Scheme of actions in cases of drowning. Drowning in fresh water. Help with true drowning

Drowning is a type of mechanical asphyxia (suffocation) as a result of water entering the respiratory tract.
The changes that occur in the body during drowning, in particular, the timing of dying under water, depend on a number of factors:

• on the nature of the water (fresh, salty, chlorinated fresh water in pools)
• from its temperature (ice, cold, warm)
• from the presence of impurities (silt, ooze, etc.)
• on the state of the body of the victim at the time of drowning (overwork, agitation, alcohol intoxication, etc.)

True drowning occurs when water enters the trachea, bronchi and alveoli. Usually a drowning person has a strong nervous excitement; he expends colossal energy to resist the elements. Taking deep breaths during this struggle, the drowning person swallows some amount of water along with the air, which disrupts the rhythm of breathing and increases body weight. When a person in exhaustion plunges into water, there is a delay in breathing as a result of a reflex spasm of the larynx (closing of the glottis). At the same time, carbon dioxide quickly accumulates in the blood, which is a specific irritant. respiratory center. Loss of consciousness occurs, and the drowning person makes deep breathing movements under water for several minutes. As a result, the lungs are filled with water, sand and air is forced out of them. The level of carbon dioxide in the blood rises even more, there is a repeated holding of the breath, and then deep death breaths for 30-40 seconds. Examples of true drowning are fresh water and sea water drowning.

Drowning in fresh water. Upon penetration into the lungs, fresh water is quickly absorbed into the blood, since the concentration of salts in fresh water is much lower than in the blood. This leads to blood thinning, an increase in its volume and the destruction of red blood cells. Sometimes pulmonary edema develops. A large amount of stable pink foam is formed, which further disrupts gas exchange. The function of blood circulation stops as a result of a violation of the contractility of the ventricles of the heart.

Drowning in sea water. Due to the fact that the concentration of dissolved substances in sea water is higher than in the blood, when sea water enters the lungs liquid part blood along with proteins penetrates from the blood vessels into the alveoli. This leads to thickening of the blood, an increase in the concentration of potassium, sodium, calcium, magnesium and chlorine ions in it. A large amount of fluid is heated in the alveoli, which leads to their stretching up to rupture. As a rule, pulmonary edema develops when drowning in sea water. That small amount of air that is in the alveoli contributes to the whipping of the liquid during respiratory movements with the formation of a stable protein foam. Gas exchange is sharply disturbed, cardiac arrest occurs.

When conducting resuscitation extremely importance has a time factor. The earlier the revival is started, the greater the chance of success. Based on this, artificial respiration it is desirable to start already on the water. To do this, carry out periodic blowing of air into the mouth or nose of the victim during his transportation to the shore or to the boat. On the shore, the victim is examined. If the victim did not lose consciousness or is in a state of slight fainting, then in order to eliminate the consequences of drowning, it is enough to give a sniff ammonia and keep the victim warm.
If the circulatory function is preserved (pulsation in the carotid arteries), there is no breathing, the oral cavity is freed from foreign bodies. To do this, it is cleaned with a finger wrapped in a bandage, removable dentures are removed. Often, the victim's mouth cannot be opened due to spasm. chewing muscles. In these cases, carry out artificial respiration "mouth to nose"; if this method is ineffective, a mouth expander is used, and if it is not available, then some flat metal object is used (do not break your teeth!). As for the release of the upper respiratory tract from water and foam, it is best to use suction for these purposes. If it is not there, the victim is laid with his stomach down on the rescuer's thigh, bent at the knee joint. Then sharply, vigorously compress his chest. These manipulations are necessary in those cases of resuscitation when it is impossible to carry out artificial ventilation of the lungs due to the blocking of the airways by water or foam. This procedure must be carried out quickly and vigorously. If there is no effect within a few seconds, you need to start artificial ventilation lungs. If a skin pale, then it is necessary to proceed directly to artificial ventilation of the lungs after cleansing the oral cavity.
The victim is laid on his back, freed from restrictive clothing, his head is thrown back, placing one hand under the neck, and the other is placed on the forehead. Then the lower jaw of the victim is pushed forward and up so that the lower incisors are ahead of the upper ones. These techniques are performed in order to restore the patency of the upper respiratory tract. After that, the rescuer takes a deep breath, holds his breath a little and, pressing his lips tightly against the mouth (or nose) of the victim, exhales. In this case, it is recommended to pinch the nose (when breathing mouth to mouth) or mouth (when breathing mouth to nose) of the person being revived. Exhalation is carried out passively, while the airways must be open.
It is difficult to carry out artificial ventilation of the lungs for a long time using the method described above, since the rescuer may develop undesirable disorders from of cardio-vascular system. Based on this, when carrying out artificial ventilation of the lungs, it is better to use apparatus breathing.
If, during artificial ventilation of the lungs, water is released from the respiratory tract of the victim, which makes it difficult to ventilate the lungs, you need to turn your head to the side and raise the opposite shoulder; while the mouth of the drowned person will be lower chest and the liquid will spill out. After that, you can continue artificial ventilation of the lungs. In no case should artificial ventilation of the lungs be stopped when independent respiratory movements appear in the victim, if his consciousness has not yet recovered or if the rhythm of breathing is disturbed or sharply accelerated, which indicates an incomplete restoration of respiratory function.
In the event that there is no effective blood circulation (no pulse on the large arteries, heart beats are not auscultated, not determined arterial pressure, the skin is pale or cyanotic), simultaneously with artificial ventilation of the lungs, an indirect heart massage is performed. The person assisting stands on the side of the victim so that his hands are perpendicular to the surface of the chest of the drowned person. The resuscitator places one hand perpendicular to the sternum in its lower third, and puts the other on top of the first hand, parallel to the plane of the sternum. Essence indirect massage the heart is in a sharp compression between the sternum and the spine; at the same time, blood from the ventricles of the heart enters the systemic and pulmonary circulation. Massage should be performed in the form of sharp jerks: do not strain the muscles of the hands, but should, as it were, "dump" the weight of your body down - it leads to the deflection of the sternum by 3-4 cm and corresponds to the contraction of the heart. In the intervals between pushes, the hands cannot be torn off the sternum, but there should be no pressure - this period corresponds to the relaxation of the heart. The movements of the resuscitator should be rhythmic with a frequency of 60-70 shocks per minute.
Massage is effective if the pulsation of the carotid arteries begins to be determined, the dilated pupils narrow to that extent, cyanosis decreases. When these first signs of life appear, indirect heart massage should be continued until the heartbeat begins to be heard.
If resuscitation is carried out by one person, then it is recommended to alternate chest compressions and artificial respiration as follows: for 4-5 pressures on the sternum, 1 air is blown. If there are two rescuers, then one is engaged in indirect heart massage, and the other is in artificial ventilation of the lungs. At the same time, 1 air blowing is alternated with 5 massage movements.
It should be borne in mind that the victim's stomach can be filled with water, food masses; this makes it difficult to carry out artificial ventilation of the lungs, chest compressions, provokes vomiting.
After removing the victim from the state of clinical death, he is warmed (wrapped in a blanket, covered with warm heating pads) and the upper and lower extremities are massaged from the periphery to the center.
When drowning, the time during which a person can be revived after being removed from the water is 3-6 minutes.
Great importance the water temperature affects the timing of the return to life of the victim. When drowning in ice water when the body temperature drops, recovery is possible even 30 minutes after the accident.
No matter how quickly the rescued person regains consciousness, no matter how prosperous his condition may seem, placing the victim in a hospital is an indispensable condition.
Transportation is carried out on a stretcher - the victim is laid on his stomach or on his side with his head down. With the development of pulmonary edema, the position of the body on the stretcher is horizontal with the head end raised. During transportation continue artificial ventilation of the lungs.

SAD STATISTICS

The expanse of water beckons with coolness and secrets of the depths, fascinates with its beauty and mystery. And at the same time, this environment is extremely dangerous and hostile to humans. Only in Moscow and the Moscow region during the swimming season, water takes 3-4 human lives every day.

According to forecasts of the State Committee for Emergency Situations, 3.5 thousand children will drown in Russia next year. It is this number of planned tragedies that is repeated year after year. Over the past five years, more than 63 thousand people have died on the water within Russia, more than 14 thousand of them are children under 15 years old.

Remember! When near the water, never forget about your own safety and be ready to help those in need.

STAGES OF ASSISTANCE

There are two stages of assistance with drowning. The first is the actions of the rescuer directly in the water, when the drowning person is still conscious, takes active steps and is able to stay on the surface on his own. In this case, there is a real opportunity to prevent a tragedy and get off with only a "light fright." But it is this option that poses the greatest danger to the rescuer and requires him, first of all, to be able to swim, good physical training and possession of special techniques for approaching a drowning person, and most importantly, the ability to get rid of "dead" grips.

Remember! panic fear drowning man - a mortal danger for the rescuer.

In the case when an already "lifeless body" is removed from the water - the victim is unconscious, and often without signs of life - the rescuer, as a rule, has no problems with his own safety, but the chances of salvation are significantly reduced. If a person has been under water for more than 5-10 minutes, he is unlikely to be brought back to life. Although in each case, the outcome will depend on the time of year, temperature and composition of the water, the characteristics of the body, and most importantly, on the type of drowning and the right tactics for providing assistance.

Remember! Success can only be hoped for with the right assistance given the type of drowning.

SIGNS OF TRUE ("BLUE") DROWNING

This type of drowning is easily identified by appearance drowned - his face and neck blue gray, and a pinkish foam comes out of the mouth and nose. The swollen vessels of the neck confirm this assumption. "Blue" drowning is most common in children and adults who cannot swim, in people who are intoxicated with alcohol, and even in good swimmers with a ruptured eardrum, when they suddenly lose their coordination.

Likewise drown those who last minute fought for his life. Being under water, they continued to move actively, holding their breath as much as possible. This very quickly led to brain hypoxia and loss of consciousness. As soon as a person lost consciousness, water immediately began to enter the stomach and lungs in large quantities. This volume was quickly absorbed and passed into the bloodstream, significantly overflowing it with diluted blood.

CAUSES OF DEATH IN THE FIRST MINUTES AFTER RESCUE

1. pulmonary edema

When drowning, there is such a sharp increase in the volume of circulating blood (HYPERVOLEMIA) that even the athlete's heart is not able to cope with it. The left ventricle is not able to pump such an amount of diluted blood through itself into the aorta and literally chokes on its excess. This leads to a sharp increase in hydrodynamic pressure in the pulmonary circulation and the pulmonary vein system.

In the alveoli, the liquid part of the blood is squeezed out of the bloodstream - the plasma, which, falling into their lumen, instantly foams. A large amount of pinkish foam is released from the upper respiratory tract, which, filling the lumen of the alveoli and airways, stops gas exchange. A condition develops, which in medicine is called pulmonary edema.

Remember! Without timely delivery emergency assistance pulmonary edema ends only in death.

Most reliable sign this formidable state is bubbling breath. This gurgling, well audible for a few steps, resembles the "bubbling" of bubbles in boiling water. It seems that something is "boiling" inside the patient.

Another symptom of pulmonary edema is frequent coughing with pinkish frothy sputum. In extremely severe cases, foam is formed so much that it begins to stand out from the mouth and nose.

The severity of the condition will be aggravated by the fact that aspiration of water will very quickly lead to mechanical asphyxia, which can only be eliminated by removing water and foam from the respiratory tract. But even in the case of successful resuscitation, the formation of a large number of ATELEKTASIS (zones of incomplete expansion or collapse of the alveoli that are not filled with air) will certainly occur. This will result in a sharp increase in the degree of pulmonary insufficiency and hypoxia, which will persist for several days.

2. Edema of the brain

Deep hypoxia of the brain and a sharp increase in the volume of circulating blood will cause cerebral edema. This is extremely dangerous state, as a rule, is difficult to recognize in the early stages of care, but coma, frequent vomiting and the appearance of seizures worsen the prognosis.

3. SUDDEN CARDIAC ARRANGEMENT

The intake of a large amount of water into the blood will significantly reduce its viscosity and change the electrolyte balance, which will provoke gross violations. heart rate and sudden cardiac arrest. Until the complete restoration of the electrolyte composition of the blood and its normal viscosity, the victim is constantly at risk of repeated cardiac arrest.

4. ACUTE RENAL FAILURE

In the next day after rescue, the victims most often die from acute renal failure, which develops due to massive HEMOLYSIS (destruction) of erythrocytes. Due to excessive blood thinning and a gross imbalance between the pressure inside the "plate" of the erythrocyte and the surrounding plasma, it literally explodes from the inside. FREE HEMOGLOBIN is released into the blood, which should be only inside the red blood cells. The presence of free hemoglobin in the blood leads to gross violations of kidney function: their most delicate filtration membranes of the tubules are easily damaged by giant hemoglobin molecules. Renal failure develops.

Remember! Within 3-5 days after the rescue, there is a threat of repeated cardiac arrest, the development of pulmonary edema, cerebral edema and acute renal failure.

EMERGENCY HELP FOR TRUE DROWNING

The first thing to do is to turn the drowned person on his stomach so that his head is below the level of his pelvis. The child can be placed on his stomach on his thigh. Do not waste time determining the pupillary and corneal reflexes, as well as looking for a pulse on the carotid artery. The main thing is to insert two fingers into the victim's mouth as soon as possible and roundabout remove the contents of the mouth.

After cleansing the oral cavity, press sharply on the root of the tongue to provoke a gag reflex and stimulate breathing. The presence or absence of this reflex will be the most important test to determine further tactics.

1. FIRST AID FOR PRESERVED VOMITING AND COUGH REFLEXES

If, after pressing on the root of the tongue, you heard the characteristic sound "E" and this was followed by vomiting; if you saw the remnants of food eaten in the water pouring out of your mouth, then you have a living person with a preserved gag reflex. The indisputable proof of this will be the reduction of the intercostal spaces and the appearance of a cough.

Remember! In case of gag reflex and cough the main task- as soon as possible and thoroughly remove WATER from the lungs and stomach. This will avoid many terrible complications.

To do this, periodically press the root of the tongue with force for 5-10 minutes until water ceases to be released from the mouth and upper respiratory tract. (Remember that this procedure is done with the drowned person face down.)

For a better discharge of water from the lungs, you can slap your back with your palms, and during exhalation, squeeze the chest several times with intense movements from the sides. After removing water from the upper respiratory tract, lungs and stomach, lay the victim on his side and try to call an ambulance.

Remember! Even if the victim feels satisfactory, he should be carried on a stretcher. No matter how prosperous his condition may seem, no matter how his relatives persuade him to let him go home, you must insist on calling an ambulance and hospitalization. Only after 3-5 days you can be sure that his life is no longer in danger.

Before the doctors arrive, do not leave the drowned person unattended for a second: every minute sudden stop hearts.

Remember! Well done first step urgent action will prevent the development of many terrible complications.

2. FIRST AID TO A VICTIMIN WITH NO SIGNS OF LIFE

If, when pressing on the root of the tongue, the gag reflex did not appear, and in the fluid flowing out of the mouth you did not see the remnants of food eaten; if there is no cough, no respiratory movements, then in no case should you waste time further extracting water from the drowned person, but immediately turn it over on your back, look at the reaction of the pupils to light and check the pulsation on the carotid artery. If not available, proceed immediately. cardiopulmonary resuscitation.

Remember! In the absence of signs of life, it is unacceptable to waste time completely removing water from the respiratory tract and stomach.

But since resuscitation of a drowned person is impossible without periodically removing water, foamy formations and mucus from the upper respiratory tract, then every 3-4 minutes you will have to interrupt artificial ventilation of the lungs and indirect heart massage, quickly turn the victim over on his stomach and remove the contents with a napkin mouth and nose. (This task will be greatly facilitated by the use of a rubber balloon, with which you can quickly suck out secretions from the upper respiratory tract.)

Remember! When drowning, resuscitation is carried out within 30-40 minutes, even if there are no signs of its effectiveness.

RENDERING ASSISTANCE AFTER RECOVERY

Even when the drowned man had a heartbeat and independent breathing, consciousness returned to him, do not fall into the euphoria that so quickly covers others. Only the first step was taken in a whole complex of measures necessary to save his life. To prevent most of the complications, immediately after the restoration of spontaneous breathing and heartbeat, it is necessary to turn the rescued person on his stomach again and try to remove water more carefully.

Everything that will be said below refers to the actions of medical professionals and may seem optional to the layman. But if you have a desire to have at least the slightest idea of ​​​​the further problems of rescuing a drowned person, to understand the reasons for the failures of medical teams and get rid of the illusions of the uninitiated, and most importantly - to take the initiative in rescuing and not make unforgivable mistakes, I recommend that you carefully read the following set of measures.

1. A PACKAGE OF MEDICAL MEASURES IN THE FIRST HOURS AFTER RESCUE

To eliminate hypoxia, it is necessary to start OXYGEN THERAPY as soon as possible - inhalation of oxygen or its mixture with air using portable oxygen devices (at the scene of the incident, their function will be successfully replaced by an oxygen pillow).

To reduce the increased volume of circulating blood, perform DEHYDRATION - REMOVING FLUID FROM THE BODY. The victim is administered intravenously large doses strong diuretics (LASIX, UREA, MANNITOL or GLUCOSE).

To reduce the likelihood of developing cerebral edema, 10 ml of 25% MAGNESIUM SULPHATE is administered intramuscularly.

To stimulate the respiratory center and quickly normalize the level of blood pressure, subcutaneous administration of solutions of CARDIAMIN AND CAFFEINE is prescribed.

If the victim suffered a state of clinical death, then intravenous drip administration of alkalizing solutions: SODA solution or TRISAMINE will need to be added to this therapy.

2. TREATMENT FOR PULMONARY EDEMA

If signs of pulmonary edema appear, the victim should immediately be seated or placed in a position with a raised head end, tourniquets should be applied to the thighs, and then oxygen should be inhaled from the oxygen bag through alcohol vapor.

These quite affordable manipulations can have an effect in stopping pulmonary edema. By giving an elevated position to the head end or seating the patient, you will ensure that most of the blood will be deposited in the lower extremities, intestines, and small pelvis. This simplest measure alone can not only alleviate his condition, but also completely eliminate pulmonary edema.

Remember! The first thing to do with bubbling breathing and the appearance foamy discharge from the respiratory tract - seat the patient as soon as possible or raise his head end.

Tourniquets on the thighs will allow for the so-called "bloodless bleeding". For greater effectiveness of this method, it is advisable to apply a warm heating pad to the feet or lower them into warm water and only after that put tourniquets on the upper third of the thighs. Under the influence hot water blood will rush to the lower limbs, and the applied tourniquets will prevent its return. (The tourniquets on the thighs will not be able to clamp the arteries, but they will impede the venous outflow: the blood will be trapped.)

Remember! The tourniquets are applied for no more than 40 minutes and are removed from the right and left legs alternately with an interval of 15-20 minutes.

Inhalation of oxygen through alcohol vapors (for this, it is enough to put a piece of cotton wool with alcohol into the mask at the level lower lip) is one of the most effective means of combating foaming in pulmonary edema. Alcohol vapor significantly reduces the surface tension of the shell of microscopic bubbles that make up the foam formed in the alveoli.

Destruction of the membranes of the blisters and preventing the formation of new ones will turn the entire volume of the foamy mass into a small amount of sputum, which can be easily removed with a cough, a rubber balloon or a special apparatus for suctioning fluid from the respiratory tract - a vacuum extractor.

Remember! Defoaming should by no means be considered the only and main way in the fight against pulmonary edema. Although it is very effective, it essentially eliminates only the consequences, and not the cause of a life-threatening condition.

3. RULES OF HOSPITALIZATION

Remember! You can’t take your eyes off the patient for a moment: at any moment there may be a second stop of the heart and breathing, pulmonary or cerebral edema may develop.

Unfortunately, the lion's share of accidents on the water occurs in places where it is very difficult to call an ambulance. And then you face a whole range of intractable tasks, which are sometimes difficult to cope even with a professional. Therefore, it is my duty to try to warn you against those gross tactical errors that can no longer be corrected.

Before you decide to transport the rescued person on random transport, imagine the following situation: on the way to the hospital, somewhere on an abandoned road, the victim’s heart suddenly stopped. Even if you manage to react in time and quickly pull him out of the back seat, lay him on his back and start cardiopulmonary resuscitation, then what will you do when its effectiveness is obvious, but an independent heartbeat does not appear? Wait for a passerby or a cart driver who appears in this wilderness no more than twice a week? Saved by you once this time is doomed!

Remember! In order not to become a hostage of criminal initiative, do not try to transport the victim yourself when there is at least slightest possibility call the rescue service.

Only in situations where the accident occurred away from populated areas and busy highways, you will have to transport the drowned person in an accidental transport. In this case, preference should be given to a bus or a covered truck, in which you can place the rescued on the floor and take two or three escorts with you, whose help may be needed at any moment.

"PALE" DROWNING

This type of drowning occurs when water has not entered the lungs and stomach. This happens when drowning in very cold or chlorinated water. In these cases, the irritating effect of ice water in an ice hole or highly chlorinated water in a pool causes a reflex spasm of the glottis, which prevents its penetration into the lungs.

In addition, unexpected contact with cold water often leads to reflex cardiac arrest. In each of these cases, a state of clinical death develops. The skin becomes pale gray, without pronounced cyanosis (blue). Hence the name of this type of drowning.

The nature of the foamy secretions from the respiratory tract will also be markedly different from the copious pricing in true "blue" drowning. "Pale" drowning is very rarely accompanied by the release of foam. If a small amount of "fluffy" foam appears, then after its removal, no wet marks remain on the skin or napkin. Such foam is called "dry".

The appearance of such foam is explained by the fact that the small amount of water that enters the oral cavity and the larynx to the level of the glottis, upon contact with saliva mucin, forms a fluffy air mass. These secretions are easily removed with a napkin and do not interfere with the passage of air. Therefore, there is no need to take care of their complete removal.

FEATURES OF FIRST AID FOR "PALE" DROWNING

With "pale" drowning, there is no need to remove water from the respiratory tract and stomach. Moreover, it is unacceptable to waste time on this. Immediately after removing the body from the water and establishing signs of clinical death, proceed to cardiopulmonary resuscitation. The decisive factor for rescue in the cold season will be not so much the time spent under water as the delay in the start of assistance on the shore.

The paradox of revival after drowning in cold water is explained by the fact that a person in a state of clinical death finds himself in such a deep hypothermia (lowering temperature) that only science fiction writers in novels about "frozen" can dream of. In the brain, as, indeed, in the whole body, immersed in ice water, metabolic processes almost completely stop. Low ambient temperature significantly delays the onset of biological death. If you read in the newspaper that they managed to save a boy who fell into the hole and was under the ice for more than an hour, this is not a journalist's fiction.

Remember! When drowning in cold water, there is every reason to count on salvation even in the case of a long stay under water.

Moreover, with successful resuscitation, one can hope for favorable course post-resuscitation period, which, as a rule, is not accompanied by such formidable complications as pulmonary and cerebral edema, renal failure and repeated cardiac arrest, characteristic of true drowning.

After removing the drowned person from the hole, it is unacceptable to waste time transferring him to a warm room in order to start providing emergency assistance there. The absurdity of such an act is more than obvious: after all, first you need to revive a person, and only then take care of the prevention of colds.

When it is necessary to free the chest to conduct an indirect heart massage, even severe frost and icing of clothes will not stop you. This is especially true for children: their sternum, which has a cartilaginous base, is easily injured during resuscitation even with ordinary buttons.

Only after the appearance of signs of life, the victim should be transferred to heat and general warming and rubbing should be carried out there. Then it should be changed into dry clothes or wrapped in a warm blanket. The rescued person will need plenty of warm fluids and a drip of heated plasma-substituting fluids.

Remember! After any case of drowning, the victim must be hospitalized, regardless of his condition and well-being.

something interesting

"I'm interested in this. I heard that only people who have completed special courses can provide first aid. Unprofessional help can be dangerous for the victim. Is this true?" Romik

The peculiarity of critical situations is that the lack of first aid, just like the provision of incorrect assistance, in most cases leads to the death of the victim.

First aid is the simplest expedient measures to save the health and life of the victim. It is a self-evident duty of every person to provide them, in accordance with his capabilities, with such assistance that would contribute to the speedy recovery of an injured person or a suddenly ill person.

Of course you need to know necessary minimum to provide proper first aid. Providing the wrong first aid may not bring any results. But any person who finds himself in a situation where no one can provide more qualified assistance should do everything possible, use all his skills in order to save the life of the victim.

Water drowning occurs among various age groups and is the second most common cause of death in emergency situations. According to statistics, the number of water emergencies ( emergencies) increases every year, as people have the opportunity to visit water bodies more often, dive on sea ​​depths and engage in active sports. An interesting fact is that people who cannot swim at all die from drowning much less frequently than good swimmers. This is due to the fact that people who swim well are more likely to swim far from the coast, dive to the depths, jump from a height into the water, and so on, while a poorly swimming person is less likely to expose himself to such dangers.

Common Causes of Drowning

Drowning may be due to:

• Gross violation of the rules of conduct on the water and failure to observe simple precautions. There are widespread cases of drowning of persons when swimming in a storm, near ships and other floating facilities, when diving into dubious water bodies, when staying in cold water for a long time, when overestimating their physical capabilities, and so on.

• Violation of the rules of scuba diving. Reasons for the emergency emergency) at great depths, there may be malfunctions of equipment, depletion of air reserves in cylinders, hypothermia of the body, and so on. If this compromises the integrity of the swimsuit or air supply, water can also enter the person's airways, leading to drowning. As a rule, first aid for drowning at great depths is late. This is due to the fact that the injured person is not immediately noticed. Moreover, it will take a lot of time to deliver it to the surface of the water, pull it ashore and begin to provide first aid.
• Exacerbation / development of any diseases or pathological conditions directly during the bathing period. Fainting ( loss of consciousness), epileptic seizure ( accompanied by severe convulsions), hypertensive crisis ( pronounced increase in blood pressure), cerebral hemorrhages, acute coronary insufficiency ( violation of the blood supply to the heart muscle) and other pathologies that caught a person while swimming in the water or diving can cause drowning. Also, this can be facilitated by a banal cramp in the leg, which occurs against the background of hypothermia of the body ( e.g. prolonged exposure to water). At the same time, the muscle affected by the spasm cannot contract and relax, as a result of which the person cannot move his leg and loses the ability to stay on the surface of the water.
• Intentional murder. If you force a person under water and hold him there for a certain time, after a few seconds the victim may choke, which can cause his death.
• Suicide. Drowning can occur if the person himself ( of one's own free will) will swim too far, knowing in advance that he will not be able to get out of the water on his own. At the same time, at a certain moment, his strength will run out, as a result of which he will no longer be able to remain on the surface of the water and will drown. Another way to commit suicide is to dive great depth. At the same time, at some point a person will need to take a breath in order to replenish the oxygen reserves in the lungs. However, he will not be able to quickly get to the surface, as a result of which he will choke and drown.
• Fear and psychological shock when hit in emergency (emergency). An emergency can occur, for example, if a person who cannot swim suddenly falls overboard and ends up in the water. Also, an emergency can occur if a well-floating person suddenly accidentally chokes on water ( for example, if it is covered by a wave). The cause of drowning in this case will be fear and panic, forcing the victim to randomly row the water with his hands and feet, at the same time, trying to call for help. In this state, the forces of the body are extremely quickly depleted, as a result of which a person can go under water in a few minutes.
• Jumping into the water from a height. The cause of drowning in this case may be brain damage ( for example, when you hit your head on a stone or on the bottom of a pool). In this case, a person may lose consciousness, as a result of which he will choke and drown.
  Another cause may be damage to the cervical spine that occurs when diving head down into water is unsuccessful. In this case, fractures or dislocations of the cervical vertebrae, accompanied by damage, can be observed. spinal cord. A person can instantly become paralyzed ( unable to move arms or legs), causing it to quickly sink.
  The third cause of drowning during jumping may be reflex cardiac arrest associated with a sharp immersion of the body in cold water. Moreover, during an unsuccessful jump, a person can fall into the water with his stomach down, while receiving a severe blow. This can cause loss of consciousness or even a reflex violation of breathing and heartbeat, as a result of which he can also choke and drown.

Risk factors provoking the development of a critical condition

Drowning can contribute to:

• Bathing alone. If a person swims or dives alone ( when no one looks after him from the shore, from the boat, and so on), the chances of drowning are increased. This is due to the fact that in the event of an emergency ( injury, convulsions, accidental ingestion of water no one can give him the help he needs.
• Bathing while intoxicated. After drinking alcohol, a person tends to overestimate his strength and capabilities. As a result, he can swim too far from the coast, leaving no strength for the way back. In addition, when drinking alcohol, the blood vessels of the skin expand, as a result of which blood rushes into them. At the same time, a person feels warmth or heat, while in fact the body loses heat. If you bathe in cold water in this state, hypothermia can quickly develop, which will lead to muscle weakness and may contribute to drowning.
• Bathing after eating with a full stomach). When a person is in water, it presses on his abdominal wall, squeezing the internal organs ( including the stomach). This may be accompanied by the appearance of belching or the so-called regurgitation, during which part of the food from the stomach returns through the esophagus to the throat. If during such a phenomenon a floating person takes another breath, this food can enter the respiratory tract. In the best case, a person will begin to cough at the same time, as a result of which he may also choke, which will contribute to drowning. In more severe cases, it is possible to block the airways with large pieces of food, which will lead to suffocation and death of the victim.
• Heart disease. If a person has had a heart attack heart muscle damage) or suffers from another pathology of the cardiovascular system, the compensatory capabilities of his heart are reduced. At higher loads ( e.g. on a long voyage) the heart of such a person may not withstand, as a result of which a new heart attack may develop ( that is, the death of part of the heart muscle). Moreover, cardiac dysfunction can be exacerbated by sudden immersion in cold water. This leads to a sharp narrowing of the blood vessels of the skin and an increase in heart rate, as a result of which the load on the heart muscle increases significantly. In normal ( healthy) for a person, this will not cause any problems, while in a person with pre-existing heart disease, this can also provoke the development of a heart attack or heart failure.
• Swimming in rivers with strong currents. In this case, a person can be picked up by the current and carried away a long distance from the coast, as a result of which he will not be able to get out of the water on his own.
• ear diseases ( eardrum). If in the past a person suffered from purulent-inflammatory or other diseases of the ears, his eardrum may be affected, that is, there may be a small hole in it ( which normally should not be). The person himself may not even know about it. At the same time, when swimming in the water ( especially when diving) through this opening, water can enter the tympanic cavity. Through eustachian tube (special channel between tympanic cavity and throat) given water can get into the throat and further into the respiratory tract, as a result of which a person can also drown.

Species, types and pathogenesis ( development mechanism) drownings

Drowning can be:

• true ( primary, blue, "wet");
• asphyxial ( false, dry);
• syncope ( reflex, pale).

True ( wet, blue, primary) drowning in fresh or salty sea water

It should be noted that the mechanism of damage to the lung tissue and the whole organism as a whole depends on what kind of water got into the lungs of the victim - fresh ( from a lake, river or pool) or marine ( i.e. salty).

True drowning in fresh water is characterized by the fact that the liquid entering the lungs is hypotonic, that is, it contains less dissolved substances than human blood plasma. As a result, it destroys the surfactant ( substance that protects the alveoli from damage) and penetrates into the pulmonary capillaries ( small blood vessels that normally receive oxygen from the alveoli). The entry of water into the systemic circulation leads to dilution of the victim's blood, as a result of which it becomes too thin. It also destroys red blood cells ( transport oxygen throughout the body) and electrolyte imbalance ( sodium, potassium and others) in the body, which leads to dysfunction of vital organs ( heart, lungs) and death of the patient.

If true drowning occurs in the sea or in the ocean, it enters the lungs salty water, which is hypertonic with respect to plasma ( that is, it contains more dissolved salt particles). Such water also destroys the surfactant, but it does not enter the systemic circulation, but, on the contrary, draws fluid from the blood into the pulmonary alveoli. It is also accompanied by pulmonary edema and death of the victim.

In both cases, circulatory disorders that develop during drowning lead to stagnation of venous blood in the periphery ( in tissues, including skin vessels). Venous blood has a bluish tint, as a result of which the skin of a person who died from true drowning will also have the appropriate color. That's why drowning is called "blue".

asphyxia ( dry, false) drowning ( death on the water)

Syncope ( reflex, pale) drowning

Signs and clinical symptoms of drowning ( discoloration of the skin, foam at the mouth)

The fact that a person is drowning may indicate:

• Call for help. It may be present only during the first 10 - 30 seconds after the onset of true drowning. With asphyxial drowning, the victim will not be able to call for help, since his glottis will be blocked. In this case, he can only swing his arms for a few seconds. With syncopal drowning, the victim almost immediately loses consciousness and goes to the bottom.

• Chaotic waving of hands in water. As mentioned earlier, as soon as a person realizes that he can drown, he will direct all his strength to stay on the surface of the water. During the first 30 to 60 seconds, this can be manifested by chaotic swinging of the arms and legs. The victim, as it were, will try to swim, but at the same time he will remain in the same place. This will only aggravate the situation of the drowning man, quickly leading to his exhaustion.
• Special position of the head. As the strength is exhausted, the person begins to throw his head back, trying to lie on his back and raise his head higher. In this case, only the face of the victim can rise above the water, while the rest of the head and torso will be hidden under water.
• Periodic diving. When a person's strength is exhausted, he stops calling for help and can no longer stay on the surface of the water. Sometimes he dives headlong into the water ( for a few seconds), however, having gathered the last strength, it again floats to the surface, after which it again goes under water. Such a period of periodic diving can last for 1-2 minutes, after which the body's reserves are completely depleted and the victim finally drowns.

Clinically, drowning can manifest itself:

• Strong cough. It is observed if the victim was removed from the water in the initial period of true drowning. Cough in this case is due to irritation of the nerve receptors of the respiratory tract by water that has entered them.
• Vomiting with excretion of swallowed water. When drowning, the victim not only draws water into the lungs, but also swallows it, which can cause vomiting.
• Excitation or retardation. If the victim is removed from the water within the first few seconds after the onset of drowning, he will be extremely agitated, mobile or even aggressive, which is associated with the activation of his central nervous system (CNS) under stress. With a later extraction of the victim, he will have CNS depression ( due to lack of oxygen), as a result of which he will be lethargic, lethargic, drowsy or even unconscious.
• Lack of breath. It is a sign of severe damage to the central nervous system and requires the start of immediate resuscitation.
• Absence of heartbeat pulse). The victim's pulse should be measured on the carotid artery. To do this, you need to attach 2 fingers to the Adam's apple ( in women - to the central part of the neck), then move them 2 centimeters to the side ( sideways). The sensation of pulsation will indicate that the victim has a pulse ( i.e. his heart is beating). If the pulse is not felt, you can put your ear to the left side of the victim's chest and try to hear the heartbeat.
• Change in skin color. As mentioned earlier, in true drowning, a person's skin will become bluish, while in syncope it will be pale.
• Convulsions. May develop in the background pronounced violation internal environment body, electrolyte imbalance and so on.
• The appearance of foam from the mouth. The appearance of foam from the patient's respiratory tract is due to damage to the lung tissue. In true drowning in fresh water, the foam will be gray in color with an admixture of blood, which is due to the destruction of the pulmonary blood vessels and the ingress of blood into the alveoli. At the same time, when drowning in salty sea water, the foam will be white, since only the liquid part of the blood will flow from the vascular bed to the alveoli, while red cells ( erythrocytes) will remain in the vessels. It should be noted that in the asphyxic form of drowning, foam will also form in the lungs, however, it will enter the respiratory tract only after the laryngospasm stops ( that is, when a person has already drowned or will be saved).
• Muscle tremor. Being in water, a person loses a large amount of heat, as a result of which his body becomes supercooled. If, after removing a drowning person from the water, he remains conscious, he has a pronounced muscle tremor- a reflex reaction aimed at producing heat and warming the body.

Periods of true drowning

In true drowning, there are:

• Initial period. During this period of drowning, water only begins to flow into the victim's lungs. At the same time, protective reflexes are activated, as a result of which a person begins to intensively row water with his hands ( while losing strength), cough hard ( most often this leads to even more water entering the lungs). Reflex vomiting may also develop.
• Agonal period. At this stage, the compensatory reserves of the body are depleted, as a result of which the person loses consciousness. Breathing is very weak or non-existent due to filling the lungs with fluid and damage to the central nervous system), while circulation can be partially preserved. Also, at the same time, a pronounced pulmonary edema develops, which is accompanied by the release of foam from the mouth, cyanosis of the skin, and so on.
• period of clinical death. At this stage, there is complete exhaustion compensatory capabilities of the body, which leads to cardiac arrest, that is, clinical death occurs ( characterized by cessation of heartbeat and breathing, absence of blood pressure and other signs of life).

Rendering first aid to the victim on the water ( first steps in drowning)

Rules of conduct on the water in case of emergency

• Try to calm down. Of course, in a critical situation, this is extremely difficult to do, but it is important to remember that panic will only aggravate the situation, leading to an early exhaustion of forces.
• Call for help. If there are people nearby, you need to as soon as possible ( within the first seconds) try to call them for help. In the future, when water begins to enter the lungs and a person begins to drown, he will no longer be able to do this.
• Save strength. You should not randomly flounder in the water. Instead, you need to choose a specific direction ( to the nearest ship or shore) and slowly, calmly begin to swim in his direction, not forgetting to help yourself with your feet. This is an extremely important point, because if you row only with your hands, the swimming speed will be relatively small, while the forces will run out much faster. If you swim far to land, a person is periodically advised to lie on his back. In this position, much less effort is spent on staying on the water, as a result of which the muscles of the arms and legs rest.
• Swim with your back to the waves if possible). If the waves hit a person in the face, the likelihood of water entering the respiratory tract increases.
• Calmly breathe. With too frequent and uneven breathing, a person can choke, as a result of which he will drown faster. Instead, it is recommended to breathe calmly, regularly inhaling and exhaling air.
• Try to grab hold of floating objects. It can be boards, branches, shipwrecks ( in a shipwreck) and so on. Even a small floating object will help keep a person on the surface of the water, which will significantly save his strength.

Removing the victim from the water

When extracting a drowning person from the water, you should:

• Call for help. If you find a drowning person, you should attract the attention of others, and only after that rush into the water to save him. At the same time, people remaining on the shore can cause ambulance or assist in rescue operations.
• Ensure your own safety. Before you start saving a drowning person, you need to be sure that there is no direct threat to the life of the rescuer. Many people drowned only because they rushed to save drowning people in whirlpools, rivers with a strong current, and so on.
• Reach out to the drowning hand. If a person drowns near a pier or shore, one should extend a hand, a branch, a stick, or some other object to which he can grab onto. It is important to remember that when extending a hand to a drowning person, the other hand should definitely hold on to something. Otherwise, a drowning person can drag the lifeguard into the water. If there is a lifebuoy or other floating object nearby ( board, styrofoam, even a plastic bottle), you can throw them into the water so that drowning people grab onto them.
• Before saving a drowning person, take off your clothes and shoes. If you jump into the water in your clothes, it will immediately get wet, as a result of which it will pull the rescuer to the bottom.
• Swim up to the drowning man from behind. If you swim up to a drowning person from the front, he, being in a panic, will begin to grab his hands on the head of the rescuer, using it as a support. Trying to stay on the surface of the water himself, he can drown the rescuer, as a result of which both will die. That is why you should swim up to a drowning person only from behind. Swim, with one hand ( let's say right) should grab the victim by the right shoulder, and the second ( left) raise his head, holding it above the surface of the water. In this case, the elbow of the left hand should be pressed left shoulder the victim, preventing him from turning over to face the rescuer. Holding the victim in this position, you should begin to swim to the shore. If the victim is unconscious, it is necessary to transport him to the shore in the same position, keeping his head above the surface of the water.
• Correctly raise a drowning person from the bottom. If the victim lies on the bottom of the reservoir in an unconscious state face down, swim up to him from behind ( from the side of the legs). Further, clasping his hands in axillary areas should be brought to the surface. If the victim is lying face up, you need to swim up to him from the side of the head. After that, you should raise the head and torso of the drowning person, wrap your arms around him from behind and raise him to the surface. If you swim up to a drowning person incorrectly, he can suddenly wrap his arms around the rescuer, thereby drowning him too.

Providing first aid and the basics of cardiopulmonary resuscitation in case of drowning

First aid for a drowning person includes:

• Assessment of the victim's condition. If the patient is unconscious and not breathing, resuscitation should begin immediately. You should not waste time trying to bring the patient to his senses, "extracting water from the lungs" and so on, as this will lose precious seconds that can cost a person life.
• Artificial respiration. If, after bringing the victim to the shore, his breathing is not determined, you should immediately lay him on his back, lowering his arms at his sides and slightly tilting his head back. Next, you should slightly open the victim's mouth and breathe air into it twice. In this case, the nose of the victim should be pinched with your fingers. A correctly performed procedure will be indicated by the lifting of the anterior surface of the chest, due to the expansion of the lungs by the air entering them.
• Indirect cardiac massage. The purpose of this procedure is to maintain blood flow in the vital organs ( that is, in the brain and in the heart), as well as removing water from the lungs of the victim. You need to start performing indirect heart massage immediately after 2 breaths. To do this, you should kneel down on the side of the victim, fold your hands into the castle and rest them on the front surface of his chest ( between the nipples). Then follows sharply and rhythmically ( with a frequency of about 80 times per minute) press on the chest of the victim. This procedure contributes to the partial restoration of the pumping function of the heart, as a result of which the blood begins to circulate through the blood vessels, delivering oxygen to the tissues of vital organs ( brain, heart muscle and so on). After performing 30 rhythmic chest compressions, you should again take 2 breaths into the victim's mouth, and then proceed to heart massage again.

After restoring breathing, the victim should be laid on his side, tilting his head face down and slightly lowering it ( this will prevent the vomit from entering the respiratory tract in case of repeated vomiting). This can not be done only if, before drowning, the victim jumped into the water from a height. In doing so, he could be damaged. cervical vertebrae as a result of which any movement can contribute to damage to the spinal cord.

When the victim's breathing is restored and consciousness is more or less clear, wet clothes should be removed from him as soon as possible ( if any) and cover with a warm blanket or towels, which will prevent hypothermia of the body. Next, you should wait for the arrival of the ambulance doctors.

First aid for a child with drowning ( briefly point by point)

When providing first aid to a child after drowning, you should:

• Assess the child's condition presence or absence of consciousness, breathing, pulse).
• With preserved breathing and consciousness, the child should be laid on its side, slightly tilting its head down.
• In the absence of consciousness and breathing, resuscitation should begin immediately.
• After breathing is restored, wet clothes should be removed from the child, wiped dry and wrapped in warm blankets, towels, and so on.

When performing indirect heart massage, it should be borne in mind that in children, the heart rate is normally higher than in adults. Therefore, rhythmic chest compressions should also be performed at an increased frequency ( about 100 - 120 times per minute). When performing chest compressions, young children do not need to fold their hands into the castle and rest them on the baby's chest, as too much pressure can lead to fractures of the ribs. Instead, pressure should be applied to the chest with one palm or several fingers of the hand ( if the child is very small).

Providing first aid ( PMP) when drowning

First aid for drowning includes:

• Patient examination. Ambulance doctors also examine the patient, assessing the presence or absence of consciousness, breathing, heartbeat. They also determine blood pressure and other parameters of the functioning of the cardiovascular system, which makes it possible to judge the severity of the victim's condition.
• Removal of water from the respiratory tract. For this purpose, the doctor can use the so-called aspirator, consisting of a vacuum suction and a tube. The tube is passed into the patient's airway, after which the pump is turned on, which helps to remove fluid or other small foreign particles. It should be noted that the presence of an aspirator does not exclude the need to perform the previously described measures to remove fluid from the lungs ( i.e. heart massage).
• Indirect cardiac massage. It is carried out according to the rules described earlier.
• Artificial lung ventilation. To do this, doctors can use special masks to which an elastic bag is attached ( balloon). The mask is designed in such a way that when applied to the face of the victim, it tightly and hermetically wraps around his mouth and nose. Next, the doctor begins to rhythmically squeeze the bag, as a result of which air is forced into the lungs of the victim. If the patient cannot be ventilated with a mask, the clinician may perform intubation. To do this, he, using a special metal device ( laryngoscope) introduces a tube into the patient's trachea, through which the lungs are subsequently ventilated. This technique also allows you to protect the airways from accidental ingestion of vomit.
• Use of a defibrillator. If the victim's heart has stopped and cannot be "started" with ventilation and chest compressions, the doctor may use a defibrillator. it special device, which directs an electrical discharge of a certain force into the patient's body. In some cases, this allows you to restart the activity of the heart muscle and, thereby, save the patient.
• Administration of oxygen. If the patient is conscious and breathing on his own, he is given a special mask through which an increased concentration of oxygen is supplied to his respiratory tract. This prevents the development of hypoxia ( oxygen deficiency) at the level of the brain. If the patient is unconscious and needs resuscitation, the doctor can also use gas with a high oxygen content to artificially ventilate the lungs.

Intensive care for drowning

Intensive care for drowning victims includes:

• A complete examination. Performed x-ray studies head and neck ( to rule out injury), ultrasound procedure (ultrasound) organs abdominal cavity, lung x-ray, laboratory tests and so on. All this allows you to get more accurate data about the state of the body of the victim and plan treatment tactics.
• Maintain respiratory function. If the victim does not breathe on his own, he is connected to a special apparatus that ventilates his lungs for the required time, ensuring the delivery of oxygen to them and removal carbon dioxide of them.
• Medical therapy. Special medicines can be used to maintain blood pressure, to normalize heart rhythm, to fight lung infection, to feed an unconscious patient ( in this case, nutrients can be administered intravenously) and so on.
• Surgery. If during the examination it turns out that the patient needs surgery ( for example, in case of fractures of the bones of the skull as a result of hitting pitfalls, the bottom of the pool, and so on), it will be carried out after stabilization of the general condition.

Consequences and complications after drowning

Drowning can be complicated by:

• pneumonia ( pneumonia). The ingress of water into the lungs leads to the destruction of lung tissue and the development of pneumonia. Moreover, pneumonia can be caused pathogenic microorganisms that may be present in the water. This is why it is recommended that all patients receive a course of antibiotics after drowning.

• Cardiovascular insufficiency. This pathology characterized by the inability of the heart to pump blood around the body. The reason for the development of such a complication may be damage to the heart muscle against the background of hypoxia ( oxygen starvation ).
• sinusitis. Sinusitis is an inflammation of the paranasal sinuses associated with the ingress of large amounts of water into them. Manifested by nasal congestion, arching pains, mucopurulent discharge from the nose.
• Gastritis. gastritis ( inflammation of the stomach lining) can be caused by large amounts of salty sea water entering the stomach during drowning. Manifested by abdominal pain, periodic vomiting.
• neurological disorders. With prolonged hypoxia, the death of part of the nerve cells of the brain can occur. Even if the patient survives, he may then develop personality disorders, speech disorders, memory impairment, hearing impairment, visual impairment, and so on.
• Fear of water. This can also become a serious problem. Often people who have survived drowning are afraid to even get close to large bodies of water or pools ( just the thought of it can cause them severe panic attacks). The treatment of such disorders is carried out by a psychologist, psychiatrist and psychotherapist and can take several years.

Pulmonary edema

In the first minutes of the development of edema, a person can be very excited and restless, but in the future ( as oxygen starvation develops) his consciousness is oppressed. In a severe form of edema and without urgent assistance, damage to the central nervous system is noted, dysfunction of the heart muscle and the person dies.

What is the duration of clinical death when drowning in cold water?

It should be noted that when drowning in cold water, the duration of clinical death can be increased. This is due to the fact that when supercooling slows down all biological processes in the cells of the human body. At the same time, brain cells use oxygen and energy more slowly ( glucose), as a result of which they can remain in a viable state for a longer time. That is why, when removing the victim from the water, resuscitation should begin ( artificial respiration and chest compressions) immediately, even if the person has been underwater for 5 to 10 minutes or more.

Secondary ( delayed, deferred) drowning

For a certain group of people that is, in children, as well as in people with mental disorders), this reflex may be weakened. If such a person chokes on water ( that is, if water will get in to his lungs), he may not cough at all or cough very weakly and for a short period of time. Part of the water will remain in the lung tissue and continue to adversely affect the patient's condition. This will be manifested by a violation of the process of gas exchange in the lungs, as a result of which the patient will begin to develop hypoxia ( lack of oxygen in the body). With cerebral hypoxia, the patient may be lethargic, lethargic, drowsy, may want to sleep a lot, and so on. At the same time, the development of the pathological process in the lung tissue will continue, which over time will lead to its defeat and the development of a formidable complication - pulmonary edema. If this condition is not recognized in time and start specific treatment, the patient will die within minutes or hours.

Coma

To date, the mechanisms of coma development have not been sufficiently studied, as well as the ways of removing patients from it. Treatment of patients in a coma is to maintain the functions of vital organs, prevent infections and pressure sores, and introduce nutrients through the stomach ( if it works) or directly intravenously and so on.

Drowning Prevention

Drowning prevention includes:

• Swimming only in permitted areas- on the beaches, in the pools and so on.
• Swimming safety rules- you should not swim in a strong storm, jump into a muddy ( not transparent) water from a pier or boat, swim too far from the shore, and so on.
• Diving with caution- It is not recommended to dive to great depths alone.
• Bathing only when sober- it is forbidden to swim in reservoirs even after a small dose of alcohol taken orally.
• Exception sudden changes temperatures- You should not jump into cold water after prolonged exposure to the sun, as this can disrupt the functioning of the cardiovascular system.
• Babysitting for swimming- if the child is in the water, an adult must constantly and continuously supervise him.

Forensic medical examination after drowning

The tasks of the forensic medical examination in this case are:

• Determine the true cause of death. A body removed from the water does not at all indicate that a person drowned. The victim could have been killed in a different place and by a different method, and the body thrown into a pond. Moreover, a person could be drowned in another place, and then his body was transported in order to hide the traces of the crime. Based on the study of samples of internal organs and water from the lungs, experts can determine where and for what reason a person died.

• Set the time of death. After the onset of death, characteristic changes begin to occur in various tissues of the body. By examining these changes, the expert can determine how long ago the death occurred, and how long the body was in the water.
• Set the type of drowning. If water is found in the lungs at autopsy, this indicates that the person drowned from the true ( wet) drowning, which will also be indicated by the cyanosis of the skin. If there is no water in the lungs, and the skin is pale in color, we are talking about syncope ( reflex) drowning.

Signs of intravital drowning

Lifetime drowning may indicate:

• The presence of water in the lungs. If you throw a lifeless body into the water, the water will not get into the lungs. At the same time, it is worth remembering that a similar phenomenon can also be observed with reflex or asphyxia ( dry) drowning, however, in this case, the skin will have a pronounced pale color.
• The presence of water in the stomach. During the process of drowning, a person can swallow up to 500 - 600 ml of liquid. The penetration of such an amount of water into the stomach when dropping an already lifeless body into a reservoir is impossible.
• The presence of plankton in the blood. Plankton are special microorganisms that live in water bodies ( rivers, lakes). When drowning, the destruction of the blood vessels of the lungs is noted, as a result of which plankton, together with water, enters the bloodstream and spreads throughout the body with the blood stream. If a lifeless body was dumped into a reservoir, there will be no plankton in the blood and in the tissues of the body. It is also worth noting that almost every individual reservoir has its own characteristic plankton, which differs from the plankton of other lakes and rivers. Therefore, by comparing the composition of the plankton from the lungs of a corpse with the plankton in the reservoir in which the body was found, it can be established whether the person really drowned here or his body was transferred from another place.

When does a body float after drowning?

The time of ascent of the body after drowning is determined by:

• Water temperature. The colder the water, the slower the putrefactive processes will proceed, and the longer the body will remain under water. At the same time, with relatively high temperature water ( about 22 degrees) the body will float within 24 to 48 hours.

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How to rescue a drowning person? How effective are pre-hospital resuscitation actions? What should be done after providing first aid before the arrival of doctors? You will read about this and much more in our article.

Almost always, the correct provision of first aid to a drowning person saves the life of the victim, since a professional medical team will not have time to arrive at the scene on time, even if it was called immediately after the formation of such a situation.

How to pull the victim to the shore?

It should be noted that important element The potential salvation of a drowning person, if he has not yet had time to submerge under water for a long period of time, is his correct pulling out, which provides not only the possibility of resuscitation of the victim, but also the safety of the helper.

The basic scheme for rescuing a drowning person:

First aid for a drowning person

After the victim was brought ashore, it is necessary to proceed with the necessary resuscitation actions.

Algorithm of first aid for drowning (briefly by points):

• from liquid or foreign matter. The victim's mouth opens, dentures, vomit, mud, and liquid are removed from it. When drowning directly in the water, the rescuer lays the person on his stomach on his knee, face down, to allow the liquid to flow freely. Two fingers are placed in the victim's mouth and pressure is applied to the root of the tongue to induce vomiting, which helps to free the airways and stomach from water that has not had time to be absorbed;
• Active pre-resuscitation actions. As part of the implementation of first aid, it is necessary to continue inducing vomiting in the victim in the initial position from 1 point until a cough appears. If the effect this process does not give, then in the vast majority of cases there is no free fluid in the respiratory tract and stomach, since it has managed to be absorbed;
• immediate resuscitation. The victim is turned over on his back and placed in a horizontal position, after which the rescuer proceeds to massage the heart and artificial respiration.

How to provide first aid for drowning, see the video:

With true (wet) drowning

How to provide first aid to a drowning person? As part of the provision of first aid when rescuing a drowning person, when the incident occurred directly within the reservoir and a large amount of water got into the human body, the above-described measures are taken.

Their average duration takes from 2 to 3 minutes for the primary two stages. At the same time, artificial respiration and indirect heart massage are effective for an average of 6-8 minutes. After 10 minutes and the absence of any signs of heartbeat and breathing, with a high degree of probability it is impossible to save a person.

An important factor with true drowning, the circumstances of the incident also act. So in salt water, a person's chances of surviving in the absence of breathing and heartbeat are higher, since irreversible processes occur later than in the case of flooding with fresh water - it is possible to restore vital processes within 10-15 minutes.

In addition, the temperature of the water also makes a certain contribution. When drowning in a cold or icy liquid, irreversible destruction processes slow down significantly. In some cases, resuscitation practice recorded situations when a person was brought back to life by performing an indirect heart massage and artificial respiration 20, and sometimes 30 minutes after drowning.

With asphyxial (dry) drowning

Asphyxic or dry drowning is a pathological circumstance that is formed as a result of spasm of the glottis and suffocation, when water does not penetrate into the respiratory tract.

In general, this type of incident is considered more favorable in the context of the potential for human resuscitation.

What to do with dry drowning? First aid for dry drowning generally coincides with first aid, as for classical drowning, however, the second stage (attempts to induce vomiting and free the airways with the stomach from the accumulated fluid) is skipped and direct resuscitation actions are immediately applied to the victim.

Resuscitation actions

As part of the resuscitation actions to provide emergency assistance for manual drowning, two main procedures are performed - chest compressions and artificial respiration. The basic rules for helping a drowning person are presented below.

Artificial respiration

The victim is laid on his back, the airway opens as wide as possible, any foreign objects that make it difficult to breathe. If there is an air duct of a medical design, it must be used as part of the first aid for a drowning person.

The lifeguard takes a deep breath and exhales air into the victim's mouth, covering the wings of his nose with his fingers and supporting his chin, pressing his lips tightly to the victim's mouth. As part of forced ventilation, a person's chest should rise.

The average blowing time is about 2 seconds, followed by a 4 second pause for a slow reflex lowering of the drowned chest. Artificial respiration during drowning is repeated regularly until stable signs of breathing appear or the ambulance arrives.

Indirect cardiac massage

Measures to start cardiac activity can be combined with the implementation of artificial respiration as part of their alternate shift. To begin with, you must first strike with a fist in the area of ​​\u200b\u200bthe projection of the heart- it should be of medium strength, but sharp and fast enough. In some cases, this helps to instantly start the functioning of the heart.

If there is no effect, you need to count two fingers down from the sternum to the center of the chest, straighten your arms, putting one palm on the other, orient yourself to the connection of the lower ribs with the sternum, and then apply pressure strictly perpendicular to the heart with both hands. The heart itself is compressed between the sternum and the spine. The main efforts are carried out with the whole torso, and not just with the hands.

The average depth of indentation should not exceed 5 cm, while the approximate frequency of pressure is about 100 manipulations per minute, in cycles of 30 times with a combination of ventilation of the lungs.

The general cycle, therefore, is as follows: 2 seconds of inhalation of air into the victim, 4 seconds for his spontaneous exit, 30 massage manipulations in the region of the heart and a repetition of the cyclic double procedure.

First aid for children

It is worth noting that the chances of resuscitating a child during drowning are significantly less than an adult, since irreversible processes leading to death develop much faster in him.

On average, there are about 5 minutes to try and rescue a drowned toddler.

Algorithm of actions for providing first aid for drowning a child:

• Pulling the victim to the shore. It is carried out as quickly as possible, while observing the general precautions described earlier;
• Release of the upper airways from foreign substances. You should open the child's mouth, try to free him from any kind of foreign matter, including water, then put a knee and put the baby on his stomach, simultaneously causing the latter to have a gag reflex by pressing on the root of the tongue. The event is repeated until the child has an active cough, and water, along with vomit, stops actively flowing out;
• resuscitation activities. In the absence of the effect of the procedure from the previous paragraph, or if there are signs of a “dry” type of drowning, the child is turned over on his back, placed in a horizontal position, and he is given an indirect heart massage, as well as artificial respiration.

Further rescue actions

If the victim managed to start the breathing of the heartbeat, then he is laid on his side, while continuing to remain in horizontal position. A person is covered with a blanket or towel for warming, while his condition is constantly monitored and in the event of a repeated stoppage of breathing or heartbeat, manual resuscitation is resumed.

It should be understood that, regardless of the circumstances, even if a person is in a satisfactory condition, it is necessary to wait for the arrival of an ambulance team that will provide first aid in case of drowning. Specialized specialists will evaluate qualified potential risks for the victim and decide on the need or lack thereof in hospitalization.

In some cases, the ingress of a significant amount of water into the lungs, secondary cerebral edema and other symptoms appear after a certain period of time, there are no medium-term health effects only when more than 5 days have occurred after drowning, while no pathological symptoms have appeared in a person.

Types of drowning

AT general case modern medicine distinguishes three types of drowning:

• True drowning. The main sign of such an incident is the ingress of a large amount of water into the lungs and stomach, against which there is swelling of the corresponding tissues and irreversible destruction of their structure. Occurs in every one of the 5 reported cases;
• Asphyxial drowning. It can also occur on water, but the liquid itself does not penetrate into the lungs of the stomach, because before this process a pronounced spasm of the vocal cords is formed with a complete stop of respiratory activity. All basic pathological processes associated with direct suffocation and shock. Occurs in 40 percent of cases;
• Syncopal drowning. It is characterized by a reflex cardiac arrest, in the vast majority it causes an almost instantaneous death. Occurs in 10 percent of cases;
• Mixed drowning. It has signs of both classic "wet" and asphyxic drowning. Diagnosed in an average of 15 percent of the victims.

The difference between sea and fresh water

Classical medicine distinguishes between drowning in fresh and sea water according to a number of characteristic features:

• Fresh water. There is a stretching of the alveoli and the penetration of the corresponding fluid into the bloodstream by direct diffusion through the violation of the integrity of the alveolar-capillary membrane. Hypotonic hyperhydration develops sharply, the functioning of the blood flow is disrupted.

  Due to the absorption of hypotonic waters into the vascular bed, pulmonary edema, hypervolemia, hyperosmolarity, blood thinning with an increase in its volume are formed.

  Ventricular fibrillation occurs, unable to cope with large quantity"diluted" biological fluid. In general, irreversible damage occurs quickly;

• Salty water. The fluid enters the alveoli, which leads to hypertensive dehydration, an increase in the amount of sodium, potassium, magnesium and calcium, as well as chlorine in the blood plasma. In fact, it is not liquefaction that occurs, but, on the contrary, blood thickening, while irreversible damage to the body occurs more slowly compared to fresh water (up to 25 percent).

The processes described above are often separated into separate categories of descriptive characteristics of the medical literature of the 20th century.

Current large-scale studies show that the pathogenesis of drowning in fresh and salt water does not differ significantly in the context of clinical hazard.

Accordingly, the difference in potential resuscitation is actually negligible and amounts to only a few minutes. As real practice shows, the chances of restoring brain function and vital signs are significantly increased in cases of drowning at very low temperatures, especially in children with low body weight.

Individual doctors recorded cases of complete resumption of life 30 minutes after drowning, while all the time the victim had no breathing and heartbeat.

Drowning– terminal state or death due to aspiration (penetration) of fluid into the respiratory tract, reflex cardiac arrest in cold water, or spasm of the glottis, resulting in a decrease or cessation of gas exchange in the lungs.

Drowning- a type of mechanical asphyxia (suffocation) as a result of water entering the respiratory tract.

There are the following types of drowning:

True ("wet", or primary)

Asphyctic ("dry")

Syncope

Secondary drowning ("death on the water")

True drowning

A condition accompanied by the penetration of fluid into the lungs, which occurs in approximately 75 - 95% of deaths on the water. characteristic long fight for a life.

Examples of true drowning are fresh water and sea water drowning.

Drowning in fresh water.

Upon penetration into the lungs, fresh water is quickly absorbed into the blood, since the concentration of salts in fresh water is much lower than in the blood. This leads to blood thinning, an increase in its volume and the destruction of red blood cells. Sometimes pulmonary edema develops. A large amount of stable pink foam is formed, which further disrupts gas exchange. The function of blood circulation stops as a result of a violation of the contractility of the ventricles of the heart.

Drowning in sea water.

Due to the fact that the concentration of dissolved substances in sea water is higher than in the blood, when sea water enters the lungs, the liquid part of the blood, together with proteins, penetrates from the blood vessels into the alveoli. This leads to thickening of the blood, an increase in the concentration of potassium, sodium, calcium, magnesium and chlorine ions in it. A large amount of fluid is heated in the alveoli, which leads to their stretching up to rupture. As a rule, pulmonary edema develops when drowning in sea water. That small amount of air that is in the alveoli contributes to the whipping of the liquid during respiratory movements with the formation of a stable protein foam. Gas exchange is sharply disturbed, cardiac arrest occurs.

With true drowning, there are three clinical periods:

Initial period.

The victim is conscious and still able to hold his breath during repeated dives under water. Rescued people react inadequately to the situation (some may be depressed, others may be overly active and agitated). Skin and visible mucous cyanosis. Breathing is frequent, noisy, and may be interrupted by bouts of coughing. Primary tachycardia and arterial hypertension soon give way to bradycardia and a subsequent decrease in blood pressure. The upper abdomen is usually swollen due to the large amount of water entering the stomach. Vomiting of swallowed water and gastric contents may occur. Acute clinical manifestations drownings quickly pass, orientation is restored, but weakness, headache and cough persist for several days.

Agonal period.

The victim is unconscious. Pulse and respiratory movements are saved. Heart contractions are weak, deaf. The pulse can be determined exclusively on the carotid and femoral arteries. The skin is bluish, cold to the touch. Pink frothy liquid comes out of the mouth and nose.

period of clinical death.

The appearance of the victim during this period of true drowning is the same as in agonal. The only difference is the absence of a pulse and respiratory movements. On examination, the pupils were dilated and did not respond to light. In this period, resuscitation is rarely successful.

Asphyxic drowning

Occurs due to liquid irritation of the upper respiratory tract (without aspiration of water into the lungs, as a result of laryngospasm) and is observed in 5-20% of all drowned people. In most cases, asphyxic drowning is preceded by preliminary depression of the central nervous system, a state of alcoholic intoxication, and a blow to the surface of the water. Usually, initial period cannot be diagnosed. In agony, a rare labile pulse is observed on the main arteries. Breathing may look like "false respiratory" (with clean airways). Over time, respiratory and circulatory depression occurs and the transition to a period of clinical death, which lasts longer (4-6 minutes) with asphyxic drowning. During resuscitation, as a rule, it is difficult to overcome trismus of masticatory muscles and laryngospasm.

Syncope drowning

It is characterized by a primary reflex arrest of the heart and breathing, caused by the ingress of even a small amount of water into the upper respiratory tract. With this type of drowning, the onset of clinical death is a priority. There is no pulse and respiration, the pupils are dilated (they do not react to light). The skin is pale. Similar mechanism development has the so-called "ice shock", or immersion syndrome, which develops as a result of reflex cardiac arrest during a sharp immersion in cold water.

Secondary drowning ("death on the water")

Occurs as a result of primary circulatory and respiratory arrest (myocardial infarction, epilepsy attack, etc.). A feature of this type of drowning is that water enters the respiratory tract again and without hindrance (when a person is already in the period of clinical death).

The changes that occur in the body during drowning, in particular, the timing of dying under water, depend on a number of factors: on the nature of the water (fresh, salty, chlorinated fresh water in pools), on its temperature (ice, cold, warm), on the presence of impurities (silt, mud, etc.), from the state of the body of the victim at the time of drowning (overwork, agitation, alcohol intoxication, etc.).

When carrying out resuscitation, the time factor is extremely important. The earlier the revival is started, the greater the chance of success. Based on this, it is advisable to start artificial respiration already on the water. To do this, carry out periodic blowing of air into the mouth or nose of the victim during his transportation to the shore or to the boat. On the shore, the victim is examined. If the victim did not lose consciousness or is in a state of slight fainting, then in order to eliminate the consequences of drowning, it is enough to smell ammonia and warm the victim.

If the circulatory function is preserved (pulsation in the carotid arteries), there is no breathing, the oral cavity is freed from foreign bodies. To do this, it is cleaned with a finger wrapped in a bandage, removable dentures are removed. Often, the victim's mouth cannot be opened due to a spasm of the masticatory muscles. In these cases, carry out artificial respiration "mouth to nose"; if this method is ineffective, a mouth expander is used, and if it is not available, then some flat metal object is used (do not break your teeth!). As for the release of the upper respiratory tract from water and foam, it is best to use suction for these purposes. If it is not there, the victim is laid with his stomach down on the rescuer's thigh, bent at the knee joint. Then sharply, vigorously compress his chest. These manipulations are necessary in those cases of resuscitation when it is impossible to carry out artificial ventilation of the lungs due to the blocking of the airways by water or foam. This procedure must be carried out quickly and vigorously. If there is no effect within a few seconds, it is necessary to start artificial ventilation of the lungs. If the skin is pale, then it is necessary to proceed directly to artificial ventilation of the lungs after cleansing the oral cavity.

The victim is laid on his back, freed from restrictive clothing, his head is thrown back, placing one hand under the neck, and the other is placed on the forehead. Then the lower jaw of the victim is pushed forward and up so that the lower incisors are ahead of the upper ones. These techniques are performed in order to restore the patency of the upper respiratory tract. After that, the rescuer takes a deep breath, holds his breath a little and, pressing his lips tightly against the mouth (or nose) of the victim, exhales. In this case, it is recommended to pinch the nose (when breathing mouth to mouth) or mouth (when breathing mouth to nose) of the person being revived. Exhalation is carried out passively, while the airways must be open.

If, during artificial ventilation of the lungs, water is released from the respiratory tract of the victim, which makes it difficult to ventilate the lungs, you need to turn your head to the side and raise the opposite shoulder; in this case, the mouth of the drowned person will be lower than the chest and the liquid will pour out. After that, you can continue artificial ventilation of the lungs. In no case should artificial ventilation of the lungs be stopped when independent respiratory movements appear in the victim, if his consciousness has not yet recovered or if the rhythm of breathing is disturbed or sharply accelerated, which indicates an incomplete restoration of respiratory function.

In the event that there is no effective blood circulation (there is no pulse in large arteries, heart beats are not heard, blood pressure is not determined, the skin is pale or cyanotic), an indirect heart massage is performed simultaneously with artificial ventilation of the lungs. The person assisting stands on the side of the victim so that his hands are perpendicular to the surface of the chest of the drowned person. The resuscitator places one hand perpendicular to the sternum in its lower third, and puts the other on top of the first hand, parallel to the plane of the sternum. The essence of an indirect heart massage is a sharp compression between the sternum and the spine; at the same time, blood from the ventricles of the heart enters the systemic and pulmonary circulation. Massage should be performed in the form of sharp jerks: do not strain the muscles of the hands, but should, as it were, "dump" the weight of your body down - it leads to the deflection of the sternum by 3-4 cm and corresponds to the contraction of the heart. In the intervals between pushes, the hands cannot be torn off the sternum, but there should be no pressure - this period corresponds to the relaxation of the heart. The movements of the resuscitator should be rhythmic with a frequency of shocks of about 100 per minute.

Massage is effective if the pulsation of the carotid arteries begins to be determined, the dilated pupils narrow to that extent, cyanosis decreases. When these first signs of life appear, indirect heart massage should be continued until the heartbeat begins to be heard.

If resuscitation is carried out by one person, then it is recommended to alternate chest compressions and artificial respiration as follows: for 4-5 pressures on the sternum, 1 air is blown. If there are two rescuers, then one is engaged in indirect heart massage, and the other is in artificial ventilation of the lungs. At the same time, 1 air blowing is alternated with 5 massage movements.

It should be borne in mind that the victim's stomach can be filled with water, food masses; this makes it difficult to carry out artificial ventilation of the lungs, chest compressions, provokes vomiting.

After removing the victim from the state of clinical death, he is warmed (wrapped in a blanket, covered with warm heating pads) and the upper and lower extremities are massaged from the periphery to the center.

When drowning, the time during which a person can be revived after being removed from the water is 3-6 minutes.

The temperature of the water plays an important role in the timing of the return to life of the victim. When drowning in ice water, when the body temperature drops, revival is possible even 30 minutes after the accident.

No matter how quickly the rescued person regains consciousness, no matter how prosperous his condition may seem, placing the victim in a hospital is an indispensable condition.

Transportation is carried out on a stretcher - the victim is laid on his stomach or on his side with his head down. With the development of pulmonary edema, the position of the body on the stretcher is horizontal with the head end raised. During transportation continue artificial ventilation of the lungs.

Brief algorithm of actions:

Make sure you're not in danger. Remove the victim from the water. (If you suspect a fracture of the spine, pull the victim out on a board or shield.)

Lay the victim on his knee with his stomach, let the water drain from the respiratory tract. Ensure patency of the upper airway. Clear the oral cavity of foreign objects (mucus, vomit, etc.).

Call (on your own or with the help of others) an ambulance.

Determine the presence of a pulse on the carotid arteries, the reaction of the pupils to light, spontaneous breathing.

If there is no pulse, breathing, and pupillary response to light, proceed immediately to cardiopulmonary resuscitation. Continue resuscitation until the arrival of medical personnel or until the restoration of spontaneous breathing and heartbeat

After restoring breathing and cardiac activity, give the victim a stable lateral position. Cover and keep him warm. Ensure constant monitoring of the condition!

Kavalenok P.P., Doctor of the Department of Anesthesiology and Intensive Care
ME "Mogilev Regional Children's Hospital"