting, in which a fairly large volume of fluid is released. This is water swallowed;
• excitement or, conversely, drowsiness when hitting the shore;
• convulsions - not the reduction of limbs in the presence of consciousness, but the arching of the whole body or uncontrolled movements of the limbs - in an unconscious state

And, finally, if water trapped in the respiratory tract caused respiratory and / or circulatory arrest, then such a person:

• loses consciousness (it must be removed from the water);
• he has no breathing movements of the abdomen or chest;
• breathing can be, but it can be "sobbing" or like gasping for air in the mouth;
• there is no pulse in the carotid artery;
• foam from mouth and nose, pink when drowning in fresh water.

Now we need to draw your attention twice:

• Even if a person was reanimated, this does not mean that his nervous system will recover in full. He - immediately or after a while - may show the same symptoms that are characteristic of a stroke: loss of the ability to think and speak coherently, impaired speech (understanding or reproduction), impaired movement in the limbs, impaired sensitivity. A person may fall into a coma caused by cerebral edema due to hypoxia.
• All people who have experienced drowning are subject to hospitalization and medical examination, even if they have not fainted, and they have a pulse and breathing. This is due to a complication of drowning called "secondary drowning".

Drowning periods

This life-threatening condition is divided into 3 periods:

1. Elementary.
2. Agonal.
3. Clinical death.

Initial period

In true drowning, the initial period is when water only slightly began to enter the lungs, and this activated all the body's defense mechanisms. With asphyxia, this is from the moment it enters the water to a spasm of the respiratory gap (very short).

The person coughs and spits out, rowing vigorously with his hands and trying to push off with his feet. Vomiting may occur. Coughing and vomiting causes more water to enter the lungs, which speeds up the onset of the next period

Agonal period

During this period, the protective forces are depleted, loss of consciousness occurs. In asphyxia, this causes the spasm of the glottis to stop, and water enters the lungs.

The agonal period is characterized by:

• loss of consciousness;
• "Sobbing" breathing with its gradual disappearance;
• tachycardia, which is replaced by an arrhythmic pulse and its slowdown;
• discoloration of the skin.

The period of clinical death

It is characterized by a triad of symptoms:

1. lack of consciousness;
2. lack of breathing;
3. lack of pulse, which is checked by pressing the index and middle fingers to the thyroid cartilage ("Adam's apple") on one side.

Clinical death turns into biological (when revival is no longer possible) after about 5 minutes, but if a person drowned in cold or ice water, then this time increases to 15-20 minutes (in children - up to 30-40 minutes).

Self-help algorithm for drowning

All that a person can do upon falling into water is:

• Don't panic. Although it is very difficult, we must try to calm down, because panic only takes away the strength necessary for survival.
• Look around. If there are wooden or plastic objects of sufficient size floating on the surface of the water, try to grab onto them.
• As calmly as possible, saving energy, row in one direction (optimally - to the shore or to some ship).
• Rest, lying on your back.
• Call for help periodically (if it's dark). During the day, in the absence of visibility of people or ships, you need to save energy and not call.
• Try to breathe as calmly as possible.
• Turn your back to the waves (if possible).

How to save a drowning man

This also requires a separate algorithm. If you try to be heroic and, not knowing the rules, swim to help the drowning man, you can easily die yourself: if the drowning person sees or feels the presence of another person, he will panic, in order to survive on his own, he will drown the rescuer.

Therefore, drowning assistance is as follows:

1. Before sailing to rescue, take off the disturbing clothes and shoes.
2. Swim up to the drowning man only from the back. Next, you need to grab him by one shoulder with one of your hands, and with the other hand, raise his head by the chin so that he can breathe. In this case, the second hand of the rescuer must press the shoulder of the drowning person so that he cannot turn over to face the person who is saving him. In this position, and you need to swim to the shore. The same position is used when transporting an unconscious person.
3. If you want to reach out to the drowning man, make sure that with the other hand you firmly hold on to some kind of support.
4. Do not neglect the call for help.
5. A drowning person can be thrown some kind of floating object (for example, a life buoy) by announcing this in monosyllables several times: "Hold!", "Grab!", "Catch!" etc.
6. If a person lies motionless at the bottom, then it is important to raise him correctly:
   • swim up to the face down from the side of the legs, clasp him in the armpits and so raise him up;
   • swim up to the person lying face up from the side of the head. Now you need to grab him from the back so that the palms of the rescuer are on the victim's chest, and raise the drowned man to the surface.

The main thing at this stage is to get a person out of the water. Assessment of his condition should be done on the shore.

First aid for drowning

First aid algorithm for true drowning:

1. We call the ambulance brigade.
2. We lay the patient with his stomach towards us on a bent knee so that his stomach is above the head and chest.
3. We take a piece of cloth, a handkerchief or clothing, open the victim's mouth, and remove everything in the mouth. If the skin is blue, additional pressure is needed on the root of the tongue: this will cause vomiting, which will remove water from both the lungs and the stomach.
4. In the “head down” position, we squeeze the chest well so that all the water comes out.
5. We quickly turn the victim onto his back and begin cardiopulmonary resuscitation:
   • 100 presses per minute on the chest with palms of straight arms superimposed on each other;
   • every 30 pressures - 2 breaths into the open mouth (while the nose is pinched) or into the open nose (the mouth is closed).
6. Continue resuscitation until pulse and breathing are restored. If there is only one resuscitator, there is no need to be distracted by checking these parameters every minute, but to continue for a rather long time until signs of consciousness appear.

All of these points relate to first aid for both children and adults. It is only necessary to take into account that children need to press on the chest more often (the smaller the child, the more often), and apply less pressure. The sequence of inhalation and pressing on the chest is the same - 30 pressures, 2 breaths.

The first aid algorithm for asphyxical drowning consists of the same points, except for points 2-4. That is, if a person with very pale skin is pulled out of the water, you need to call for medical help and proceed directly to cardiopulmonary resuscitation.

What to do after the drowned man regained consciousness

After drowning, whatever it may be - true or "dry", the victim should not be released in any case. To avoid complications, he needs to be hospitalized and examined.

What will the hospital do

At the hospital, the person will be thoroughly examined: oxygen and carbon dioxide will be determined in his blood (in the venous and arterial separately). An analysis will be made for the content of potassium, sodium, chlorine and other indicators in the blood. Be sure to perform an ECG and chest x-ray.

If the patient is unconscious, intensive therapy will be started, which will consist of:

• providing it with an increased oxygen content (so that it can pass through the foam and water in the alveoli - into the blood);
• extinguishing foam in the lungs;
• removing excess fluid from the lungs;
• normalization of the heartbeat;
• normalization of electrolyte levels, especially potassium and sodium;
• bringing the temperature to normal numbers;
• the introduction of antibiotics,
• other events selected individually.

Complications of drowning

Drowning is often complicated by one of these conditions:

• pulmonary edema;
• secondary drowning (when a little water gets into the lungs, but it is not removed from them in the near future). This water impairs the exchange of gas between the lungs and blood, and after a short time ends in death;
• pneumonia;
• edema of the brain, the consequences of which can be from a complete restoration of the central nervous system to a coma, ending lethally, or a complete vegetative state ("like a plant"). "Intermediate stages" are loss of sensitivity, impaired movement in one or more limbs, loss of hearing, vision, memory;
• decompensation of cardiac activity;
• gastritis and gastroenteritis - due to ingestion of dirty water, as well as due to reverse peristalsis caused by vomiting;
• sinusitis (inflammation of the sinuses of the cranial cavity), which can also be complicated by meningitis;
• panic fear of water.

Drowning

Drowning is a fairly common cause of death, the third most common cause of death in the world from unintentional injury. Drowning in water is especially common in spring and summer, when the swimming season begins. This state does not always end with death. Timely medical care for drowning helps save a person's life. You just need to know what to do. First aid for drowning is a series of simple steps that even children should know. Special attention is paid to this issue, practical and theoretical classes on this topic are held in all educational institutions, starting from primary school age.

Drowning is a pathological condition or death of a person that develops due to the inability to breathe, since the respiratory organs are closed with water. This process is complex, but very little time passes from the moment it gets into the water to death. And if you do not provide emergency assistance in case of drowning in time, the person will die. In order for death to occur, it is not at all necessary for a person to hit a great depth. Drowning can only occur when the head is immersed in liquid. This happens in accidents, when a person, intoxicated or unconscious, falls face down into a puddle or a container with liquid standing next to it.

Drowning in water and other liquids

Most often, a person's drowning occurs in water, but sometimes situations can occur when asphyxiation occurs with any other fluids. Most often these are industrial accidents. Drowning in water has its own characteristics, depending on the composition of the water. It has been observed that drowning in fresh water has some distinguishing characteristics from drowning a person in salt water. These data are of great importance in establishing the mechanism and cause of death, which is very important if there is a suspicion of the criminal nature of this case.

Drowning in fresh water

The penetration of water into the lungs leads to the fact that, due to the difference in osmotic pressures of ordinary water and blood plasma, the liquid is inevitably absorbed into the blood. The blood is diluted with water, and the total blood volume is doubled. Due to the ingress of water into the general bloodstream, hemolysis (destruction) of erythrocytes occurs, followed by the release of hemoglobin. The doubled blood volume creates a colossal load on which it cannot withstand. A decrease in the concentration of red blood cells can lead to ventricular fibrillation. The membranes from erythrocytes, free hemoglobin are trying to remove the kidneys - acute renal failure develops. Drowning in fresh water is also accompanied by irritation of the lung receptors, which provokes abundant foam formation, which only accelerates the onset of asphyxia.

The electrolyte composition of seawater differs significantly from the electrolyte composition of humans. The salt concentration in sea water is much higher. According to the law of osmosis, when salty sea water enters the lungs, the liquid part of the blood is "drawn" from the blood vessels to the lung. This mechanism is directly opposite to that of drowning in fresh water. Pulmonary edema develops, and the formation of persistent foam in the airways is also characteristic. Death occurs from cardiac arrest, which develops as a result of oxygen deficiency, resulting from blood clots. It is believed that drowning in salt water occurs a little more slowly, which is due to the increased buoyancy of the body in sea water. It was also noted that for the development of cardiac arrest from anoxia (lack of oxygen), which develops as a result of blood thickening, it takes about 8 minutes, while when drowning in fresh water, it takes 2-3 minutes to stop the heart from hemodilution (blood thinning). Such knowledge will come in handy in the implementation of first aid for drowning.

Drowning a person in other fluids

Drowning a person can happen not only in water. It can be any other liquid. Most often these are industrial accidents. There are known stories when drowning took place in huge containers with milk, gasoline, wine. Such a tragedy can also occur at home, when small children are left unattended. Drowning in this case can occur in any liquids left by adults in buckets, baths, tanks in places accessible to babies.

Types of drowning

Drowning in water and liquids can proceed in different ways. In connection with the differences discovered, the following types of drowning began to be distinguished:

• True, or "pale" drowning;
• Asphyxia, or "blue" drowning;
• Syncope drowning;
• Mixed type of drowning.

It is important to be able to differentiate the types of drowning, since the volume and duration of first aid for drowning depends on the knowledge of the mechanism by which the pathological process developed in the body.

True or "pale" drowning is understood as the process when liquid (water) flows into the lungs, is absorbed into the bloodstream, leading to hemodilution. It is noted that more often this type of drowning occurs in cases where the drowning person resisted the water element for a long time. This type is called "pale" drowning due to the color of the skin of the drowned. Skin color when drowning by this mechanism is characterized by strong pallor. And the term "wet" has become entrenched, because water is found in the internal organs. The lungs become large, heavy, filled with fluid. Water is found in the stomach, intestines, sinuses.

Asphytic (spastic, "blue", "dry")

Asphytic drowning is the result of a spasm of the larynx resulting from irritation of the receptors in the respiratory tract with water. In this case, water in the lungs may not be detected at all or flow out after death from asphyxia. For this reason, it is also called "dry". In contrast to "pale" drowning, the skin color during drowning by this mechanism has a bluish color. Therefore, such drowning is also called "blue".

Syncope drowning (reflex)

The onset of death due to vasospasm and reflex cardiac arrest is called syncope drowning (syn. Reflex). Syncope drowning can occur due to a person's heart and lung diseases, or if they are allergic to water. In this case, death occurs even before the onset of those changes that are caused by the filling of the respiratory tract with water. Therefore, pathognomonic changes in the blood for drowning and during the examination of internal organs during syncope drowning are not found.

Mixed drowning

When mixed, they show signs of both true and asphytic types of drowning. It is registered in 20% of cases.

The processes occurring in the body due to the closure of the airways with water can proceed in different ways. It depends, as we have already said, on the composition of the water and on the type of drowning. But, according to experts, the mechanism of drowning in all cases is similar and has a number of successive stages.

Reflex breath holding

As soon as the body is submerged in water, breathing is reflexively delayed. The duration of this stage is different for each person and depends on the reserve capabilities of the body. After holding the breath, movements of the respiratory muscles involuntarily occur.

Stage of inspiratory dyspnea

Motions that imitate inhalation prevail, during which water begins to actively flow into the lungs. Irritation of receptors with water causes a cough reflex. At this point, the water, mixing with the air in the lungs, forms the foam characteristic of drowning.

Expiratory dyspnea stage

Exhalation movements prevail. The pressure in the chest increases, the heart rate increases, extrasystoles develop against the background of oxygen starvation of the heart muscle. The stages of shortness of breath during inhalation and exhalation are the time of struggle, when a person is trying with all his might to save himself. Loss of consciousness from hypoxia can prevent this.

Stage of relative rest

At this moment, respiratory movements cease due to the processes of inhibition in the respiratory center, relaxation of all muscle groups occurs, the body of the drowned man goes to the bottom.

Terminal breathing stage

The spinal control center of the respiratory center is activated, trying to somehow correct the situation. Irregular sharp respiratory movements appear. As a result of these movements, the water penetrates even deeper into the parts of the lungs, tearing the alveoli and penetrating into the blood vessels.

Final cessation of breathing

The final cessation of breathing is the result of transcendental inhibition in the central nervous system.

The reasons for drowning are diverse, and in order to better understand why it occurs, one has only to think about what situations force a person to be in close contact with water. The main cause of drowning is an accident, which can be caused by various factors. Less commonly, drowning in water can be the result of a deliberate act of crime. But this method of murder is not used very often. Natural disasters such as floods can contribute to drowning. In such situations, it is difficult to cope with the water, even as a master of sports in swimming.

Indirect causes of drowning that are risk factors:

• Access to water

Naturally, in regions with a large number of water bodies, drowning is much more common. Moreover, the reason for drowning is almost always the neglect of simple rules of behavior on the water: swimming behind buoys, swimming in reservoirs with unknown depth and bottom topography indicators, drunk bathing, swimming in unfavorable climatic conditions, etc.

• Inability to swim

We can say the main reason for drowning. People who cannot swim should not be in the water at all without special devices that can keep them on the water (circle, vest).

• Bathing or being drunk by water

Alcohol is the cause of many troubles in human life. Being in alcoholic intoxication, a person is unable to assess the current situation, which often leads to sad consequences.

• Male gender

According to statistics, among all drowning people, men are more often registered. This is due to the hobbies of the stronger sex (fishing, diving, rafting, surfing, etc.), as well as to the fact that men often drink alcohol, are not afraid to swim alone, etc.

• Childhood

A huge percentage of child deaths from drowning occur between ages 1-14. Left unattended even for a couple of minutes, they become victims of the water element.

• Swimming in cold water

Cold water, when it enters the respiratory tract, irritates the receptors, laryngeal spasm and asphyxia occur. This is how the "dry" type of drowning develops. Swimming in cold water or accidental exposure to icy water (for example, during winter fishing) can cause death from cramps in the limbs, making it difficult for a person to swim ashore. Being in cold water in combination with alcoholic intoxication can especially quickly contribute to drowning.

• Health problems

When a person is in the water, diseases do not disappear, and sometimes they can cause an accident. Drowning in water can be caused by heart attacks that catch a person while swimming, an epileptic seizure, etc.

There are different types of help for a drowning man. It is important to remember that a drowning person is in urgent need of drowning care. The whole process of drowning takes 6-8 minutes. If you do not have time to provide first aid for drowning, a person can be lost.

Types of drowning assistance:

• First aid for drowning (PMP for drowning);
• Drowning resuscitation.

First aid for drowning

First aid for drowning - these are the actions that must be carried out by any person who happens to be near the drowning person. Even schoolchildren are taught these simple skills.

The volume of PMP during drowning includes:

• The first step is to get a person out of the water. To do this, it will be correct to swim up to him from behind, so that in a panic he does not grab the rescuer and pull him into the depths. You need to grab the drowning man by the hair or by the arms from the back and swim to the shore.
• On the shore, place the victim in a position on his side, examine the oral cavity. If there is sand, algae, debris, vomit in the mouth, empty your mouth.
• Call an ambulance.
• You can press your finger on the root of the tongue, artificially causing vomiting. This will cleanse the stomach fluid, the person will begin to come to his senses.
• Evaluate the presence of pulse, heartbeat and pupil response to light.
• If the victim does not show signs of life, urgently proceed with resuscitation in case of drowning.

Drowning resuscitation

Drowning resuscitation includes chest massage (indirect) and artificial respiration during the first aid stage for drowning. Upon the arrival of doctors, the drowned man is delivered to a medical institution, where, if necessary, resuscitation measures can be continued in a hospital in the intensive care unit. The rescuer of the drowning person must immediately begin resuscitation after clearing the oral cavity from possible contamination. The implementation of artificial respiration in combination with cardiac massage should be carried out until the arrival of the emergency carriage or until the moment when the victim regains consciousness. Such events should be carried out within 30 minutes.

Upon the arrival of doctors, the victim undergoes a series of resuscitation measures aimed at restoring respiratory function (artificial ventilation of the lungs), emptying the stomach from fluid (gastric intubation). If clinical death is stated, doctors take measures to get out of this state: cardiopulmonary, adrenaline administration, etc.

Even if a person has come to his senses after receiving medical assistance during drowning and assures that everything is in order, he should not be allowed to go home. There is a high risk of developing "secondary drowning" when death occurs some time after drowning and resuscitation of the drowning person. Therefore, he is taken to the hospital, where doctors treat the complications of drowning (pulmonary edema, airway inflammation, electrolyte disturbances, acute renal failure).

Drowning PMP and types of drowning

First aid measures for drowning may have their own nuances depending on the type of drowning. You need to know about this, because the correctly chosen tactics of behavior will help not to lose valuable minutes on which a person's life depends.

First aid for drowning aspiration type

"Wet" drowning, types of assistance:

• PMP for drowning aspiration type

The provision of first aid for drowning, characterized by the filling of the respiratory and digestive organs with water, boils down to the fact that after moving the drowned person to the shore and emptying the oral cavity, it is necessary to remove the fluid that has entered the body. To do this, it is enough to put pressure on the root of the tongue and put the victim's body with his stomach on his own knee. Push between the shoulder blades. This action should be allotted no more than 15 seconds. Even if the liquid does not come out, there is no point in wasting time. It is necessary to quickly switch to artificial respiration and heart massage.

Resuscitation for drowning of this type does not have any peculiarities, it is carried out according to well-known rules before the arrival of an ambulance.

Treatment of complications that arise in the long term. This is a therapy aimed at preventing and treating pulmonary edema, restoring the rheological properties of blood (combating hemolysis), restoring the functions of the brain, kidneys, etc.

"Dry" drowning, types of assistance:

• First aid for drowning asphyxia

No measures are required to remove fluid from the body, since with this type it may not be there. But you need to inspect your mouth for foreign objects. After that, go to cardiopulmonary resuscitation according to general principles.

• Emergency care for drowning in a medical institution for dry drowning is carried out symptomatically and is aimed at restoring all body functions.

The asphytic type of drowning is considered somewhat more favorable in the sense that a successful result in the provision of emergency care for drowning is possible if the body has been in the water for up to 8 minutes. Whereas with aspiration drowning, this period is no more than 6 minutes.

Reflex drowning emergency care

First aid for reflex drowning has the same principles as PMP for asphyxia. It is believed that first aid for drowning in the event of syncope drowning can give a positive result, even if the victim's body was in the water for about 12 minutes. And if the water was cold or icy, then due to the fact that in the chilled brain metabolic processes slow down, this period can be shifted to 20 minutes.

Signs of drowning

Signs of drowning are divided into external and internal. External signs are visible with the naked eye, and to detect internal signs, it is necessary to conduct a study of the organs and tissues of the drowned person using special methods. This is to confirm drowning as the cause of death. After all, the discovery of a person in the water does not mean that he drowned. Drowning types play an important role in the appearance of certain symptoms.

At the moment of the drowning process itself, the picture can be different. We are accustomed to seeing on TV screens that a drowning person is actively waving his hands, floundering in the water and calling for help. But this is not always the case. Most often, this behavior of a drowning person is associated with the panic that gripped him. Moreover, during a cry, air leaves the lungs, which only accelerates the movement of the body to the bottom. In most cases, filling the airways with water prevents sounds from being emitted. It is possible to suspect that a person is drowning by such signs as surfacing out of the water, taking deep breaths and diving again. At the same time, the eyes have a "glass" look, the mouth is open.

• Skin color when drowning

The color of the skin during drowning is also noteworthy. True and syncopal drowning types are characterized by pale skin with a bluish or pinkish-blue tint. Skin color when drowning is "dry" type: the skin becomes blue or dark blue.

• Foam at the mouth and nose

The presence of white or pink foam around the mouth and nose is a common sign of drowning. This foam is formed as a result of air and water mixing while trying to breathe. Its peculiarity is its persistent character, the foam is difficult to separate from the mucous membranes. When it dries, it leaves a characteristic fine-mesh gray mesh on the skin surface.

• Swelling of the mucous membranes

There is swelling of the conjunctiva, lips, sometimes the puffiness of the whole face is noted.

When removing a drowned person from the water alive, the following symptoms may occur:

• Cough;
• Vomiting;
• Diarrhea;
• Impaired consciousness, up to coma.
• Respiratory distress, up to a stop.

Internal signs of drowning

The body of a drowned person is subjected to careful examination. This is necessary to confirm drowning as the cause of death. The internal organs of the drowned man are examined by various methods. This is a description of the changes in internal organs detected during the autopsy, as well as a number of studies carried out in special laboratories using a microscope and other technologies.

Persistent foam in the airways

In the mouth, nose and bronchial cavity, a characteristic fine-bubble foam is found. In the case of a true type of drowning, it has a pink color, possibly with an admixture of blood, whereas in the case of asphytic ("dry") drowning, the foam remains white or grayish.

• Wet lungs

The lungs become enlarged, on their surface there are imprints of ribs, which arose from the fact that a sharp increase in the volume of the paired organ led to the fact that the chest cavity became small for them. When cut from the tissue of the lung, a pink liquid flows, the color of the lungs is pale, with pink areas. Such changes are called "marble lung".

• Muscle hemorrhages

When examining the muscles in the neck, arms and back, hemorrhages can be detected - this is the result of very active attempts by a drowning person to escape. The movements become so strong and sharp that small vessels can be damaged.

• Swelling of internal organs

When examining the internal organs, you will notice that some organs are edematous, for example, the liver, lungs, gallbladder. This is confirmed by further examination of the organs under a microscope.

• Eardrum rupture

A ruptured eardrum cannot be considered a specific symptom; according to some authors, this phenomenon can occur posthumously. But the fact that the rupture of the eardrum and the ingress of water into the middle ear cavity is detected in drowned people is considered undoubted.

• Compression fracture of the cervical spine

It often happens that a person who dives into the water appears on the surface of the water already dead. The reason for this is a fracture of the cervical vertebrae, which happens when jumping into the water in shallow water or in an unknown body of water with a rocky bottom.

It is also necessary to establish a diagnosis of drowning by laboratory research methods. Finding a person in the water does not mean that his death occurred from drowning. Often, the body is placed in water to hide the traces of a crime, simulating an accident. But experts, after conducting a number of studies, can give a reliable conclusion about whether an accident occurred or the body fell into the water after death.

• Plankton testing

The main and highly informative research method is the detection of plankton in the body of a drowned person. Plankton is the name for small inhabitants of plant and animal origin inhabiting water bodies. They cannot be seen with the naked eye, but they are clearly visible under a microscope. A special class of microorganisms whose shell consists of silicon is of particular value for research. This is diatom plankton (diatoms), its detection in the human body is possible even long after drowning. Their shell is so hard that it is not subject to destruction from the influence of environmental factors.

Each body of water is inhabited by certain types of plankton. In different areas and nooks and crannies of the globe, the planktonic composition of water is different. This also has its value in the drowning investigation. Therefore, when examining human tissues and organs for the presence of plankton, a water sample taken in the reservoir where the drowned man was found is also examined.

If the body is found outside the water, samples are taken from water bodies in the area. Later, the results are compared: the diatoms found in the body are compared with diatoms in water samples. If plankton is found in the lungs and respiratory tract, it only means that the person was in the water. An undoubted sign of drowning is the presence of plankton in the kidneys and bones, where these microorganisms got into the bloodstream when mixing blood with water.

• Internal microscopy

In order to detect reliable signs of drowning, it is also necessary to study the internal organs of the drowned person under a microscope. There are no specific signs of drowning, but there are small changes that indicate possible drowning. And together with other signs obtained during the external examination of the body of a drowned person, they make it possible to establish or refute the diagnosis of drowning.

The most informative in this regard are the lungs. So, when examining lung tissue, areas of emphysema (swelling) with ruptures of interalveolar septa alternate with areas of alveoli containing fluid (edema). Inside the alveoli, as well as in the bronchi, a pale pink content is found, sometimes erythrocytes are visible. Also in these structures can be found particles of algae, elements of plankton.

• Lymphogemia

The flow of blood into the common lymphatic duct, resulting from an increase in venous pressure in the vena cava system, is called lymphogemia. The lymph is examined under a microscope, the detected erythrocytes are to be counted using a special counting chamber.

An important aspect in the prevention of drowning is teaching children from the period of primary school age the rules of safe behavior on the water, swimming skills, as well as methods of first aid for drowning.

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

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

Drowning is promoted by drunkenness, overwork, hypothermia, increased sweating, overheating of the body, overfilling of the stomach with food, a sharp change in the conditions of blood circulation in water, an increase in stress on the cardiovascular system, mental factors, diseases of the cardiovascular and nervous systems, and trauma.

Swimming in cold water or prolonged exposure to relatively warm water can lead to convulsive contractions of certain muscle groups. Such a reaction occurs during prolonged swimming in one style, a feeling of fear, panic. Occasionally, there is the so-called "immersion syndrome" (water, ice or cryogenic shock), which occurs due to a sharp temperature drop, causing over-irritation of skin thermoreceptors, vasospasm, cerebral ischemia and reflex cardiac arrest.

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

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

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

Sometimes death in water caused by diseases (myocardial infarction, non-traumatic cerebral hemorrhage), as well as injuries not associated with drowning occurs.

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

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

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

Plunging into the water, a person instinctively holds his breath (pre-asphytic period) for different times, due to the state of health and fitness (about 1 minute), tries to emerge.

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

Taking spasmodic breaths during the emergence, a person can swallow water. A crowded stomach makes it difficult for the diaphragm to move. Physical stress and fear further exacerbate oxygen deprivation, which irritates the respiratory center. Involuntary breathing movements are formed under water (stage of expiratory dyspnea). Following thisreflexively a deep exhalation occurs, throwing out the air contained there along with water from the respiratory tract. At 3-4 minutes, a diffuse protective inhibition of the cortex occurs. By this time, consciousness is usually lost, air bubbles appear on the surface of the water and the person sinks to the bottom. In the middle or at the end of the second minute after immersion in water, general convulsions occur due to the spread of overexcitation processes through the cortex and the capture of the motor zones of the cortex by them, reflexes are lost. The person becomes motionless. Further, the waves of initial motor excitation begin to descend into the lower parts of the central nervous system and, reaching the cervical part of the spinal cord, cause a series of deep, but rare breaths with a wide open mouth (the so-called terminal respiratory movements). Water, swallowed, enters the stomach and the initial section of the small intestine. In the stage of terminal breaths, it enters the airways in a wide stream under pressure that increases with the depth of the body's immersion, filling the bronchi and alveoli. Due to high pulmonary pressure, the expansion of the alveoli develops - alveolar emphysema. Water enters the tissue of the interalveolar septa, breaks the walls of the alveoli, penetrates into the lung tissue, displaces the air in the bronchi and mixes with the air contained in the lungs (normally up to 2.5 liters). Through the capillaries, water enters the vessels of the pulmonary circulation, significantly diluting the blood and hemolyzing it. The blood diluted with water enters the left half of the heart, and then into the systemic circulation. There comes a final cessation of breathing, the work of the heart soon stops, and after 5-6 minutes death occurs from a lack of oxygen (Fig. 281).

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

The presence of foam indicates active respiratory movements during the drowning process. Due to the rupture of the vessels of the alveoli, the released blood stains the foam in a pinkish color.

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

This type of drowning occurs when water at a temperature of about 20 ° C suddenly enters the upper respiratory tract. Water irritates the mucous membranes and endings of the superior laryngeal nerve, leading to spasm of the vocal cords and reflex cardiac arrest. The spasm of the vocal cords closes the glottis, which prevents water from entering the lungs during a dive and the exit of air from the lungs at the time of emerging to the surface. The sharply increased intrapulmonary pressure causes acute asphyxia, accompanied by loss of consciousness. The phases of deep and atonal breathing are manifested by intense movements of the chest. Sometimes the terminal pause may be absent. In connection with a drop in cardiac activity, conditions are created for the development of pulmonary edema, impaired permeability of the alveolar-capillary membranes, which causes blood plasma to enter the airspace of the final units of the lungs (alveoli), which, mixing with air, forms a persistent fine-bubble foam. Edema can also be caused by mechanical damage to the membrane due to a drop in intrapulmonary pressure due to intense false inspiration with a closed glottis.

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

The likelihood of laryngospasm depends on age, body reactivity, gender, water temperature, pollution with chemical impurities, chlorine, sand, shells and other suspended particles. Most often, laryngospasm occurs in women and children.

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

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

Sometimes drowning begins as an asphyxia type and ends as a true drowning type, when laryngospasm is resolved by water entering the respiratory tract and lungs. It is possible to distinguish true insulation from false by the signs given in table. 26.

Occasionally, there are no signs of asphyxia and true drowning. Such drowning is called reflex (syncope)... This type is associated with rapid reflex cessation of breathing and primary Cessation of cardiac activity as a response of the body to the aquatic environment in extreme conditions (water shock, allergic reaction to water, etc.).

It arises from the action of cold water on the body, which intensifies the vasospasm of the skin and lungs. There comes a contraction of the respiratory muscles, which results in sharp disturbances in breathing and cardiac activity, hypoxia of the brain, leading to a rapid onset of death even before the development of drowning itself. Syncopal typedrowned contribute to: emotional shock immediately before immersion in water (shipwreck), hydroshock caused by exposure to very cold water on the skin, laryngopharyngeal shock from the action of water on the receptor fields of the upper respiratory tract, water irritation of the vestibular apparatus in people with a perforated tympanic membrane.

Death in the waterrarely occurs in expert practice. As a rule, it is observed in persons suffering from diseases of the cardiovascular system (angina pectoris, postinfarction cardiosclerosis, acute coronary and respiratory failure), pulmonary tuberculosispneumosclerosis,diseases of the central nervous system (ecylepsy, mental disorders). The cause of death in water in divers can be barotrauma of the lungs, nitrogen anesthesia, oxygen starvation, oxygen poisoning, subarachnoid hemorrhage in cerebrovascular diseases, allergic shock to water associated with exposure to an allergen in water on a sensitized body, fainting followed by a reflex caused by water irritation nasopharynx and larynx, leading to drowning, prolonged exposure to water at a temperature of +20 ° C, causing progressive heat loss, leading to hypothermia, damage to the tympanicmembranes followed by irritation of the middle ear with water and reflex cardiac arrest or ingress of water into the middle ear through the perforated eardrum due to a previous illness irritation of the vestibular apparatus, leading to vomiting and drowning loss of orientation in survivors, irritation with water in the mouth, upper respiratory ways, aspiration of vomit during the onset of unconsciousness.

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

Drowning can be accompanied by the outpouring of blood into the tympanic cavities, mastoid cells, and caves. It can be in the form of free accumulations or abundant soaking of the mucous membranes. Their occurrence 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 and the outflow of blood.

In the tympanic cavity, sand and other foreign particles from the reservoir are found. Outpouring of blood into the middle ear and eardrum is revealed.

When examining the corpses of drowned people, bilateral, parallel to the longitudinal fibers, blood stratification of the sternocleidomastoid and pectoralis major muscles (Paltauf), broad and scalene muscles, and neck muscles are found (Reuters). They occur as a result of strong muscle tension during a drowning attempt to escape. Occasionally, vomit is found in the circumference of the nose and mouth and in their openings, indicating vomiting during the agonal period.

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

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

Foreign particles can penetrate into a corpse when they are and for a long stay in turbid water containing them, in reservoirs with a fast current, and therefore their probative value is small. Large pebbles and pebbles deeply penetrated into the trachea indicate active aspiration during the convulsive period of drowning. In the respiratory tract, gastric contents are sometimes found, penetrating to the small bronchi. In such cases, it should be noted whether it is squeezed out of the bronchi on the cut. Its presence indicates vomiting in the agonal period. Occasionally mucus is found in the airways. Foam in the airways can be formed as a result of pulmonary edema, during vigorous artificial respiration, mechanical asphyxia from compression of the neck with a loop or hands and, as a result, prolonged agony. The mucous membrane of the trachea and bronchi is edematous, cloudy, the foam is usually unstable and coarsely bubbly.

Lungs - large, completely fill the pleural cavities and sometimes "protrude" from them, cover the heart, emphysematous swollen, increased in volume and sometimes in weight, which is explained by the penetration of fluid during wet drowning. The edges of the lungs are rounded, go behind each other, sometimes cover the heart bag. On the surface of the lungs you can see the prints of the ribs, which appeartrapped, between which the lung tissue acts in the form of rollers - "the lung of a drowned man". Similar prints are found on the posterolateral surfaces of the lungs. Such changes are explained by the pressure of water entering the airways into the lungs on the air available there, which breaks the walls of the alveoli and passes under the pulmonary pleura, causing emphysema. The displaced air is replaced by water. As a result, the lungs significantly increase in volume, putting pressure on the chest from the inside, as a result of which transverse grooves appear on them - traces of rib pressure.

An increase in lung volume occurs during vigorous and prolonged artificial respiration, which must be borne in mind when examining a corpse. The upper lobes and the lung margins adjacent to the root are usually dry and stretched with air. The organ pleura is unclear, under it there are rather large spilled reddish-pink spots with indistinct blurred borders, described independently by Rasskazov (1860), Lukomsky (1869), Paltauf (1880) and called the Rasskazov-Lukomsky-Paltauf spots in the literature. Their color and size are due to the amount of water that has entered the systemic circulation through the torn and gaping capillaries of the interalveolar septa, and by hemolysis of blood, as a result of which diluted and hemolyzed blood becomes lighter, its viscosity decreases, it liquefies, and hemorrhages blur, acquiring fuzzy contours. The lungs become "marble" due to the alternation of bulging pink and sunken red areas. Drowning in seawater does not cause hemolysis, and they retain their normal color.

Light dough to the touch, resemble a sponge soaked in water. With wet drowning, the lungs are distinguished by a huge volume, with alternating dry areas with watery ones, and acquire a gelatinous appearance. From the surface of the incision of such lungs, a frothy liquid flows, similar to that contained in the respiratory tract. The lungs are heavy, full-blooded, with hemorrhages under the pulmonary pleura.

In cases of dry drowning, the lungs are emphysematous swollen, dry, under the pulmonary pleura, the mucous membrane of the gastrointestinal tract, renal pelvis, bladder - Tardier spots, which are formed during the period of inspiratory dyspnea. In the initial parts of the respiratory tract, there may be particles of sludge, etc. The venous system is overflowing with blood with a few dark red bundles.

Drowning in seawater, which is a hypertonic environment in relation to blood, releases blood plasma into the alveoli, which leads to the rapid onset of pulmonary edema and pulmonary insufficiency. The blood does not thin, its viscosity increases, hemolysis of erythrocytes is absent, Rasskazov-Lukomsky-Paltauf spots are not observed. Areas of atelectasis are combined with foci of emphysema and uneven blood filling.

Thinning of the blood contained in the left ventricular cavity is a consequence of intravascular hemolysis and is a valuable trait found only in true drowning in fresh water, which rapidly permeates the left ventricular endocardium and aortic intima.

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

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

The section draws attention to a large amount of liquid in the stomach, sometimes with an admixture of silt, sand, aquatic plants, which penetrate the stomach when swallowed during drowning. The same fluid is found in the duodenum, where it passes only through the open pylorus in vivo as a result of increased reflex peristalsis, which can be considered a sign of drowning.

Overfilling the stomach with swallowed water, especially sea water and contaminated water, causes vomiting. On the gastric mucosa, there are streaky hemorrhages, as well as its ruptures in the lesser curvature, which are the result of vomiting during the agonal period or hitting the stomach with water. Occasionally, punctate hemorrhages occur under the capsule of the pancreas.

Signs of a corpse being in water, accompanying signs of drowning, include: wet clothes, covered with silt, sand with the presence of shells, fish, crayfish, water beetles, algae and fungi inherent in this reservoir in its folds, sticky hair, sharp pallor of the skin, raised vellus hair ("goose bumps"), wrinkling of the nipples, areola of the breast and mammary glands, scrotum, glans of the penis, pink color of the skin along the edges of cadaveric spots, rapid cooling of the corpse, skin maceration phenomena, "bath hand", "skin laundresses "," death glove "," sleek hand ", posthumous hair loss, rapid development of decay, fat wax, posthumous injuries.

A sharp pallor of the skin is formed when immersed in cold - below body temperature - water, which causes contraction of the vessels of the skin and pallor of its integuments.

The pink color of the skin along the edges of the cadaveric spots occurs due to the swelling and loosening of the epidermis under the influence of water. This facilitates the penetration of oxygen through the skin, oxidizing hemoglobin and converting it to oxyhemoglobin.

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

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

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

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

A significant influence on their development is exerted by the temperature of the environment, air, the depth of the reservoir, the concentration of salts in the environment (fresh or salty), the mobility of water (standing or running), the speed of the current, the thermal conductivity of the environment, clothes, gloves and shoes.

Maceration is one of the signs that a corpse is in the water. Maceration, or softening, is formed by the action of water, as a result of which the epidermis soaks, swells, shrinks and gradually flakes off on the palms and soles. Maceration is well detected in places where the skin is thick, rough, callous. It starts with the hands and feet. Initially, whitening and small folding of the skin appear (weakly expressed maceration, "bath skin"), then - pearl-white color and large folds of the skin (clearly pronounced signs of maceration - "washerwoman's skin." Gradually, there is a complete separation of the epidermis along with the nails (pronounced signs of maceration) .The skin is removed along with the nails (the so-called "glove of death") .After its discharge, the skin remains devoid of epidermis, smooth skin ("sleek hand").

Further, maceration spreads to the whole body.

In warm running water, maceration is accelerated. Cold water, gloves and shoes trap it. The degree of development of maceration makes it possible to roughly judge the duration of the stay of a corpse in water. In the literature, various periods of appearance of the initial and final signs of maceration are presented without taking into account the water temperature. The timing of the development of skin maceration, depending on the water temperature, was most fully studied by Ukrainian scientists E.L. Tunina (1950), S.P. Didkovskaya (1959), supplemented by I.A. Kontsevich (1988) and are presented in table. 27.

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

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

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

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

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

In warm water, decay processes develop faster than in cold water. In small bodies of water with a water temperature of more than 22 ° C, a corpse can emerge on the second day. In central Russia, corpses emerge on the second or third day, depending on the water temperature. According to the Japanese researcher Furuno, from July to September, in cases of drowning at a depth of 1-2 m, a corpse emerges after 14-24 hours, at a depth of 4-5 m - after 1-2 days, at a depth of 30 m - after 3-4 days ... In winter, corpses can stay in the water for up to several months. Putrefaction in water is slower than in air, but after being removed from the water, putrefactive processes are extremely rapid. Already 1-2 hours after the removal of the corpse, the skin takes on a greenish color, cadaveric emphysema develops, the corpse begins to swell, the skin becomes dirty green, and a putrid venous network and bubbles appear. A fetid odor emanates from the corpse. In corpses that are in the water in the summer of 18 hours and in the winter of 24-48 hours, along with the whitening of the hands and feet, the light blue color of the skin turns into a brick-red color of the head and face to the ears and the upper part of the occipital region. The head, neck and chest become dirty green interspersed with dark red in summer after 3-5 weeks, in winter - after 2-3month After 5-6 weeks. in summer and winter more than 3month the body is swollen with gases, the epidermis is exfoliating everywhere, the entire surface takes on a gray or dark green color with a putrid venous network. The face becomes unrecognizable, the color of the eyes is indistinguishable. Determining the length of time a corpse is in the water becomes impossible in the summer after 7-10 weeks. and in winter after 4-6month due to the development of putrefactive changes. If something prevents the ascent, then the onset of rotting stops and the formation of a fat wax gradually occurs.

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

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

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

Moreau in the pleural and abdominal cavities found a bloody colored fluid in an amount of up to 200 ml, which seeped into the pleural cavities from the lungs, and into the abdominal cavity from the stomach and intestines. The duration of the presence of a corpse in water can be decided by the flow of fluid into the pleural cavity and the disappearance of signs of drowning. The presence of fluid in the pleural and abdominal cavities indicates the presence of a corpse in water for 6-9 hours.

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

Drowning laboratory diagnostics

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

Plankton- the smallest organisms of plant and animal origin found in tap water, water of various reservoirs, in the air. They are typical for this reservoir and have specific features. In the diagnosis of drowning, phytoplankton, and especially diatoms, are of greatest importance. Their shell is made of silicon, which can withstand high temperatures, strong acids and alkalis. The shape of the diatom is diverse and typical for each reservoir.

Plankton along with water enters the mouth, from there into the respiratory tract, lungs, from them through the vessels to the left heart, aorta and through the vessels it is carried throughout the body, lingering in the parenchymal organs and bone marrowge long tubular bones (Fig. 282). Plankton persists for a long time in the sinuses of the main bone and can be found in scrapings from its walls. Together with water, grains of sand, starch grains, the so-called pseudoplankton, suspended in water, can enter the bloodstream from the lungs (Fig. 283). Methods for detecting plankton and pseudoplankton were until recently considered the most convincing methods for diagnosing drowning. Their subsequent inspection showed the possibility of posthumous penetration of plankton elements into the lungs and other organs of the corpse with damage to the skin. Therefore, the detection of plankton and pseudoplankton is of evidence only when the skin is intact.

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

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

A corpse of a person discovered or taken out of the water can be damaged in a variety of ways. A correct assessment of their morphology and localization will make it possible to correctly assess what happened and avoid wasting time searching for non-existent intruders. The main questions that the expert must answer are: who, during what, what and how long ago the damage was caused.

The most common damage occurs when diving. They are formed when the jumping technique is incorrectly performed, impact on objects on the way of falling, objects in water, on water, impact on the bottom and objects on and in it. Impacts on objects in the path of falling, located in the water, and objects on the bottom cause extremely diverse damage, reflecting the features of the contacting surfaces and localized in any area of \u200b\u200bthe body, on any of its surfaces, sides, levels (Fig. 284).

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

A blow with a stream of water at the moment of entering it sometimes forms ruptures of the tympanic membrane. Water penetration into the middle ear cavity causes a loss of orientation of movements in the water. Those who jump into the water have ruptures of the tympanic membrane, injuries in the lumbar region, contusion and dislocation of the spine in the lumbar spine due to the bending of the body entering the water, sprains of ligaments and muscles,depressed spinous processes of the vertebrae, fractures of the spine from impact with water. In case of an incorrect fall into the water, there may be bruises and ruptures of internal organs, shock, fractures of tubular bones, dislocation of the shoulder joint.

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

Striking the water while flat on entering it causes bruises, bruising and damage to internal organs, the severity of which determines the angle and height of the fall. A blow to the epigastric region of the abdomen or genital area sometimes causes shock, leading to death. An improperly executed jump by a "soldier" with legs spread apart causes bruises of the heels, scrotum, testicles, followed by the development of traumatic epididymitis. A swallow jump causes damage to the wrists of one or both hands, any surface of the head, chin, at the handle of the sternum from a chin strike. Fractures of the base of the skull and spine are sometimes observed, accompanied by trauma to the brain and spinal cord, causing paralysis of the limbs, due to the level of damage to the spinal cord.

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

Parts of sea and river vessels cause various damages up to body separation. Rotating propeller blades inflict chopped-like damage. The presence of several similarly directed fan-shaped wounds indicates the action of the propeller blades having the same direction of turns.

The significant time spent by the corpse under water in a stagnant reservoir and the developing putrefactive changes do not exclude the possibility of moving the corpse along the bottom and in different layers of water, dragging along the bottom with a blow to various objects in the water and on the surface. In reservoirs with running water, the listed damage can form before the development of putrefactive changes. In mountain rivers and rivers with a fast flow, corpses sometimes move a considerable distance. Depending on the topography of the bottom, objects on it and individual stones, rapids, snag, clothes and shoes are sometimes completely removed, and on the rest there are various damages caused by friction and catch. Damage to the corpse caused by dragging and impact is localized on the skin, nails and even bones of any surface of the body. For movement with water, transverse tears of the legs in the area of \u200b\u200bthe knee joints, wear of the socks of shoes in men and heels in women, abrasions on the back of the hands are typical. Such localization and morphology of damage is explained by the fact that the corpse of a man floats face down, and a woman - up. In these cases, cadaveric spots in men are primarily formed and located on the face.

Damage by the action of sharp objects can be inflicted when dragging along the bottom, but unlike sharp tools and weapons used for the purpose of deprivation of life, these injuries are single, superficial, localized in various areas of the body, including those inaccessible to one's own hand.

Corpses in water are sometimes injured by water rats, snakes, crayfish, fish, snails, stingrays, crabs, amphipods, birds, and leeches. The leeches inflict typical damage, forming multiple T-shaped superficial wounds. Fish gnawing at a corpse leave funnel-shaped depressions on the skin. Cancers and crustaceans can eat all soft tissues, penetrate into cavities and eat out all internal organs.

Atonal damage occurs during the terminal periods of drowning during seizures. They are manifested by abrasions, broken nails, bruises on the forearms, abrasions on the anterolateral surfaces of the body, etc.

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

Damage from rough extraction from water with gaffs, "cats", etc. are localized in any areas of the body and reflect the features of their active part.

Drowning accident site inspection

In the protocol of the inspection of the scene by the investigator, the temperature of the water and air, the mobility of the water, the speed of the current, the depth of the reservoir, the position of the corpse in the water - face up or down, the method of removing the corpse from the water must be reflected. The corpse is oriented in relation to the course of the river, its turn, or some other fixed landmark.

Inspection of the corpse notes the presence or absence of objects that hold the body on the surface of the water (life jacket, etc.) or contribute to its immersion (stones tied to the body, etc.)

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

Cadaveric phenomena are studied especially carefully at the scene of the incident, which, after removing the corpse from the water in the air, develop extremely quickly. The examination focuses on the color of cadaveric spots, which have a pinkish tint, indicating that the corpse is in water, their localization on the face and head, indicating the position of the corpse in the water, the degree of development of putrefactive changes, indicating where they are most pronounced, the presence or absence of hair, the degree of their retention by pulling the hair in different areas of the head. In the absence of hair, the area and severity of their holes are indicated.

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

Describing the body of a corpse, they focus on the puckering of the areola, nipple, scrotum and penis.

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

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

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

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

Before taking a water sample, rinse the liter glassware twice with water from the given reservoir in which the drowning occurred. Water is taken from the surface layer at a depth of 10-15 cm at the place of drowning or the place where a corpse was found. The dishes are closed, sealed by the investigator, the label indicates the date, time and place of sampling, the name of the investigator who took the water, and the number of the case for which the water was taken.

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

Describing the posture of a corpse, indicate which areas of the body are immersed in liquid, which are above it, if the body is completely immersed in water, then at what depth it is located and in which layer of water. If the corpse is in contact with the parts of the containers, then the contacting area of \u200b\u200bthe body and parts are described. Diagnosis of drowning is based on a combination of morphological characteristics of laboratory results and circumstances of the case, which can be decisive in establishing the type of drowning and death in water. Drowning - an accident is evidenced by eyewitness testimony about the circumstances of immersion in water, alcohol consumption (confirmed by laboratory tests), the presence of diseases.

In favor of suicide is the failure to take measures to save, tying a load, tying limbs, the presence of non-fatal injuries that suicides inflict near the water. In these cases, death does not come from injury, but from drowning. The criminal deprivation of life is indicated by the presence of injuries that the victim himself could not inflict.

Information necessary for an expert to conduct an examinationdrowning

In the setting part of the decree, the investigator must reflect: from which reservoir the corpse was taken, the place of its discovery - in the water or on the shore, full or partial immersion in water, whether the person was in the water, the temperature of the water and air, the speed of the current, the mobility of the water, the depth of the reservoir , the method of extraction from the water (with hooks, cats, etc.), testimony of witnesses about the circumstances of the victim's immersion in the water, about the attempt to stay on the surface of the water, the alternation of immersion with the appearance above the water surface, information about a previous fight, drinking alcohol, diving, participation in competitions on the water, shipwreck, first aid by a specialist or an unauthorized person, diseases that the victim had at the time of drowning and suffered earlier.

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

The external examination of the corpse in the sectional room differs from that at the scene of the incident by the special thoroughness of the study and fixation of the identified features of the nodes and loops, weighing the load used to hold the corpse at the bottom, sketching and detailed photographing of the injuries.

Internal research uses a variety of sectional techniques and complementary research methods to detect damage, changes typical of drowning, and painful changes that contribute to death in water.

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

When examining the gastrointestinal tract, the presence of foreign bodies and fluid in the stomach and duodenum, its nature and quantity (free fluid, dilution of the contents) are noted. The stomach and duodenum are ligated before being removed from the corpse, and then, above and below the ligatures, cut and placed in a glass vessel to settle the liquid. Dense particles will settle to the bottom, the liquid layer above them is sometimes covered with foam. The presence of fluid in the duodenum is one of the most reliable signs of drowning, indicating increased peristalsis, but this sign has a diagnostic value only on fresh corpses. Particular attention is paid to the lesser curvature of the stomach, where there may be ruptures of the mucous membrane. The diagnosis of drowning is confirmed by laboratory tests for the presence of elements of diatom plankton in the internal organs. For research, an unopened kidney is taken with a ligature applied to the leg in the area of \u200b\u200bthe gate, about 150 g of the liver, the wall of the left ventricle of the heart, brain, lung, fluid from the middle ear cavity or sinus of the main bone. The femur or humerus is completely removed from the putrefactive corpses. In addition to testing for diatom plankton, it is necessary to carry out a histological examination in order to determine the changes caused by drowning and diseases that contribute to death in water.

Drowning is a type of mechanical suffocation or death that results from filling the lungs and airways with water or other fluids.

Types of drowning

Depending on external factors, the state and reaction of the body, there are several main types of drowning:

• True (aspiration, "wet") drowning is characterized by the ingress of large amounts of liquid into the lungs and respiratory tract. It accounts for about 20% of the total number of drowning cases.
• False (asphyxical, "dry") drowning - a spasm of the airways occurs, resulting in a lack of oxygen. In the last stages of dry drowning, the airways relax and fluid fills the lungs. This type of drowning is considered the most frequent and occurs in about 35% of cases.
• Syncope (reflex) drowning - characterized by vasospasm, which leads to cardiac arrest and respiratory arrest. On average, this type of drowning occurs in 10% of cases.
• Mixed type of drowning - combines the signs of true and false drowning. It occurs in about 20% of cases.

Causes of drowning and risk factors

The most common cause of drowning is neglect of basic safety precautions. People drown because of swimming in questionable bodies of water and places where entry into the water is prohibited, as well as because of swimming during a storm. Swimming behind buoys and drunk bathing are quite common causes of drowning.

The so-called fear factor also plays a significant role. A person who does not swim well or does not know how to swim may accidentally go to great depths and panic. As a rule, this is accompanied by chaotic movements and screams, as a result of which the air leaves the lungs, and the person really begins to drown.

Other risk factors are high flow rates, eddies, and cardiovascular disease in humans. Drowning can also be caused by fatigue, diving injuries, and sudden changes in temperature.

Drowning mechanism and signs of drowning

It is believed that a drowning person is always screaming and waving his arms, so it is very easy to identify such a critical situation. In fact, cases are much more common when a drowning person does not at all look like a drowning person, and the signs of drowning are invisible even from a fairly close distance.

A person who is actively waving their arms and calling for help is most likely under the influence of panic when the real signs of drowning do not appear. He is able to assist his rescuers, for example by grabbing the rescue equipment.

Unlike cases of sudden panic in the water, a truly drowning person may look like they are normally floating in the water. He is unable to call for help as his breathing is impaired. When he emerges, he only has enough time for a quick exhalation and inhalation, after which the drowning person again goes under water and he does not have enough time to call for help.

Before completely immersed in the water, a drowning person can hold out at the surface of the water from 20 to 60 seconds. At the same time, his body is located vertically, his legs are motionless, and the movements of his hands are instinctively aimed at pushing off the water.

Other signs of drowning include:

• the characteristic location of the head, when it is thrown back, and the mouth is open, or completely immersed in water, and the mouth is located directly at the surface;
• a person's eyes are closed or not visible under the hair;
• Glass look;
• a person takes frequent breaths, gasping for air;
• the victim tries to roll onto his back or swim, but to no avail.

How to help with drowning

First aid for drowning is to remove the victim from the water. It is best to swim up to the drowning person from behind, after which he must be turned over onto his back so that his face is on the surface of the water. Then the victim must be transported to shore as soon as possible.

You should be aware that when providing assistance with drowning, you can often encounter an instinctive reaction in a drowning person, when he can grab the rescuer and drag him into the water. In such cases, it is important not to panic, try to breathe in as much air as possible and dive deeply. The drowning person will lose support and will instinctively unclench his hands.

Immediately after transporting the victim to the shore, it is necessary to check the pulse and determine the type of drowning. In true ("wet") drowning, the victim's skin and mucous membranes have a bluish tint, and the veins on the neck and limbs swell. With false drowning, the skin does not have such a bluish color, and with syncope, the skin has a pronounced pale color.

In the case of wet drowning, the first step is to remove fluid from the victim's respiratory tract. He must be put on a bent knee and patted on the back. If there is no pulse, you need to start artificial respiration and chest compressions as soon as possible.

First aid for drowning dry or syncope does not require the removal of water from the lungs and respiratory tract. In this case, you must immediately proceed to the above-mentioned resuscitation measures.

It is very important to remember that drowning assistance should by no means be limited to these activities. After resuscitation, complications in the form of repeated cardiac arrest or pulmonary edema are possible, so in any case, the victim should be shown to a doctor as soon as possible. Even in cases when the drowning man was pulled out of the water very quickly, and he did not have time to lose consciousness, you need to call an ambulance - this will help to avoid possible complications.

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

fixed ("dry") and secondary. Also, in case of accidents

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

myocardium, cerebrovascular accident, etc.).

Primary drowning occurs most often (75-95% of all accidents

cases in water). With it, fluid is aspirated into the respiratory

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

When drowning in fresh water, severe hemodilution quickly occurs

and hypervolemia, hemolysis, hyperkalymia, hypoproteinemia, hy-

ponatremia, a decrease in the concentration of calcium and chlorine ions in plasma. Ha-

a sharp arterial hypoxemia is characteristic. After removing the victim

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

the release of bloody foam from the respiratory tract.

When drowning in seawater that is hypertonic to

plasma, hypovolemia, hypernatremia, hypercalcemia develops,

hyperchloremia, blood thickening occurs. For true drowning in seafood

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

paths of white, persistent, "fluffy" foam.

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

reflex laryngospasm develops and water aspiration does not occur, but

asphyxia occurs. Asphyxia is more common in children and

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

new water. In this case, water in large quantities enters the stomach. Can

develop pulmonary edema, but not hemorrhagic.

Secondary drowning develops as a result of cardiac arrest

as a result of the victim getting into cold water ("ice shock",

"immersion syndrome"), a reflex reaction to the ingress of water into the breath

body pathways or middle ear cavity with damaged tympanic

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

their vessels. Pulmonary edema usually does not occur.

Symptoms The condition of the victims taken out of the water is largely determined

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

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

preserved, but patients are agitated, trembling, frequent vomiting are noted. When

relatively long true or asphyxial drowning, consciousness descended

tanno or absent, sharp motor excitement, convulsions. Dermal

the integument is cyanotic. Secondary drowning is characterized by a sharp pallor

skin. The pupils are usually dilated. Breath is bubbling

frequent or with prolonged stay under water rare with the participation

auxiliary muscles. Swelling builds up quickly when drowning in seawater

lungs. Severe tachycardia, sometimes extrasystole. With prolonged and

secondary drowning, the victim can be removed from the water without acknowledgment

breathing and cardiac activity.

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

hours, sometimes later, hematuria develops. Pneumonia and atelectasis of the lungs

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

With severe hemolysis, hemoglobinuric nephrosis and

acute renal failure.

Urgent care. The victim is removed from the water. With a loss of consciousness

artificial ventilation in an easy way from mouth to nose is desirable

start on the water, however, these techniques can only be well prepared

a well-trained, physically strong rescuer. Artificial lung ventilation

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

howling the victim's hand, being behind his back and on the side. Your right

the hand of the rescuer covers the victim's mouth, while simultaneously pulling

up and forward his chin. Injection of air into the nasal

drowned.

When retrieving the victim onto a boat, rescue boat or shore

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

use an air duct or mouth-nose mask and Ruben's bag. When ot-

the absence of a pulse on the carotid arteries should be started immediately with an indirect

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

With true drowning, the patient is quickly laid with his stomach on the thigh

the rescuer's chipped leg and squeeze the sides with sharp jerky movements

the surface of the chest (within 1015 s), after which the

roll him onto his back. The oral cavity is cleaned with a finger wrapped in a scarf

or gauze. If there is a trismus of the chewing muscles, you should press

fingers on the corner of the lower jaw. With electrical or

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

tetra of large diameter, but with pulmonary edema, one should not strive to

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

When carrying out artificial ventilation by methods from the mouth to

mouth or mouth to nose one condition is absolutely essential:

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

bathhouse. Assisting from the side of the victim, with one hand

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

and with the other hand, slightly opens his mouth behind his chin. It does not follow

can bring the lower jaw forward, since with the correct position of the

catching the patient, the root of the tongue and the epiglottis are displaced anteriorly and open

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

with his lips to the patient's mouth, makes a sharp exhalation. In this case, 1 and

II, with the fingers of the hand placed on the forehead, squeeze the wings of the nose to prevent

scheniya air outlet through the nasal passages. If you do not open the patient's mouth

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

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

leg breathing 12-16 in 1 min.

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

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

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

necessary conditions and tools - conicotomy.

After the patient is delivered to the rescue station, resuscitation measures

the process must continue. One of the most common mistakes is

premature termination of artificial respiration. The presence of victims

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

full ventilation of the lungs, so if the patient does not have

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

breath. Artificial respiration is also required if

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

in 1 min, severe cyanosis.

With preserved breathing, inhalation of ammonia vapors should be carried out

alcohol (10% ammonia solution).

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

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

if consciousness is absent or impaired.

In case of respiratory disorders and pulmonary edema, tracheal intubation and

carrying out artificial ventilation 2 and lungs, preferably 100% oxygen

house. Intubation can be performed using intravenous administration

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

atropine solution - 0.8 ml. With a sharp excitement of the patient, atropine and

listenone can be inserted into the root of the tongue. If you have a RO respirator,

"Phase", "Lada" shows the resistance to the output +8; +15 cm H2O Art. under

control of blood pressure.

The danger of premature termination of the

artificial lung ventilation. The emergence of independent respiratory

movement does not mean the restoration of adequate pulmonary ventilation

tion, especially in conditions of pulmonary edema.

After tracheal intubation and initiation of artificial respiration,

insert a probe into the stomach and evacuate the accumulated water and stagnant

content.

When drowning in fresh water to the victim in stationary conditions

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

pressure shows bloodletting in a volume of 400-500 ml from the central vein

(subclavian or jugular). With severe hemolysis, intravenous

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

(under control of the acid-base state). Against the background artificially

created metabolic alkalosis should be administered lasix 40-60 mg

2-3 times a day until the disappearance of gross hematuria.

For hypoproteinemia, transfusion of concentrated protein is indicated

(20% albumin - 100-150 ml).

With late development of pulmonary edema, if there is no indication for artificial

ventilation of the lungs, inhalation of oxygen passed through

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

intravenous administration of ganglion blockers (ar-

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

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

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

150-180 mg of prednisolone per day. Previously shown antibiotic use

for the prevention of aspiration pneumonia. To combat motor air

arousal and for the purpose of protecting the brain (prevention of hypoxic encephalop-

tii) intravenous administration of sodium oxybutyrate is shown - 120-150 mg / kg

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

When drowning in sea water, artificial ventilation of the lungs with a

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

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

should be directed to the elimination of hypovolemia and the correction of rheological

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

the use of heparin - 20,000-30,000 U / day.

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

Hospitalization. In severe forms of drowning, the victim must

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

nii resuscitation. During transportation, you must continue to use

artificial ventilation of the lungs and all other necessary measures. Beli

a gastric tube was inserted; it is not removed during transportation.

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

porting the victim on the side with the headrest down