Drowning. Causes and mechanism of development of the pathological condition. Types of drownings. Rules for the provision of emergency and medical care. Complications, consequences and prevention of drowning. First aid for drowning

In the scorching summer months, not even being on vacation, but having a river (pond, rates, lake, sea ...) near the house, few people refuse to freshen up and swim in order to remove the heavy feeling of stuffiness and heat from the body. Having reached the relief coolness, people lose their caution and absolutely do not think about the consequences. As a result, it is quite possible that someone left on the shore will need first aid for drowning for a person who has not managed to get out of the water. Since we are all (less often or more often) on the banks of water bodies, it would be nice for everyone to know what to do in critical situations.

Types of drowning

As in any other highly specialized business, when rescuing drowning people, a forced rescuer will not interfere with at least a small theoretical base. It is necessary to at least slightly distinguish between the types of drowning - the first aid that must be provided before the arrival of doctors depends very much on how exactly the victim drowned. Broadly speaking, there are three types of drowning:

1. Imaginary. It is also called white asphyxia, according to the color of the skin. Another name is syncopal drowning. Very little water enters the respiratory organs: it immediately causes a spasm, and the person stops breathing.
2. True drowning, it's also blue asphyxia. The skin turns blue, especially around the ears and on the tips of the fingers. Water enters the lungs and organs suitable for them in large quantities.
3. Asphyxic drowning. Water does not penetrate the respiratory organs at all - spasm (and possible subsequent death) are caused by other factors. External signs, one might say, are somewhere in the middle between blue and white asphyxia. And, by the way, this type of drowning is the most difficult to rehabilitate.

If it is in your power to provide first aid for drowning, first of all, you should pay attention to the skin tone - with its help you can determine what exactly needs to be done first.

Syncope drowning

Most often it comes with an unexpected immersion in water. The vast majority of those who drowned during disasters are from this category. A person is suddenly lost and does not even make an attempt to fight for his life. Literally a teaspoon of water that has fallen into the larynx causes its spasm, as a result of which breathing stops and - almost immediately - the heartbeat. Accordingly, the first medical aid for syncope-type drowning requires immediate artificial respiration, accompanied by chest compressions. You should not think that such drowning can only happen when the liner crashes. A person who has been abruptly pushed into the water may also be in this position, and he will need exactly the same first aid for drowning. Ice shock from unexpected immersion in ice water has similar manifestations.

True drowning: the first stage

With a "real" drowning, a person has time to realize what is happening to him, and actively fights for life. He is able to hold his breath when once again immersed in water, and makes every effort to rise to the surface. If the rescuers managed to pull out the drowning person at this stage, the first aid for drowning is to warm him up (a stressful situation can manifest itself in severe chills), control over vomiting, from which water that has entered the body is removed, and calm: the victim may be either in severe depression, or, conversely, in excessive excitement. Despite the blueness of the skin, breathing and a normal heartbeat are restored quickly, although headaches, weakness and coughing can last up to a week.

True drowning: second stage

It is called agonal. The person is unconscious, but the pulse and breathing are preserved, although the pulse can only be felt on large arteries. The skin is cold and blue, with pinkish foam coming from the nose and mouth. Rescuers (and just those who are nearby) have very little time for resuscitation: it has a chance of success only if the person has been under water for a maximum of six minutes. Respiratory ability must be restored urgently, and the first first aid for drowning at this stage is to remove water from the respiratory system.

The third stage of true drowning

clinical death. External signs are similar to the symptoms of the second stage, but are supplemented by the absence of breathing and pulse, dilated pupils that do not respond to light. The skin becomes purple and pale. The victim can only be helped by first aid for drowning, carried out by a professional. However, even the actions of a competent physician are rarely able to help with clinical death.

Asphyxic drowning

Its causes may be preliminary overheating in the sun, alcohol consumed shortly before bathing, hitting the water, an epileptic seizure, a heart attack, and even diseases like tonsillitis or flu. Respiration stops due to spasm not caused by water ingress. It may subsequently end up in the lungs, but flows there after drowning. Providing first aid for drowning of the asphyxic type is complicated by the difficulty of determining the reason why the person was drowning. Even if he was brought back to consciousness, and breathing is stable, it is recommended to take the victim to the hospital in case he had a heart attack.

The very first actions

Immediately after quickly determining what type of drowning the rescuer is dealing with, first aid for drowning is provided. Briefly list the necessary actions:

1. The tongue is pulled out so that the victim does not suffocate because of it. You may need to secure it with a loop so that it does not sink. The very first aid for drowning (suffocation) is to release the clogged mouth and nose. When a person drowns, they can be filled with silt or sand. So before carrying out further activities, it is necessary to check the external respiratory organs.
2. Water is removed from the body of a drowning person (with true drowning). For this, a person is placed on his knee and pressed on his back until water stops flowing from his mouth.
3. The victim turns over; he is given artificial respiration. The most effective method is mouth-to-mouth. If the jaws are compressed, and it is impossible to unclench them, they resort to the mouth-to-nose method.
4. If there is no pulse, an indirect (it is also closed) heart massage is done.
5. When a person comes to his senses, he is wrapped up, soldered hot (if any) and sent to the hospital.

When first aid is provided for drowning, you should not resort to either Atropine to eliminate bradycardia, or any sedative to relieve chills. All medicines should be prescribed by a doctor after assessing the condition of the drowning person.

Artificial respiration and cardiac massage

Every person should know how it is done, at least in general terms. First of all, the victim is pressed on the stomach - if there was air in the lungs, it will come out. Then the resuscitator blows the collected air through the mouth (nose) to the "patient". A sign that the procedure was successful is the lifting of the victim's chest. You need to blow air at least a dozen times a minute. If there is no certainty that the air spontaneously leaves the lungs, after blowing, the stomach is pressed again.

To massage the heart, one hand is placed in the area where it is located, the other is placed across it, and pressure is applied using the mass of the whole body. Large people must measure their efforts - there have been cases when a person with a large weight broke a rib to be saved. There should be 4-5 pushes for each artificial breath. Since these resuscitation activities are quite physically demanding, first aid for drowning is usually provided by several people, replacing each other.

Children under the age of eight are massaged with one hand at a speed of one hundred strokes per minute, infants with two fingers, and the frequency is increased to 120 pressures.

Injuries associated with drowning

The most difficult is the first first aid for drowning in cases where the drowning person was injured while diving. The most common injuries in this case are the skull and cervical vertebrae. The presence of spinal cord injury can be determined by the absence of sensation in the extremities. The victim must be urgently laid on his back, on a flat and preferably hard surface. Under no circumstances should you turn your head. If there is a danger that a person will suffocate with vomit, one must carefully turn the whole body on its side, holding the head. In the position on the back, the head is gently fixed with rollers laid on the sides. No further action can be taken until the ambulance arrives.

Drowning, like other causes of accidental death, is often recorded in young and healthy individuals.

The prognosis for drowning depends on the timeliness of removing the victim from the water and resuscitation.

Definition

There are many definitions of the concept of drowning, probably no less than the authors dealing with this problem.

Some authors define drowning as death by suffocation when submerged under water. Some authors use the more general term "immersion syndrome", although it is also used to describe sudden death due to immersion in cold water. The occurrence of post-immersion syndrome, or secondary drowning, is associated with a deterioration in the condition of a seemingly healthy patient, which occurs as a result of immersion under water.

Epidemiology

About 4,500 people drown each year in the US; Drowning is the third leading cause of death in accidents.

Many more victims (their exact number is unknown) can be saved even in the most severe cases of drowning. Drowning in fresh water, especially in whirlpools, occurs more often than in salt water. The highest frequency of drowning deaths is observed in adolescence and youth, although children under 4 years of age represent an increased risk group. In young children, drowning is not always associated with certain injuries, which is due to the high degree of responsibility of their parents (or relatives) and timely assistance in case of an accident.

Alcohol or drugs often play a critical role in drowning.

In some cases, drowning can occur due to trauma, especially if the cervical spine is damaged. Factors such as overestimation of the ability to swim or dive, hypothermia, and convulsions often contribute to drowning.

Clinical picture

After the occurrence of a critical incident, panic fear often sets in, followed by intense movements in the water and hopeless breath-holding or hyperventilation.

All this quickly leads to vomiting and aspiration of water and vomit. "Dry drowning" without aspiration is the result of laryngospasm and glottic occlusion, which is believed to be the cause of death in 10-15% of cases. Whatever the mechanism for the development of a critical condition, the common ending is profound hypoxemia.

Both sea and fresh water leaches the surfactant from the alveoli, but fresh water also changes the surface tension properties of the surfactant. Loss of surfactant leads to atelectasis, impaired ventilation-perfusion relationship, and damage to the alveolar-capillary membrane. Hypoxemia occurs when even a small amount of water is aspirated; in the experiment, it is observed during aspiration of 2.2 ml/kg of fresh or salt water. Aspiration of bacteria, algae, sand, particulate matter, vomit, and chemical irritants can contribute to hypoxemia.

Non-cardiogenic pulmonary edema occurs as a result of direct damage to the lungs, loss of surfactant, inflammatory changes and cerebral hypoxia.

The occurrence of respiratory failure and cerebral ischemia after diving poses a threat to life.

According to Modell et al., in 40 drowning survivors, the mean arterial pressure POl during spontaneous breathing of room air was 67 mmHg. More than 1/3 (out of 91) of their patients were intubated; most of them required artificial ventilation with positive end-expiratory pressure. Despite such a high incidence of pulmonary dysfunction, death was observed in only one patient who had Pa02 FiO over 150; death was due to neurological disorders.

Poor tissue perfusion and hypoxemia in the vast majority of patients lead to metabolic acidosis, but the state of the cardiovascular system is surprisingly stable, which is probably due to the young age of the victims. Changes in blood volume depend on the nature and amount of aspirated fluid, but life-threatening changes are observed infrequently. Electrolyte disturbances in drowning victims are rarely significant; hematological parameters usually remain normal, although in some cases hemolysis is observed, leading to anemia. Rarely, disseminated intravascular coagulation occurs.

Kidney function is usually not affected, although proteinuria and (as a consequence of hemolysis) hemoglobinuria may be noted. As a result of hypoxia or myoglobinuria, acute tubular necrosis may occur.

Treatment

Prehospital care

Treatment for drowning begins at the scene with a quick but careful removal of the victim from the water (Table 1).

Some care must be taken in view of the possible damage to the spinal cord when diving or surfing. In the vast majority of cases, damage to the cervical spinal cord occurs when diving, when a vertebral fracture occurs when the head hits a solid barrier, especially C5.

Diagnostic signs of spinal cord injury may include paradoxical breathing, lethargy, priapism, unexplained hypotension, or bradycardia. Rescuers and paramedics must support the neck of the victim, observing the necessary precautions when providing first aid. Anamnestic data on the mechanism of injury can be unreliable, so the doctor should definitely obtain x-rays of the cervical spine.

Table 1. Prehospital care for victims of drowning

It should ensure the patency of the respiratory tract and (if necessary) artificial ventilation of the lungs; all patients should receive supplemental oxygen. Any casualty with respiratory and cardiac arrest should begin cardiopulmonary resuscitation, even if the chances of success are minimal.

Patients with mild symptoms are given sodium bicarbonate solution, while more severely affected patients are hospitalized for evaluation.

Cardiopulmonary resuscitation on the water is usually ineffective and even dangerous for the rescuer; it can only be attempted if there is a solid and stable surface. Postural drainage or abdominal pressure (Heimlich maneuver) has not been shown to be effective in removing water from the lungs and improving oxygenation.

As experimental studies show, fresh water can be removed from the trachea only in a very small amount, while salt water is removed in a much larger amount. Drowning victims aspirate small amounts of water, and there is little evidence that this water interferes with ventilation. The victim should not be placed in the head down position for long periods of time at the scene, as this limits airway control, requires interruption of ventilation or CPR, and creates the risk of spinal cord injury and deterioration from other unrecognized injuries.

Hospital treatment

When assessing the condition and providing assistance to the victim, special emphasis is placed on initial resuscitation, recognition of concomitant injuries, treatment of respiratory failure and taking measures to protect the brain from hypoxia (Table 2).

Table 2. Hospital treatment of victims of drowning

The feasibility of resuscitation in the ED, especially in children who do not stop CPR before they enter the department, has been discussed since the 70s. Peterson reports that all surviving children who required CPR on admission to the hospital had severe anoxic encephalopathy.

At the same time, they argue that this does not cause any serious consequences.

Recent studies show that about 20% of patients presenting in a comatose state, with fixed and dilated pupils, survive without significant neurological impairment. Unfortunately, the incidence of persistent vegetative state was about the same (15%). Allman et al. noted a good outcome in 24% of patients requiring complete cardiopulmonary resuscitation in the emergency department.

Upon delivery to the ED, adequate oxygenation should be provided, the integrity of the cervical spine should be confirmed, and associated injuries should be identified.

Pulmonary insufficiency can be judged by dyspnea, tachypnea, or participation in breathing of additional muscles. On examination, wheezing or wheezing may be noted, although auscultation after aspiration of water from the lungs does not reveal abnormalities.

During examination, all patients should receive supplemental oxygen, and casualties with moderate symptoms should receive 100% oxygen until adequate oxygenation (documented) is achieved. If a high oxygen flow (40-50%) cannot maintain arterial POl at a sufficient level (above 60 mm Hg in adults and 80 mm Hg in children), then the patient is intubated and mechanically ventilated.

Some patients may require only increased oxygenation and continuous positive airway pressure (CPAP) without mechanical ventilation.

Candidates for mask ventilation with CPAP are only awake patients who do not vomit. Most intubated patients require some form of mechanical ventilation, such as intermittent mandatory ventilation with CPAP or regular mechanical ventilation with positive end-expiratory pressure.

Patients whose temperature register is at the lower mark of a standard thermometer need further examination.

It is best to have a hypothermic thermometer, but emergency departments may use low temperature thermometers available in the clinical laboratory and operating room. Hypothermia can immobilize a swimmer, leading to drowning, primary ventricular fibrillation, or various metabolic disorders.

Severe hypothermia often indicates a prolonged dive and is a poor prognostic sign.

Despite this, many patients survive even after prolonged (more than 40 minutes) exposure to cold water. Their body temperature was less than 30 °C, and after immersion in water - less than 20 °C. The nature of the protective effect of hypothermia is unclear; perhaps hypothermia slows metabolism or promotes preferential shunting of blood to the brain, heart, and lungs (dive reflex). The similarity between severe hypothermia and death gave rise to the well-known aphorism: "no one should be considered dead while he is dead, but warm." Drowning victims who develop hypothermia should be rewarmed to at least 30-32.5°C before attempts at resuscitation are abandoned.

Appropriate laboratory data should be obtained (see Table 2).

In intubated patients, Gram staining and tracheal cultures are appropriate. Direct measurement of oxygenation and assessment of acid-base status in the analysis of arterial blood gases allow correcting the therapy of pulmonary complications and determining the need for the introduction of sodium bicarbonate.

X-ray changes in the lungs do not correlate well with POl, so direct determination of arterial blood gases is important. Despite this, X-ray examination may have prognostic value. Almost 50% of patients with significant abnormalities on lung imaging require intubation, which is very rarely needed in patients with normal chest radiographs. A chest x-ray after a severe drowning incident may remain normal or show generalized pulmonary edema, hilar infiltrates, or other changes.

Patients with severe symptoms or unstable condition are given NaHCO3 (initial dose of 1 mEq/kg) even before blood gas results are available, unless this was done at the scene.

If necessary, standard therapy for bronchospasm is carried out, as well as correction of electrolyte imbalance, hypoglycemia, hypothermia, arrhythmia and hypotension. To avoid inducing arrhythmias in hypothermic patients, a central venous catheter (if used) should not be inserted into the heart. Emptying the stomach with a nasogastric tube helps prevent vomiting, and insertion of a Foley catheter helps control diuresis.

In drowning, neither antibiotics nor steroids change the course of aspiration pneumonia or pulmonary edema and should not be given prophylactically.

Post-immersion syndrome

In the past, many publications have reported post-immersion syndrome, or "secondary drowning", in which 2-25% of patients experienced deterioration and subsequent death after seemingly successful resuscitation.

Most victims of secondary drowning have progressive pulmonary insufficiency. The vast majority of these patients have symptoms or signs that today can be easily identified with adequate examination. Despite this, the concept of secondary drowning has led to numerous recommendations for monitoring the condition of all victims in a hospital setting.

It is important to correctly determine which of the victims needs hospitalization.

Patients with severe transient hypoxia who have aspiration or previous cardiopulmonary disease are at risk for developing pulmonary insufficiency. These patients have a "significant" drowning incident and symptoms such as cough, dyspnea, or tachypnea; they may have a history of fainting episodes in the water. More information is needed to identify asymptomatic patients requiring investigation in the emergency department, and to determine a sufficient period of examination and observation in the ED for patients with significant impairment.

Forecast and resuscitation in cerebral disorders

Interpretation of statistics on survival and the incidence of severe neurological impairment after drowning causes certain difficulties.

These data vary depending on the definition of the condition of patients, their age, water temperature, the nature of the treatment, and many other factors. A number of recent studies indicate good treatment outcomes in 2/3 of patients, while approximately 20% of patients die, and 15% have severe neurological disorders, including a persistent vegetative state.

Almost all patients who were awake and fully conscious survive without serious consequences.

According to Allman et al., 24% of their patients who required complete cardiopulmonary resuscitation and had a Glasgow score of 3 at the start of their stay in the ED survived with intact neurological function. Patients who had a coma score of 3 and were treated in the intensive care unit (ICU) either died or (if survived) fell into a vegetative state, while patients who had a coma score of 4 to 5 in the ICU were divided into survivors without serious consequences, dead and surviving, but falling into a vegetative state. The death of patients with scores above 5 in the ICU was unlikely to be due to neurological complications.

Conn et al. treated children who were in serious condition after drowning, according to a scheme based on the principles of cerebral resuscitation.

This regimen includes moderate dehydration with fluid restriction and the use of diuretics, mechanical ventilation at OR > 150 mmHg. and PCOj = 30 mm Hg, hypothermia up to 30 °C, muscle relaxation, the use of corticosteroids, and turning off consciousness with barbiturates. The authors report improved outcomes in patients with decortication and decerebration compared with retrospective controls in the group of the same category of victims.

Despite the widespread use of cerebral resuscitation techniques in pediatric drowning victims, a recent randomized prospective study using thiopental loading in comatose cardiac arrest survivors showed that thiopental does not improve survival and does not increase the number of patients with good recovery of brain function.

Patients who develop intracranial hypertension (intracranial pressure greater than 20 mmHg) after severe cerebral ischemia almost always die or remain permanently in a vegetative state.

However, the prognosis in patients with normal intracranial pressure (ICP) may be different, i.e., the victims may survive without serious consequences or be in a vegetative state; therefore, control of ICP does not distinguish between the two groups. ICP monitoring is a fairly accurate predictor of survival, although it is of little help in prognosis for those who remain with severe neurologic deficits.

Conclusion

Drowning is a common cause of accidental death, especially among young people.

The pre-hospital care system should ensure the quick and safe removal of the victim from the water and the implementation of measures at the scene of the incident that support his basic vital functions, including adequate artificial ventilation of the lungs. Severely disabled victims should be taken to the hospital.

The focus of prehospital care should be on the management of non-cardiogenic pulmonary edema and pulmonary insufficiency. The approach to providing emergency medical care depends on the severity of the victim's condition and the degree of respiratory distress.

Patients can be divided into four groups.

The first group includes victims who do not have signs of significant immersion in water, who can be released after a short observation. Arterial blood gas analysis and chest X-ray are not mandatory in case of a favorable history, but their conduct allows to substantiate the decision to discharge patients from the ED.

The second group includes victims who do not have severe symptoms after a significant episode of immersion; they need hospitalization for observation in order to detect the possible development of late symptoms.

Patients of the third group have moderately severe hypoxemia, which can be corrected by oxygen therapy. They are hospitalized and discharged from the hospital after elimination of hypoxemia and in the absence of complications.

The fourth group consists of patients with respiratory distress who require tracheal intubation and mechanical ventilation. The prognosis in these patients usually depends mainly on their neurological status and, to a lesser extent, on lung changes.

Drowning is one of the most common causes of death in young people. Thus, according to WHO, about 10 thousand people die every year as a result of drowning in Russia, 7,000 people die in the USA, 1,500 people die in England, and 500 people die in Australia.

Drowning- this is an acute pathological condition that develops with accidental intentional immersion in a liquid, followed by the development of acute respiratory and heart failure, as a result of the liquid entering the respiratory tract.

The main causes of death on the water are: the inability to swim, the use of alcohol, the presence of children without parental supervision, violation of safety rules. If adults die mainly due to their own negligence, then the death of children, as a rule, is on the conscience of their parents.

Accidents occur not only due to violation of the rules of conduct on the water, but also due to swimming in unequipped water bodies, as well as due to accidents of swimming facilities. Recently, underwater sports (diving) and snorkeling have become very popular. Having bought a snorkel, mask and fins, some people believe that they are ready to master the underwater element. However, the inability to handle equipment often ends in death.

With a long stay under water, not being able to renew the supply of oxygen in the body, a person can lose consciousness and die. Overwork, overheating or hypothermia, alcohol intoxication and other concomitant causes contribute to death on the water.

Resting on the water, you must follow the rules of conduct and safety measures:

swimming should take place only in permitted places, on well-maintained beaches;

do not swim near steep steep banks with strong currents, in swampy and overgrown areas;

the water temperature should not be lower than 17-19 degrees, it is recommended to stay in it for no more than 20 minutes, and the time spent in the water should increase gradually by 3-5 minutes;

it is better to bathe several times for 15-20 minutes, since hypothermia can cause convulsions, respiratory arrest and loss of consciousness;

you should not enter or jump into the water after a long stay in the sun, as with a sharp cooling in the water, cardiac arrest may occur;

it is not allowed to dive from bridges, berths, piers, swim up to nearby boats, boats, ships;

you can’t sail far from the coast on air mattresses and circles if you don’t know how to swim;

while on boats, it is dangerous to transfer, board, overload the boat in excess of the established norm, ride near locks, dams and in the middle of the fairway of the river;

it is important to know that restrictive signs on the water indicate the end of the water area with a checked bottom;

adults need to remember not to leave children alone without supervision.

There are three types of drowning in water:

Blue (true, wet);

White dry);

Death in water (syncope type of drowning).

With blue drowning water fills the airways and lungs, drowning fighting for his life, makes convulsive movements and draws in water, which prevents the flow of air. In the victim, the skin, auricles, fingertips, mucous membrane of the lips acquire a violet-blue hue. With this type of drowning, the victim can be saved if the duration of stay under water does not exceed 4-6 minutes.

With white drowning there is a spasm of the vocal cords, they close and water does not enter the lungs, but air does not pass either. At the same time, the skin and mucous membranes of the lips become pale, breathing and heart function stop. The victim is in a state of fainting and immediately sinks to the bottom. With this type of drowning, the victim can be saved after 10 minutes of being under water.

Syncope type of drowning occurs as a result of a reflex arrest of cardiac activity and respiration. The most common variant of this type of drowning occurs when the victim is suddenly immersed in cold water. It occurs mainly in women and children.

Rules for removing the victim from the water.

If a drowning person is capable of independent ascent from under the water to the surface, but the feeling of fear does not make it possible to stay on the surface and get rid of the water that has entered the respiratory tract, the main task of the rescuer's help is to prevent the person from re-immersing himself in the water. To do this, use a lifebuoy, an air mattress, a floating tree, a board, a pole, a rope. In the event that none of the above was at hand, then the rescuer himself must support the drowning man. In this case, it is necessary to correctly swim up to the drowning man, capture him, but be extremely careful.

You need to swim up from behind, grab it by the hair or under the armpits, turn it face up and keep your head above the surface of the water.

Keeping this position of the victim, swim to the shore. If there is a boat nearby, then the victim is dragged into it.

First aid measures for drowning.

First aid begins immediately after removing the injured drowning person from the water.

The victim is placed with his stomach on the bent knee of the assisting person in such a way that the head is lower than the chest, and any tissue (handkerchief, piece of cloth, part of clothing) is removed from the oral cavity and pharynx water, sand, algae, vomit. Then, with several vigorous movements, they squeeze the chest, thus pushing water out of the trachea and bronchi.

With blue drowning, you can use the technique of pressing on the root of the victim's tongue, thereby reproducing the gag reflex and removing water from the respiratory tract and stomach.

After the airways are freed from water, the victim is laid on his back on a flat surface and, in the absence of breathing and cardiac activity, they begin to carry out resuscitation measures.

With a white type of drowning, if the victim is unconscious after being removed from the water, it is necessary to lay the victim on a flat surface, tilt his head back, push the lower jaw forward, then clean the oral cavity from silt, algae, vomit with fingers wrapped in a handkerchief.

If airway patency cannot be restored, start cardiopulmonary resuscitation immediately.

It is unacceptable to waste time removing water from the lungs and stomach, transferring the victim to a warm room if there are signs of clinical death!

If the victim is conscious during the removal to the shore, the pulse and breathing are preserved, then it is enough to lay him on a flat surface. In this case, the head should be lowered. It is necessary to undress the victim, rub with a dry towel, drink hot tea or coffee, wrap him up and let him rest.

The victim must be hospitalized without fail, since there is a possibility of complications.

We all love to relax, especially by the sea or the river. However, holidays are not always pleasant. From childhood, we were taught that games have no place on the water, and that if you can’t swim, don’t go far. Having matured and learned to swim, we consider ourselves professional swimmers and, being firmly confident in our strengths and capabilities, we swim wherever our eyes look.

Few of us think about the consequences and dangers of a long swim or playing on the water. Misbehavior, drunk bathing, emergency situations - all this is fraught with drowning. Drowning is an accident, accompanied by the ingress of liquid into the respiratory tract of a person, and as a result - oxygen starvation.

Not a single person is immune from such cases. The sooner a drowning person is removed from the water, and the sooner he is given first aid, the higher will be the chance of saving his life. Everyone should be able and to know how to provide ambulance to the victim on the water. From this article, you will learn how to act if a person begins to drown in your presence.

In medical practice, there are four types of drowning. Each of them is characterized by its own characteristics.

1. Primary, wet or true. Accompanied by penetration into the respiratory and gastrointestinal tract fluid. When immersed in water, there is no loss of the respiratory instinct. As a result, the bronchi and lungs fill with water. It is characterized by the release of foam from the mouth and cyanosis of the skin.
2. Dry or asphyxial. It is accompanied by immersion under water and loss of orientation, spasm of the larynx and filling of the stomach with liquid. There is also a blockage of the respiratory tract and the development of asphyxia.
3. Fainting or syncope. It is also called pale. It is characterized by the acquisition of a pale, white-gray or bluish hue by the dermis. Death occurs due to reflex cessation of the heart and lungs. Pale drowning is caused by a temperature difference, immersion in ice water.
4. Secondary. This is the result of an epileptic seizure or heart attack that suddenly occurred during drowning. The lungs fill with water after the onset of clinical death.

Algorithm of actions when rescuing a drowning person

Help for a drowning person should be provided immediately. Any delay is fraught with critical consequences, in particular death. The condition of the victim and life will depend on how competently and timely the ambulance was provided. The algorithm of actions and their sequence during drowning is divided into three stages: actions in water, on land and after an ambulance.

The first action in helping a drowning person is pulling him ashore. It is necessary to act quickly and as correctly as possible.

• Swim up to the victim from behind, grab him in a way that is safe for you (a drowning person can grab onto clothes and drag you along). The most acceptable and versatile option is towing by the hair (the method is justified if the victim has long hair).
• If a person still grabbed his hand or clothes, do not try to unclench his hands, so you will only lose time. Dive with him, in the water he will instinctively unclench his hands.
• Swim to the shore on your back, while rowing with your right hand if you are right-handed and with your left hand if you are left-handed.
• Make sure that the victim's head is above the water and that he does not swallow water.

After you have pulled the drowning person to land, proceed to the second stage. The sequence of actions is as follows.

• Lay him on his back, then free the airways from foreign substances and objects, vomit and mud, remove dentures. Do not reach into the victim's mouth with bare hands, wrap the finger with a soft material.
• Turn it over and put it on your knee with your stomach. Fluid that has entered the VRT will flow out.
• Insert two fingers into the mouth, then press on the root of the tongue. Together with the gag reflex, all excess fluid will come out and the breathing process will be restored.
• If these measures do not work, give artificial respiration and chest compressions. In case of asphyxial drowning, resuscitation should be carried out immediately. In this case, the stage of provoking vomiting is skipped.

The third stage involves the implementation of measures that contribute to the further restoration of the condition of the victim.

• Lay it on its side.
• Cover with a blanket or dry towel.
• Call an ambulance.
• Do not leave the patient alone for a second, monitor his condition until the doctors arrive.

With true or wet drowning, water in 70% of cases penetrates directly into the lungs. In addition to feeling the pulse, examining the pupils, warming and maintaining blood circulation (raising the legs), artificial respiration is often necessary.

In asphyxic drowning, fluid never enters the lungs. Instead, there is a spasm of the vocal cords. The lethal outcome is caused by untimely help and hypoxia. With this type of drowning, the first thing to do is to perform cardiopulmonary resuscitation. The second stage is calling an ambulance and the third is warming the patient.

Cardiopulmonary resuscitation

Respiratory arrest and cardiac arrest during drowning are frequent phenomena. In order to restore lung function and save human life, artificial respiration and heart massage should be started without delay. The mouth-to-mouth technique is performed as follows.

• Open the victim's mouth, remove the mucus and algae (do not forget to wrap the fingers with a cloth). Wait until all liquid has drained from your mouth.
• Grasp your cheeks so that your mouth does not close, tilt your head back, and lift your chin.
• Pinch the nasal passages, take a deep breath and inhale the air into the victim's mouth. The number of repetitions is 12 per minute.
• Check your pulse.
• After some time, the breath will appear.

Heart massage should be carried out as carefully as possible, as there is a high risk of damage to the ribs.

1. Position the person on the ground.
2. Put one hand on the sternum, put the other on top, at an angle of 90 degrees.
3. Perform rhythmic chest compressions, about one per minute.
4. In order to resume the work of the heart of a small child, pressure should be carried out with two fingers.
5. If there are several rescuers, CPR is carried out simultaneously, if there is one, then artificial respiration with heart massage must be alternated every half a minute.

Causes and signs of drowning

Drowning is defined by the World Health Organization as a respiratory disorder caused by immersion or prolonged exposure to water. Long stay under water is fraught not only with respiratory failure, but also with asphyxia. Untimely or incorrect provision of first aid to the victim is fraught with a fatal outcome. The brain can work for a maximum of six minutes during hypoxia, which is why you should act as quickly as possible, without waiting for an ambulance.

There are several reasons why a person may drown. Not all of them and not always random. This situation may be due to:

• injuries while diving in shallow water;
• swimming in unexplored reservoirs;
• alcohol intoxication;
• emergency situations: convulsions, stroke, diabetic or hypoglycemic coma;
• inability to swim;
• negligent attitude towards children, lack of education;
• falling into whirlpools, storm.

Contrary to popular belief, it is rather difficult to recognize a drowning person, since his external holding on the water looks completely ordinary. Calm behavior is due to the inability to call for help due to impaired breathing. The maximum that a person has enough time and energy for is to inhale. How to understand that a person is drowning if he does not cry for help? It is easy to understand that the victim needs help if you are attentive.

The head of a drowning person is located in the rear direction, while the mouth is open. The head can be under water, and the mouth can be located near the surface of the water. The eyes of a drowning person are either hidden under the hair or closed. The breathing of a drowning person is frequent and deep. This is due to the desire to capture the maximum possible portion of air.

To understand that the victim was drowning, after removing him from the water, you can use the following symptoms: bloating, retrosternal pain, blue or bluish skin tone, cough, vomiting, shortness of breath.

Consequences and possible complications

Even after the patient has come to his senses, he needs qualified help. The fact is that when drowning in fresh water, death can occur even after a few hours. That is why you should keep the situation under control and not step away from the victim until the ambulance arrives. Prolonged stay in an unconscious state and without oxygen is fraught with:

• impaired functioning of the brain and other internal organs and systems;
• neuralgia;
• chemical imbalance;
• permanent vegetative state.

Drowning in sea and fresh water: is there a difference?

An accident can happen both in the sea, at the rate and in the river. However, drowning in fresh water is fundamentally different from immersion in salty sea water. What is the difference?

Salt water inhalation is less dangerous and has a more reassuring prognosis. The high salt content helps to prevent the penetration of fluid into the lung tissue. However, there is a thickening of the blood and there is pressure on the circulatory system. Within ten minutes, a complete cardiac arrest occurs, but this time is enough to save a person's life.

Diving into fresh water is a more complicated process. The ingress of fluid into the cells of the lungs is accompanied by their swelling and bursting. In addition, water is absorbed into the blood and makes it more liquid, which causes rupture of capillaries, disruption of cardiac activity and complete cardiac arrest. The duration of this process is a couple of minutes. Lethal outcome in fresh waters occurs much faster.

Dangers that may lie in wait for everyone

A variety of dangers can lurk in the water: algae, a storm or a strong current. And from each of these situations, in order to save lives, it is necessary to find a reasonable way out. Of course, it is difficult to think when you start to sink or when you are being sucked in by algae. But you still need to concentrate.

Quite often it happens that a person without swimming skills finds himself in the water, and not at the shore. In this case, the main thing is not to panic, but try to stay on the water until help arrives. It is necessary to lie on the water and breathe slowly and deeply. Don't try to swim, you'll just waste all your energy. When staying in cold water, a shock condition may occur. It is important to monitor your breathing and try to always stay on the water.

Strong currents often cause drowning. All you have to do is stop fighting him. It's a waste of energy. Go with the flow, and as soon as his strength decreases, turn around and swim to the shore.

Often on the way of the swimmer come across algae. Many immediately try to get rid of them. Some even dive to unravel. This is not worth doing, as algae, while you free your legs, can entangle your neck. It is correct when entangling in river or sea vegetation to make sharp repulsive shocks. You can also try rolling them by rubbing one foot against the other.

1. Don't play in the water. Do not use entertainment that involves the capture of a person.
2. If you start to sink or get entangled in seaweed, in no case do not scream. When screaming, a person takes deep breaths, which is fraught with swallowing water. The liquid, once in the blood and the upper respiratory tract, provokes a deterioration in the functioning of internal organs.
3. If you are tired, give up swimming for long distances.
4. If your leg cramps, dive in, pull on your big toe, try to straighten it.
5. Do not swim in unexplored and unknown waters.
6. Learn to swim.
7. Don't walk on thin ice.
8. Avoid swimming while intoxicated.

Do not neglect safety measures and before you dive and swim for a long distance, soberly assess your capabilities. Do not brag about your skills and brag to your friends. Water games are dangerous. Take care of yourself and try to behave correctly on the water.

Today I want to continue the theme of summer holidays, but with a focus on water.

Of course, I would like the essence of the article to be as easy as its beginning, but, unfortunately, this will not work out here. Because the sun is getting hotter. Water in the sea and other bodies of water is warming up. The number of picnics is increasing. The degree in the body of many people rises, and sanity often fades into the background. The result is drowning. Moreover, as statistics and news reports show, people, despite all the warnings and other preventive measures, still continue to drown. The reason in most cases is heat, alcohol, water - a cramp, loss of consciousness ...

Our mind can replace the three dots of the previous paragraph with “drowned man”, but I want to replace them with “saved person”, who next time will be more conscious about his own safety on the water.

Let's look, dear readers, how we can help in a situation where a person begins to drown and needs the help of another person. Moreover, after pulling a person out of the water, it is also necessary to provide him with first aid. So…

Help a drowning man. What to do?

If you saw a drowning person, no matter how trite it sounds, you must:

1. Pull a person out of the water;
2. Call an ambulance;
3. Provide him with first aid.

These 3 points, if done correctly and quickly, are actually the key to a successful conclusion to the situation. Delays are not allowed!

1. Pulling a drowning person out of the water

A drowning person in most cases panics, does not hear words, and does not understand what is happening. He grabs for everything that is possible and this becomes dangerous for the person who wants to save him.

If a person is conscious

To pull a person out of the water, if he is conscious, throw him a floating object - an inflatable ball, a board, a rope, etc., so that he can grab onto it and calm down. Thus, you can safely pull it out.

If the person is unconscious or weak:

1. While still on the shore, get as close as possible to the drowning person. Be sure to take off your shoes, excess clothing (or at least heavy ones), turn out your pockets. Jump into the water and approach the drowning man.

2. If a person has already gone under water, dive after him and try to see him or feel him.

3. When you find a person, turn him over on his back. If a drowning person starts grabbing you, quickly get rid of his grip:

- if a drowning person grabbed you by the neck or torso, then grab him by the lower back with one hand, and push his head away with the other hand, resting on his chin;
- if you grabbed a hand, then twist it and pull it out of the hands of a drowning man.

If such methods do not help to get rid of the grip, then take air into your lungs and dive, the drowning person will change the grip, and you will be able to free yourself from it at this time.

Try to act calmly and do not show cruelty to a drowning person.

4. Transport the drowning person to the shore. There are several methods for this:

- Being behind, clasp your chin with your palms on both sides and row towards the shore with your feet;
- put your left hand under the arm of the left hand of the drowning person, at the same time, grab with your left hand also the wrist of his right hand, row with your feet and with one hand;
- take the victim by the hair with your hand and put his head on your forearm, row with your feet and with one hand.

2. First aid to a drowning person (First aid)

When you pulled the victim ashore, urgently call an ambulance and immediately begin to provide him with first aid.

1. Get on one knee next to the injured person. Lay him on your knee, belly down, and open his mouth. At the same time, press with your hands on his back so that the water that he swallowed flows out of him. The victim may appear and - this is normal.

If the person is semi-conscious and is vomiting, do not let him lie on his back or he may choke on the vomit. If necessary, help remove vomit, mud, or other substances that interfere with normal breathing from his mouth.

2. Lay the victim on their back and remove any excess clothing. Put something under his head so that it is a little elevated. To do this, you can use his own clothes, twisted into a roller or your knees.

3. If a person does not breathe for 1-2 minutes, it can be fatal.

Signs of cardiac arrest are: lack of pulse, breathing, dilated pupils.

If these signs are present, immediately begin to take resuscitation measures - do "mouth to mouth" and.

Draw air into your lungs, pinch the victim's nose, bring your mouth close to the victim's mouth and exhale. It is necessary to do 1 exhalation in 4 seconds (15 exhalations per minute).

Place your palms on top of each other on the victim's chest between his nipples. In the pauses between exhalations (during artificial respiration), do 4 rhythmic pressures. Press on the chest quite hard - so that the sternum moves down by about 4-5 cm, but no more, so as not to aggravate the situation and additionally harm the person.

If the affected person is elderly, then the pressure should be gentle. If the injured child, then press not with the palm of your hand, but with your fingers.

Give artificial respiration and chest compressions until the person is awake. Don't give up and don't give up. There were cases when a person came to his senses even after an hour of such measures.

It is most convenient to resuscitate together, so that one would do artificial respiration, and the second.

4. After breathing is restored, before the ambulance arrives, lay the person on their side so that they lie stably, cover and warm them.

If an ambulance cannot arrive, but there is a car, follow all the above points in the car while driving to the nearest medical facility.

May the Lord keep us all, dear readers, from such situations.

Help a drowning man - video