The sequence of assistance with drowning. With true drowning. Internal signs of drowning

Summer is a long-awaited time for many, but it is in summer that situations occur, the danger of which is best case allows you to get off subsequently with fright, and at worst leads to death at all, drowning, in fact, is one of these situations. First aid for drowning, provided promptly and competently, can save a person's life, and this, as you can guess, is not an exaggeration.

A man is drowning: what happens to him?

At the moment when a person drowns, water enters through the upper respiratory tract, which, in turn, leads to the expulsion of air by it. Therefore, the first event during drowning is laryngospasm, that is, a spasm of the vocal folds, as a result of which the path to the trachea is closed while breathing stops. This type of flooding is defined as "dry flooding".

If the victim is in the water for too long and if a significant amount of liquid enters his respiratory tract, oxygen starvation. This, in turn, leads to the exclusion of the possibility of a vital action. important reflex, which acts as this case cessation of breathing, and therefore a drowning person simply “inhales” water, subsequently it ends up in his lungs. Absence of the first medical care drowning can cause the death of the victim before rescuers arrive at the scene.

The difference between sea and fresh water

Undoubtedly, it exists, no matter how you look at it. So, when more than one liter of water enters the human body, a number of its functions are disturbed, which is important regardless of the water options considered.

If fresh water enters the body, it appears in the blood. This, in turn, leads to a change in its composition, which is especially reflected in the amount of protein and salt. In turn, this leads to trembling of the ventricles of the heart, a kind of "gap" occurs.

At the meeting sea ​​water in the lungs, blood plasma enters the pulmonary alveoli with subsequent accumulation there. This subsequently leads to .

Regardless of what kind of water ended up in the human body, its presence in it with such manifestations has an extremely negative effect on the condition of the victim and is dangerous for his life.

With severe overheating in the sun, overeating, overwork, you should refrain from swimming for a while. The fact is that jumping into cold water can lead to the so-called reflex cardiac arrest, which can cause sudden death.

Resting by a pond is not always pleasant. Incorrect behavior in the water or emergencies may lead to drowning. Young children are especially susceptible to this risk, but even adults who can swim well can become victims of strong currents, cramps, whirlpools. The sooner the victim is removed from the water, and he will be given first aid for drowning (removal of fluid from the respiratory tract), the higher the chance to save a person's life.

What is drowning

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

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

• injuries from diving in shallow water, in unexplored places;
• alcohol intoxication;
• emergencies (convulsions, heart attack, diabetic or hypoglycemic coma, stroke);
• inability to swim;
• neglect of the child (when children drown);
• falling into whirlpools, storm.

Signs of drowning

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

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

Types of drowning

There are several types of drowning, each of which is characterized by its own characteristics. These include:

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

Rescue of a drowning man

Anyone can notice the victim, but it is important to provide first aid in a short time, because someone's life depends on it. Being on the shore, the first thing to do is to call the rescuer for help. The specialist knows exactly what to do. If he is not around, you can try to pull the person out yourself, but you need to remember the danger. The drowning man is in stressful condition, his coordination is impaired, so he can involuntarily cling to the rescuer, preventing him from grabbing himself. There is a high probability of drowning together (with improper behavior in the water).

First aid for drowning

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

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

The difference between sea and fresh water when drowning

An accident can occur in various water sources (sea, river, pool), but drowning in fresh water is different from immersion in a salty environment. What is the difference? Inhalation of sea fluid is not as dangerous and has a more favorable prognosis. High concentration salt prevents water from entering lung tissue. However, the blood thickens, putting pressure on the circulatory system. Within 8-10 minutes, a complete cardiac arrest occurs, but during this time it is possible to resuscitate a drowning person.

As for drowning in fresh water, the process is more complicated. When fluid enters the lung cells, they swell and some of the cells burst. Fresh water can be absorbed into the blood, making it more liquid. Capillaries rupture, which disrupts cardiac activity. There is ventricular fibrillation, cardiac arrest. This whole process takes a few minutes, so death in fresh water occurs much faster.

First aid on the water

A specially trained person should be involved in rescuing a drowning person. However, it is not always nearby, or several people can drown in the water. Any vacationer who knows how to swim well can provide first aid. To save someone's life, you should use the following algorithm:

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

First aid rules

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

1. After the person has been pulled out of the water and covered with a blanket, symptoms of hypothermia (hypothermia) should be checked.
2. summon ambulance.
3. Avoid deforming the spine or neck, do not cause injury.
4. Fix the cervical region by placing a folded towel.
5. If the victim is not breathing, start artificial respiration, heart massage

With true drowning

In about 70 percent of cases, water enters directly into the lungs, resulting in true or "wet" drowning. This can happen to a child, or to a person who cannot swim. First aid for drowning includes the following steps:

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

With asphyxia drowning

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

• perform cardiopulmonary resuscitation immediately;
• call an ambulance;
• when the victim came to his senses, warm him.

Artificial respiration and cardiac massage

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

1. It is necessary to part the lips of the victim, remove mucus, algae with a finger wrapped in a cloth. Allow liquid to drain from the mouth.
2. Grab your cheeks so that your mouth does not close, tilt your head back, raise your chin.
3. Pinch the nose of the rescued, inhale the air directly into his mouth. The process takes a fraction of a second. Number of repetitions: 12 times per minute.
4. Check the pulse in the neck.
5. After a while, the chest will rise (the lungs will begin to function).

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

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

Actions after first aid

Even if a person comes to his senses, this does not mean that he does not need medical care. You should stay with the victim, call an ambulance or seek medical help. It is worth knowing that when drowning in fresh water, death can occur even after a few hours (secondary drowning), so you should keep the situation under control. With a long stay without consciousness and oxygen, the following problems may occur:

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

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

• learn to swim;
• avoid swimming while intoxicated;
• do not go into too cold water;
• do not swim during a storm or at great depths;
• don't walk on thin ice.

Video

Drowning can occur during sea and river disasters, when an aircraft falls into the water, when natural disasters. But in Everyday life most often it happens when swimming in unfamiliar waters, jumping into water, skiing on thin ice or fishing on it. Unintentional drowning can occur even in a puddle, in shallow water, in a bathtub. In these cases, our help, as a rule, is especially needed.

Death from drowning due to lack of oxygen in the body usually occurs within 2-3 minutes, provided that the victim had a healthy heart. However, there are cases of instant cardiac arrest; this, as a rule, occurs under the influence of a sudden action of cold during a rapid jump into water or a small amount of water entering the upper respiratory tract, and the heart first of all reacts to these factors. When drowning, a large amount of water also plays a role, penetrating from the lungs into the blood and significantly disturbing the chemical balance of the body.

Low water temperature under certain conditions of the body (a tendency to anti-spasms, an allergy to cold, etc.) causes a spasm of the vessels of the skin and lungs, a prolonged contraction of the respiratory muscles, which leads to acute respiratory and cardiac disorders.

But there are also many accidents in sun-warmed water. Risk factors are high current speed, the presence of whirlpools, key sources that dramatically change the water temperature in a limited area, storms, the possibility of collision with floating facilities, etc. Significant reduction The risk of drowning, not only in normal, but also in extreme conditions, is promoted by the development of volitional qualities in a person and hardening of the body. But the main thing is to try not to lose your composure in the water.

Often people drown not only because of the loss of self-control, but also because of the onset of a fainting state, that is, loss of consciousness. Fainting state It can occur, for example, due to the fact that on a hot day a person overheated under the sun rapidly plunges into water, as a result of which either a spasm of the brain occurs, or an outflow of blood from the brain, or both. Fainting can also occur due to the overflow of the stomach with abundant and dense food when, during digestion, blood flows away from the central nervous system in gastrointestinal tract. The cause of fainting can also be fear during an accidental fall into the water.

There are two types of drowning: true and "dry" - caused by a sudden stop of breathing and heart.

When drowning, two phases of death are distinguished: clinical and biological. Drowned, even when quickly removed from the water, in appearance resembles a dead one. Nevertheless, it should be considered as ostensibly dead, in the phase clinical death and therefore immediate revitalization measures must be taken.

First aid for a drowned man

The nature of the provision of emergency care to the victim depends on the severity of his condition. If a person is conscious, he needs to be calmed down, removed from him wet clothes, wipe dry the skin, change clothes; if consciousness is absent, but the pulse and breathing are preserved, the victim must be allowed to breathe ammonia(in last resort cologne or other pungent-smelling liquid, up to gasoline). Then release from tight clothing, especially the neck and chest. To activate breathing, you can use the rhythmic twitching of the tongue.

Here's something else to keep in mind. Pulling a drowning man ashore, look at the color of his face. If it is white, and there is foam on the lips and nose, then his lungs are full of water. Of course, it must be removed as soon as possible. To do this, put your patient on a bent leg so that his head and torso are down, and your hip is pressing under him. lower ribs. After that, press on the back until all the water has flowed out. And then you can already do artificial respiration, and indirect massage hearts.

If the face is cyanotic, then it is necessary first of all to clean the oral cavity of mucus and other dirt that has got there with a handkerchief or a clean cloth wound around a finger. Sometimes a sharp short blow to the back is enough.

At the end of the procedure (and you should try to do it in 15-20 seconds), you can start resuscitation. Place a bundle of clothes or something like that under the victim's shoulder blades so that the head is thrown back as far as possible: this is the only way to open the airways. The tongue is best pulled out by hand. If the jaws are brought together, and the mouth cannot be reached, artificial respiration is done according to the mouth-to-nose method. Perform chest compressions at the same time. In the meantime, you are pumping out a drowned man, let someone call an ambulance. It makes sense to pump out 30-40 minutes.

When saving a drowning person, there is no time to waste, therefore, in some cases, it is possible not to pump out the water. After cleaning the mouth (preliminary measure), it is necessary to immediately begin to carry out artificial respiration. At the same time, every second is precious!

In any condition of the victim, measures are taken to warm the body by rubbing, massage the upper and lower extremities. All this is desirable to do together.

As soon as the victim resumed breathing, he should be given hot tea to drink, wrapped in a blanket and taken to a medical facility.

➨ In order to avoid accidents, you should follow the rules of behavior on the water: you can not leave children unattended, swim from boats, rafts, swim outside the designated swimming areas, swim before 1.5-2 hours after eating, in a state of intoxication and in state of physical and mental fatigue.

➨ It is dangerous to swim after a strong overheating in the sun, especially for elderly people with diseases of cardio-vascular system. It is extremely dangerous to jump into the water in an unfamiliar place, especially head down.

➨ It is recommended to swim in the evening or in the morning when the sun is not hot. Warming up in the sun before swimming, you are at great risk. At sharp drop temperatures, a reflex contraction of the muscles can occur with a complete cessation of breathing.

➨ Stay in the water is not recommended for more than 10-15 minutes. Do not think that if the air temperature approaches 35 ° C, then you can swim all the time: a long stay in the water causes hypothermia of the body and, as a result, convulsions, which can lead to irreparable trouble.

➨ Do not make stupid jokes while bathing. Favorite joke - to dive and pull the legs - a reliable way to send a person to the next world, because it is almost impossible to resist in such a situation, and respiratory reflex turns out to be depressed. The same applies to immersing the head in water and holding it there until blisters appear. Bubbles may be the last...

It is forbidden to swim or climb on the navigational signs of the navigable situation (buoys, buoys).

How long does a person stay alive if he loses the ability to breathe? Brain cells remain viable under hypoxic conditions for no more than 5-6 minutes. Although drowning in cold water this time may increase. In any case, assistance to the victim should be provided even before the arrival of the medical team. In this situation, the matter is decided by minutes. This is why knowing how to help is so important.

Not all people, however, are ready to answer the question, and even more so to show in practice how to act correctly in case of drowning. And this is very sad. For some reason, many believe that only employees of specialized services should have such skills, while an ordinary person, far from medicine, does not need to know this. But life sometimes puts people in difficult situations. It's very scary to see how it dies close person and not know how to help him.

What is drowning?

This is a life-threatening condition characterized by the inability to breathe as a result of a person falling into water or other liquid. Often, the airways fill with water, although this is not strictly necessary. death by respiratory failure may occur even if the lungs remain "dry". On this basis, by the way, they distinguish different types drowning.

Classification by mechanism leading to death

Types of drowning and their characteristics:

1. True drowning. It is called so because in this case water (or other liquid) enters the lungs. Pathological processes underlying true drowning differ depending on whether the drowning occurred in fresh water or salt water. In the first case, water quickly penetrates from the alveoli into the vascular bed, thinning the blood and destroying red blood cells. Salt water, on the contrary, promotes the release of plasma from the vessels, which is accompanied by thickening of the blood, as well as the development of pulmonary edema.
2. Asphyxial drowning. In this case, water does not enter the lungs, as the glottis closes, protecting the airways from the penetration of fluid into them. However, breathing still becomes impossible, because with laryngospasm, air is also not allowed to pass. The person dies of suffocation.
3. Syncopal drowning. The main cause of death is reflex cardiac arrest. The lungs remain dry. Similar situation possible when drowning in very cold water.

Classification according to the color of the skin of the victim

Types of drowning by skin color:

1. White asphyxia. As the name suggests, it is characterized by a pronounced pallor of the skin. Occurs if there is no flooding of the respiratory tract with liquid. This type is most typical for the syncopal mechanism of drowning, when death occurs as a result of the cessation of cardiac activity.
2. Blue asphyxia. Occurs when the victim respiratory movements causing the lungs to fill with water. The skin becomes bluish in color due to severe hypoxia. Death occurs due to respiratory failure. Cardiac arrest occurs after the cessation of breathing.

Appearance of the victim

Different types of drowning have certain differences in clinical manifestations.

If the victim was conscious at the time of immersion in water, the scenario for the development of events looks something like this. A person tries to escape by swallowing water. Breathing becomes impossible, the body experiences hypoxia, as a result of which a characteristic bluish coloration of the skin appears. Often there is an expansion of the veins of the neck. Foam comes out of the mouth Pink colour. If a person is removed from the water at the stage of agony, breathing and heart activity may still be preserved.

If drowning was preceded by depression of the central nervous system (intoxication, poisoning, intoxication), laryngospasm often occurs. The lungs do not fill with water, but death also occurs as a result of asphyxia. The skin becomes bluish in color.

Syncopal drowning occurs against a background of severe fright or cold shock. In the first place in the pathogenesis comes the cessation of cardiac activity. The skin is pale, there is no release of liquid and foam from the nose and mouth of the victim, which is characteristic of other types of drowning. White asphyxia is the most favorable for resuscitation, the time of clinical death with it can be significantly lengthened.

Basic Principles of Drowning Rescue

The types of drowning are varied and require different approaches to care, however general principles remain unchanged in all cases.

All events include 2 stages:

1. Extraction of the victim from the water.
2. Providing assistance on the coast.

How to save a drowning person?

No matter how different types of drowning are from each other, first aid for drowning should begin with ensuring the safety of the rescuer himself. A drowning person (if he is still conscious) can behave extremely inappropriately. That is why, when pulling the victim out of the water, care should be taken. Otherwise, the lifeguard runs the risk of becoming a drowning man himself.

If a person is close enough to the shore, you can try to reach him with a stick, use a rope or other devices to pull him out.

Remember: you don’t need to get into the water if you don’t swim well yourself!

Types of drowning, first aid for drowning. Activities on the coast

There are different types of drowning, and their signs are discussed above. This knowledge must be taken into account when assisting the victim.

• Everything is extremely simple if the person extracted from the water is conscious. The main actions will be aimed at warming him up and calming him down.
• If the person is unconscious, the first thing to do is remove water from the airways. With white asphyxia, this is not necessary (the mechanism of this type of drowning is discussed above), you can immediately start resuscitation.
• With the blue type of drowning, we first clean the mouth and nose from algae, sand, etc. Then we press on the root of the tongue, thereby determining the presence of a gag reflex. The preservation of the latter means that the victim is alive, so the primary task will be to remove water from the lungs and stomach. For this, we turn the victim over on his stomach, turn his head to one side, make him vomit several times, press on his chest. Then we repeat these steps every 5-10 minutes, until water stops coming out of the mouth and nose. It is necessary to monitor breathing and pulse, be ready to perform resuscitation.


• If a vomiting reflex absent, it is urgent to check the presence of vital functions. Most likely they won't. Therefore, you should not spend a lot of time on removing water from the lungs (no more than 1-2 minutes), but start resuscitation as soon as possible.

Types of drowning. Features of resuscitation during drowning

The various approaches to helping the victim have been given above. There are different types of drowning, it is not surprising that they require different measures. However, cardiopulmonary resuscitation is always performed according to a specific plan, which is not affected by the causes that led to clinical death.

What is included in the revitalization package?

• Restoration of airway patency.
• Artificial respiration.
• Indirect cardiac massage.

No matter how different the types of drowning are, first aid always begins with cleansing the mouth and nose of sand, algae, vomit, etc. Then water is removed from the lungs. For this purpose, the victim should be turned face down and laid on his stomach on his knee. The head, therefore, will be lower than the body. Now you can press on the chest, stimulating the flow of fluid from the lungs. If help is provided little child, it can be thrown over the shoulder head down or even taken by the legs and turned over, thereby creating more favorable conditions for water to flow out of the lungs.

In conclusion

Never forget about the rules of behavior on the water. It is easier to prevent a tragedy than to try to fix it. Remember: life is given only once. Take care of her and don't play with death.

Types of drowning

When the victim is pulled ashore, it is necessary to quickly assess what type of drowning was encountered, since the first aid algorithm will depend on this.

First aid algorithm

After the victim is pulled ashore, the upper respiratory tract must be quickly freed from foreign objects (mud, dentures, vomit).

Since when drowning is wet, or blue type, in respiratory tract the victim is a lot of liquid, the rescuer should lay him on his knee with his stomach, face down to let the water drain, put two fingers in the victim's mouth and press on the root of the tongue. This is done not only to induce vomiting, which will help free the airways and stomach from water that has not been absorbed, but also to help start the respiratory process.

If everything worked out, and the rescuer achieved the appearance of vomit (their hallmark is the presence of undigested pieces of food), this means that first aid arrived on time, was carried out correctly, and the person will live. Nevertheless, one must continue to help him remove water from the respiratory tract and stomach, without stopping pressing on the root of the tongue and causing the gag reflex again and again - until the water stops being released during vomiting. At this stage, there is a cough.

If several attempts in a row to induce vomiting were unsuccessful, if at least confused breathing or coughing did not appear, this means that there is no free fluid in the respiratory tract and stomach, it has been absorbed. In this case, you should immediately turn the victim on his back and proceed to resuscitation.

First aid for dry type drowning is different in that in this case, resuscitation should be started immediately after the release of the upper respiratory tract, skipping the stage of inducing vomiting. In this case, there are 5-6 minutes to try to start the respiratory process in the victim.

Actions after first aid

After it was possible to start independent breathing, the victim is laid on his side, covered with a towel or blanket to warm. It is imperative to call an ambulance. Before the arrival of a doctor, the victim must be constantly under control, in case of respiratory arrest resuscitation should be resumed.

The rescuer must insist on medical assistance the victim, even if he is able to move independently and refuses it. The fact is that the terrible consequences of drowning, such as cerebral or pulmonary edema, sudden respiratory arrest, etc., can occur in a few hours, and even a few days after the accident. The danger is considered past only when, 5 days after the incident, no serious problems health did not occur.

Kinds

There are several types of drowning, which are divided according to the characteristics of the symptoms:

1. True or primary. It is characterized by the ingress of fluid into the stomach and lungs. In turn, the true is represented by drowning in fresh water and sea water. In the first case, liquefaction and an increase in blood volume occur, resulting in the destruction of blood substances. Drowning in sea water is accompanied by an increased concentration of metal ions in the blood, which is caused by high content salts in marine waters. The lungs, on the other hand, undergo significant deformation and destruction of the integrity of tissues, due to which there is edema of the mentioned respiratory organs. Water entering the blood in large numbers, provokes the appearance of a bluish tinge of the skin. Also, true drowning is accompanied by pink foamy secretions that come out through the oral and nasal cavities. In this case, breathing is characterized by bubbling sounds.
2. Asphyctic. This type due to the lack of water entering the respiratory system, since a spasm of the glottis occurs. In this case greatest danger represents a state of shock and subsequent suffocation.
3. Syncope. Occurs if a person accidentally fell into ice water. Such drowning is dangerous by stopping the work of the heart organ and the breathing process.
4. Secondary. It is the result of a heart attack or an epileptic attack that suddenly occurred during drowning. Water enters the lungs after the onset of clinical death.

Symptoms

Contrary to popular belief, it is quite difficult to recognize a drowning person, since outwardly his holding on the water looks completely ordinary. However, this "calm" behavior is due to the inability to call for help, the reason for which is impaired breathing. A critically small amount of time above the water is only enough for a drowning person to inhale. However, there are a number hallmarks, thanks to which it still becomes possible to recognize a drowning person:

• the head is located in the rear direction, while the mouth remains open. Also, the head can be completely covered with water, and the mouth can be located at the very surface of the water;
• eyes closed or hidden under hair;
• the look becomes "glassy";
• drowning people take frequent breaths, which is caused by the desire to capture more air;
• unsuccessful attempts to swim or change body position.

First aid

The sequence of actions when rescuing a drowning person is conditionally divided into three main stages:

1. Actions in the water

Providing first aid to the victim begins with pulling him to land. This process is special, since it is he who determines the further state of the drowned. So, in order to safely transport the victim to the shore, it is necessary:

1. Approach the drowning person from behind, and then grab him in a way that is safe for himself so that the drowning person is not able to cling to clothes or any parts of the body. The most acceptable and versatile option is "towing" the victim by the hair. Of course, this method is justified with a sufficient length of hair. In this way, you can quickly and easily get to the shore.
2. If the drowning man still managed to cling, you must dive into the water with him. In the water space, the victim will instinctively open his hands.

2. Operations on land

After the drowning person is successfully brought to shore, the second stage of first aid begins, the sequence of actions of which is as follows:

1. The upper respiratory tract is freed from foreign and foreign objects and substances, which can be represented by mud, dentures, vomit.
2. The victim is placed on his knee with his stomach, while the face should be lowered down. In this way excess amount liquid flows out.
3. Two fingers are inserted into the victim's oral cavity, with which they press on the root of the tongue. Thanks to these actions, a gag reflex is provoked, along with which excess water is removed, and the breathing process is also restored. Next comes the cough.
4. In the absence of a gag reflex, the victim rolls over onto his back, and artificial massage hearts.

It is important to remember that in the presence of an asphyctic type of drowning, resuscitation should be carried out immediately, and the stage of provoking vomiting should be skipped.

3. Actions after first aid measures

After the successful start of the breathing process, an equally important number of measures should be performed aimed at further recovery victim's condition:

• lay it on its side;
• cover with a dry towel;
• call an ambulance;
• constantly monitor the condition of the rescued. In the event of another respiratory arrest, resuscitation should be resumed.

Precautionary measures

To avoid unpleasant consequences It is useful to adhere to the following rules in the process of swimming in deep waters:

1. Refuse to enter the water area while intoxicated.
2. Do not dive in unfamiliar and suspicious areas.
3. Swim away from watercraft, as well as from their course.
4. When using air mattresses, circles and other water devices, deep and distant swims should be abandoned.
5. Children should be under the constant supervision of adults and be at a close distance from the shore.

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, it would seem, healthy patient which occurs as a result of submersion under water.

Epidemiology

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

Much more victims (their exact number 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 death due to drowning is observed in adolescence and youth, although children under 4 years of age represent a group increased risk. 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 help 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. Factors such as overestimation of the ability to swim or dive, hypothermia, and convulsions often contribute to drowning.

Clinical picture

After a critical incident, there is often panic fear, 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 development mechanism 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, fatal outcome was observed only in one patient who had Pa02 FiO more than 150; death resulted from 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. Hypoxia or myoglobinuria may result in acute necrosis tubules.

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 possible damage spinal cord 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 necessary precaution 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 examination.

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 show experimental studies, fresh water can be removed from the trachea only in a very small amount, while salty water removed significantly more. Drowning victims aspirate a small amount 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 give rise to 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.

O lung failure 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 thermometers to measure low temperatures available in the clinical laboratory and operating room. Hypothermia can immobilize a swimmer, leading to drowning, primary ventricular fibrillation, or various violations metabolism.

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). Similarity between severe hypothermia and death famous aphorism: "no one should be considered dead while he is dead, but warm." Drowning victims who develop hypothermia should be kept warm. at least to 30-32.5 °C before resuscitation attempts are abandoned.

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

In intubated patients, Gram staining and tracheal cultures are appropriate. Direct measurement oxygenation and assessment of the acid-base state 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 predictive 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.

When drowning, neither antibiotics nor steroid drugs don't change the current 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. Row latest research testifies to good consequences treatment 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 3 points on the coma scale and were treated in the department intensive care(ICU) either died or (in case of survival) fell into a vegetative state, while patients who had 4 to 5 points in the ICU were divided into survivors without serious consequences, those who died and those who survived, but fell 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 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.

In spite of wide application methods of cerebral resuscitation in drowning children, a recent randomized prospective study using thiopental loading in comatose cardiac arrest survivors found that thiopental does not improve survival or 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.

Rendering system prehospital care should ensure the quick and safe removal of the victim from the water and the implementation of activities at the scene that support his basic vital functions, including adequate artificial ventilation 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 identify possible development 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.