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

Terminology

According to the latest amendments, drowning is a process that results in damage to the respiratory tract due to exposure to a liquid environment. Previously, this definition sounded like death from water (or other liquids) entering the respiratory tract and lungs. But it turned out to be not accurate enough.

The modern formulation implies that the liquid becomes a barrier to air entering the respiratory tract. But this does not mean that a person must die. In any case, it will be considered drowning.

Types of drowning

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

1. True (wet), also called aspiration, occurs if the lungs or airways are filled with a large amount of fluid. This usually happens when a person is floundering with all his might.
2. False (dry), or asphyxial drowning - occurs due to a reflex spasm of the glottis. In this case, neither air nor liquid enters the lungs, and the person dies from suffocation.
3. Syncopal drowning occurs in cold water. It causes a reflex vasospasm and cardiac arrest. Death in water, in fact, has nothing to do with the liquid that enters the respiratory tract after the victim sinks to the bottom.
4. Mixed type - characterized by the presence of signs of several types of drowning.

Causes of drowning

First of all, drowning occurs because swimmers neglect the rules of behavior on the water, such as: “do not swim beyond the buoys,” “do not swim in reservoirs with an unknown bottom,” “do not swim in a storm.” In addition, people who do not know how to swim and suddenly find themselves in water at a considerable depth, begin to flounder, quickly waste energy and air, and thereby accelerate their immersion.

Scuba divers and diving enthusiasts often fail to time things correctly and drown or suffer from decompression sickness when they ascend too quickly. Of particular importance are factors such as the presence of waterfalls and whirlpools, strong currents or muddy bottoms.

Drowning mechanism

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

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

Critical periods

In case of true drowning in water, three clinical periods are distinguished:

1. Initial, during which the victim can still hold his breath. If a person is saved at this moment, he will react inadequately to the situation, his skin and mucous membranes are cyanotic, his breathing is rapid, shallow, and noisy. There may be a cough. High blood pressure replaced by hypotension and bradycardia. There may be a significant amount of water in the stomach, which may cause vomiting. A person usually recovers quickly after an incident.
2. The agonal period is characterized by the fact that the victim is unconscious. He still has a heartbeat and breathing, but muscle activity is fading. The skin is bluish and cold. At this moment, pulmonary edema occurs, and dense pink foam emerges from the mouth.
3. Clinical death does not outwardly differ from the agonal period. The man is motionless, there is no pulse even large arteries, cardiac arrest is observed. no reaction to light. If you pull a person out of the water at this moment, then cardiopulmonary resuscitation is unlikely to be successful.

Symptoms

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

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

Aseptic drowning is characterized by alcohol intoxication or head injuries. arrhythmic, palpable only on large vessels. The lower airways are usually clear or contain little fluid. Death occurs within four to five minutes. Resuscitation is hampered by laryngospasm and clenching of teeth.

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

Forensic-medical examination

Syncopal drowning leaves behind characteristic features, which can be seen in autopsies at the medical examiner's office. Among others, signs of rapid death prevail, such as bright bluish liquid blood spills in the cavities of the heart and great vessels, as well as the absence of pink persistent foam at the mouth.

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

You can also determine the signs of a corpse being in water: the skin is pale, wrinkled at the fingertips (the so-called “washerwoman’s hands”), and with a long stay in the liquid, it can peel off along with the nails like gloves. The presence of sand, silt and algae on the victim’s clothing and hair also indicates that the corpse was fished out of the water.

The longer a body is in the water, the more difficult it is to determine the cause of death, and if there are any wounds on it, then marine fauna will quickly get to the corpse and can damage the remains to such an extent that all physical evidence will be destroyed.

Emergency care algorithm

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

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

Secondly, lay the victim so that his stomach rests against the rescuer’s knee, but only on the condition that no more than three to five minutes have passed since the moment of drowning. If by the time a person was caught from a reservoir he had already been unconscious for a long time, then it is necessary to immediately begin to clean the oral cavity for better air passage. At this stage, be sure to call an ambulance.

From the third step, emergency assistance for drowning begins - you need to check the pupils, pulse, and breathing. Then, after making sure that all of the above signs are absent, you need to begin CPR techniques. Continue pumping your heart and inhaling air until the emergency team arrives. If spontaneous breathing does not occur, this may save the victim's life.

Assistance for drowning after breathing, heartbeat and consciousness are restored consists of warming the person and monitoring vital signs. Until the doctors arrive, unfortunately, nothing significant can be done for the victim.

Treatment

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

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

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

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

myocardium, cerebrovascular accident, etc.).

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

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

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

When drowning in fresh water, severe hemodilution quickly occurs

and hypervolemia, hemolysis, hyperkalemia, hypoproteinemia, hy-

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

Severe arterial hypoxemia is typical. After removing the victim

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

separation from respiratory tract bloody foam.

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

blood plasma, hypovolemia, hypernatremia, hypercalcemia develops,

hyperchloremia, blood thickening occurs. For true drowning at sea

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

paths of white, persistent, “fluffy” foam.

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

reflex laryngospasm develops and water aspiration does not occur, and

asphyxia occurs. Asphyxial drowning occurs more often in children and

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

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

pulmonary edema develops, but not hemorrhagic.

Secondary drowning occurs as a result of cardiac arrest

due to the victim getting into cold water("ice shock"

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

body tract or middle ear cavity with damaged tympanic membrane

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

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

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

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

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

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

relatively long true or asphyxial drowning, consciousness is reduced

tanno or absent, sudden motor agitation, convulsions. Skin

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

skin. The pupils are usually dilated. Breath bubbling

frequent or during prolonged stay under water rare with the participation

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

lungs. Severe tachycardia, sometimes extrasystole. With prolonged and

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

kov breathing and cardiac activity.

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

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

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

With severe hemolysis, hemoglobinuric nephrosis and

acute renal failure.

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

artificial ventilation the easy way mouth to nose preferably

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

trained, physically strong rescuer. Artificial ventilation

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

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

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

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

y drowned.

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

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

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

in the absence of a pulse in the carotid arteries, indirect

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

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

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

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

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

or gauze. If trismus of the masticatory muscles occurs, you should apply pressure

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

slow breathing 12-16 per 1 min.

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

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

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

necessary conditions and tools - conicotomy.

After delivering the patient to the rescue station, resuscitation measures

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

premature termination of artificial respiration. The presence of

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

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

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

breath. Artificial respiration is also necessary if

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

in 1 min, sharp cyanosis.

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

alcohol (10% ammonia solution).

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

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

if consciousness is absent or impaired.

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

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

house. Intravenous fluid can be used to perform intubation.

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

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

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

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

blood pressure control.

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

artificial ventilation of the lungs. The emergence of independent breathing

movements does not mean restoration of adequate pulmonary ventilation

tions, especially in conditions of pulmonary edema.

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

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

content.

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

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

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

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

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

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

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

2-3 times a day until gross hematuria disappears.

For hypoproteinemia, transfusion of concentrated protein is indicated.

(20% albumin - 100-150 ml).

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

ventilation of the lungs, inhalation of oxygen passed through

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

al hypertension, indicated intravenous administration ganglion blockers (ar-

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

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

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

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

for the prevention of aspiration pneumonia. To combat motor anxiety

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

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

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

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

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

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

should be focused on eliminating hypovolemia and correcting rheological

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

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

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

Hospitalization. In severe forms of drowning, the victim must

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

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

artificial ventilation and all other necessary measures. Beli

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

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

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

Drowning is a fatal condition that occurs when water or other liquids enter the respiratory tract.

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

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

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

Rules for transporting a drowning person:

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

Signs of drowning

Signs initial stage drowning:

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

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

Agony stage:

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

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

Stage of clinical death:

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

How dangerous is drowning?

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

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

First aid for drowning

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

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

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

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

What not to do?

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

Nota Bene!

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

Created using materials:

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

There are three types of drowning. Drowning can be primary wet, dry or secondary. In addition to drowning, death in water sometimes occurs due to various injuries, heart disease, brain disorders, and so on.

Drowning is possible under a variety of circumstances:

1. From an injury received in water.
2. When sudden stop hearts.
3. In case of cerebrovascular accident.
4. Spasm of the larynx and inability to inhale and exhale:
- because of fear;
- sharp when suddenly entering very cold water.

Types of drowning.

Primary (true) drowning.

This is the most common type of drowning. A drowning person does not immediately plunge into the water, but tries to stay on the surface; in panic, he begins to make feverish and erratic movements with his arms and legs. It is the most common type of water accident.

With it, fluid enters the respiratory tract and lungs, and then enters the blood. When a drowning person inhales, he swallows a large amount of water, which fills the stomach and enters the lungs. The man loses consciousness and sinks to the bottom. Oxygen starvation - hypoxia - gives the skin a bluish color, which is why this type of drowning is also called “blue”.

When victims drown in fresh water, the blood quickly becomes diluted with water, the total volume of circulating blood increases, red blood cells are destroyed, and the balance of salts in the body is disrupted. As a result, the oxygen content in the blood sharply decreases. After rescuing a drowning person and providing him with first aid, the phenomenon of pulmonary edema is often noted, in which bloody foam comes from the mouth.

Drowning in sea water has a very different effect on the victim’s body than drowning in fresh water. Sea water has a higher salt concentration than human blood plasma. As a result of sea water entering the human body, the amount of salts in the blood increases and its thickening develops. In case of true drowning in sea water, pulmonary edema quickly develops, and white “fluffy” foam is released from the mouth.

"Dry" drowning.

Also quite common. With this type of drowning, a reflex spasm of the glottis occurs. Water does not enter the lower respiratory tract, but suffocation occurs. This usually occurs in children and women, and also when the victim gets into dirty or chlorinated water. With such drowning, water enters the stomach in large quantities.

Secondary or “pale” drowning.

Occurs due to cardiac arrest when the victim falls into cold water, which is called ice cold. This is based on the body's reflex response to water entering the windpipe or ear when there is damage eardrum. Secondary drowning is characterized by pronounced spasm of peripheral blood vessels. Pulmonary edema, as a rule, does not develop. Such drownings occur when a person does not try or cannot fight for his life and quickly goes to the bottom.

This often happens during shipwrecks at sea, capsizes of boats and rafts, when a person plunges into the water in a state of panic. If the water is also cold, this can lead to irritation of the pharynx and larynx, which in turn often leads to sudden cardiac and respiratory arrest. This type of drowning can also occur if a person in the water has a head injury or has already fallen into the water with one. In this case, a rapid loss of consciousness occurs. The skin is characterized by increased pallor, hence the name of the type.

Rescue of drowning people.

When rescuing a drowning person, you should not grab him by the hair or head. The most reliable and safest way is to grab him under the arms, turn his back to you and swim to the shore, trying to keep the victim’s head above the water.

Condition of drowning victims.

It is associated with the duration of being under water, the type of drowning and the degree of cooling of the body. In mild cases, consciousness is preserved, but agitation, trembling, and repeated vomiting are noted. With prolonged stay in water, with true or “dry” drowning, consciousness is impaired or completely absent, the victims are very excited, there may be convulsions, and the skin is bluish. In case of secondary drowning, pronounced pallor of the skin is noted, the pupils are dilated. The victims have bubbling, rapid breathing.

When drowning in sea water, pulmonary edema quickly develops and the heart rate increases. When drowning is prolonged and secondary, the victim can be removed from the water in a state of clinical or biological death. True drowning in fresh water can be complicated by impaired kidney function in the form of blood in the urine. During the first 24 hours, pneumonia may occur. With pronounced breakdown of red blood cells in the body, acute renal failure develops.

Emergency assistance for drowning.

Regardless of the type of drowning, help must be provided immediately, otherwise irreversible brain changes will occur. In case of true drowning, this occurs within 4-5 minutes, in other cases after 10-12 minutes. First aid on shore will be different for blue and pale drowning. In the first case, it is necessary first of all to quickly remove water from the respiratory tract. To do this, standing on one knee, place the victim on the bent second leg so that the lower part of the chest rests on it, and the upper part of the torso and head hang down.

After this, you need to open the victim’s mouth with one hand, and with the other pat him on the back or gently press on the ribs from the back. These steps must be repeated until the rapid flow of water stops. Then perform artificial respiration and indoor massage hearts. In case of pale type of drowning, artificial respiration is needed immediately, and in case of cardiac arrest - closed massage. Sometimes large foreign bodies end up in the respiratory tract of a drowned person, which get stuck in the larynx, as a result of which the airways become obstructed or a persistent spasm of the glottis develops. In this case, a tracheostomy is performed.

In any type of drowning, it is strictly forbidden to turn the victim’s head, as this can cause additional injury and a possible spinal fracture. To prevent the head from moving, place cushions of tightly twisted clothing on both sides, and if necessary, turn the victim over, while one of those providing assistance should support the head, preventing it from moving on its own.

Resuscitation, in particular artificial respiration, must be continued even if the victim begins to breathe spontaneously, but there are signs of pulmonary edema. Artificial respiration is also carried out when the victim has a breathing disorder (i.e., its frequency is more than 40 per minute, irregular breathing and a sharp blue discoloration of the skin). If breathing is maintained, then the patient should be allowed to breathe ammonia vapor. If the rescue of the victim was successful, but he is feeling chills, you need to rub his skin and wrap him in warm, dry blankets. Do not use heating pads in the absence or impairment of consciousness.

In severe types of drowning, the victim must be taken to the intensive care unit. During transportation, artificial ventilation should be continued. An emergency medical technician or a hospital intensive care unit doctor, in case of impaired breathing and pulmonary edema in a victim, inserts a breathing tube into the trachea and connects it to a device or ventilator.

First, a probe is inserted into the victim's stomach. This will prevent stomach contents from entering the respiratory tract. The patient must be transported in a position lying on his side, with the headrest of the stretcher lowered. It is dangerous to stop artificial ventilation prematurely. Even if a person begins to breathe independently, this does not mean that normal breathing has been restored, especially with pulmonary edema.

When drowning in fresh water, a victim in a hospital with sudden blueness and swelling of the neck veins is sometimes bled. In case of pronounced breakdown of red blood cells, sodium bicarbonate solution, red blood cell mass, and blood plasma are transfused intravenously. To reduce swelling, diuretics, such as furosemide, are administered. A decrease in protein levels in the body is an indication for transfusion of concentrated albumin.

With the development of pulmonary edema against the background arterial hypertension 2.5% benzohexonium solution or 5% pentamine solution, glucose solutions are administered intravenously. Large doses of hormones are used: hydrocortisone or prednisolone. Antibiotics are prescribed to prevent pneumonia. To calm motor agitation, 20% sodium hydroxybutyrate solutions, 0.005% fentanyl solution or 0.25% droperidol solution are administered intravenously.

Based on materials from the book “Quick Help in Emergency Situations.”
Kashin S.P.

Drowning is a type of mechanical suffocation that occurs as a result of the lungs filling with fluid. The time and nature of death in water depends on external factors and the state of the body. Around 70,000 people worldwide die from drowning every year. The victims are mainly young men and children.

Causes of drowning

Risk factors include alcohol intoxication, the presence of heart disease, and damage to the spine when diving upside down. Drowning can also be caused by sudden temperature fluctuations, fatigue, or various injuries during diving.

The risk of drowning increases in the event of a whirlpool, high water flow speed, or the presence of key springs. Calm behavior in a critical situation and lack of panic can significantly reduce the risk of drowning.

Types of drowning

There are three types of drowning.

The true form of drowning is characterized by the filling of the respiratory tract with liquid to the smallest branches - the alveoli. In the alveolar septa, under fluid pressure, capillaries burst, and water or other liquid enters the blood. As a result, water and salt balance is disrupted and red blood cells disintegrate.

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

Syncopal drowning is characterized by death from reflex cardiac and respiratory arrest. This type of drowning occurs from hypothermia or severe emotional shock. Accounts for 10-14% of all drowning cases.

Signs of drowning

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

In case of true drowning, a sharp cyanosis of the skin and mucous membranes is observed, pink foam is emitted from the respiratory tract, and the veins in the neck and limbs are very swollen.

In asphyxial drowning, the skin is not as blue in color as in true drowning. Pink fine bubble foam is released from the victim's lungs.

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

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

Drowning assistance

Assistance in case of drowning consists of performing resuscitation measures. It must be remembered that the sooner resuscitation measures are taken, the better the prognosis will be, and the higher the victim’s chances of recovery.

The main help for drowning is artificial ventilation of the lungs and indirect massage hearts.

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

Special suction can be used to free the lungs from water and foam. If they are not there, then it is necessary to lay the victim with his stomach down on the rescuer’s knee and vigorously squeeze chest. If the water does not drain within a few seconds, you need to start artificial ventilation. To do this, the victim is placed on the ground, his head is thrown back, the rescuer places one hand under the neck and the other on the patient’s forehead. It is necessary to advance the lower jaw so that the lower teeth protrude forward. After this, the rescuer takes a deep breath and, pressing his mouth to the victim’s mouth or nose, exhales the air. When respiratory activity appears in the victim, artificial ventilation cannot be stopped unless consciousness is restored and the breathing rhythm is disrupted.

If there is no cardiac activity, then indirect cardiac massage must be performed simultaneously with artificial respiration. The rescuer's hands should be placed perpendicular to the patient's sternum in its lower third. The massage is performed in the form of sharp jolts with intervals of relaxation. The frequency of tremors is from 60 to 70 per minute. When indirect cardiac massage is performed correctly, blood from the ventricles enters the circulatory system.

If the rescuer performs resuscitation alone, then it is necessary to alternate cardiac muscle massage and artificial ventilation. For 4-5 pushes, one blow of air into the lungs should fall on the sternum.

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

In any case, at the first opportunity, even if all vital functions are restored, it is imperative to take the victim to a hospital.

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