Drowning. Causes and mechanism of development of a pathological condition. Types of drowning. Rules for the provision of emergency and medical care. Complications, consequences and prevention of drowning. "Pale" drowning Drowning happens

Content

A life-threatening condition characterized by the onset of asphyxia when fluid enters the lungs, followed by swelling, is called drowning. In the absence of timely resuscitation measures, a person may suddenly die from acute respiratory failure. This should not be allowed, so it is useful for everyone to remember what pre-medical actions on the part of the rescuer include emergency assistance in case of drowning. Act immediately.

What is first aid for drowning

Before proceeding with resuscitation measures, it is important to be aware of what processes occur in the body during drowning. If fresh water enters the lungs in large quantities, the cyclic contraction of the heart ventricles is disrupted, extensive edema develops, and the function of the systemic circulation ceases. When salt water enters the body, the blood pathologically thickens, which leads to stretching and rupture of the alveoli, pulmonary edema, disruption of gas exchange and subsequent rupture of the myocardium with a fatal outcome for the patient.

In both cases, in the absence of first aid, the victim may die. This cannot be allowed. First aid for drowning provides for a special complex of resuscitation measures aimed at forced drainage of water in order to maintain the functionality of internal organs and systems. It is important to assist a drowning person no later than 6 minutes from the moment of loss of consciousness. Otherwise, extensive cerebral edema develops and the victim dies. Due to the observance of the algorithm of actions, the statistics of the drowned persons reduced the indicators.

First aid rules for drowning

The first step is to pull the victim ashore, after which first aid should be provided for drowning. It is important to know the basic and false rules that will help save a person's life:

The first step is to clearly determine the pulse and the presence of signs of breathing in the victim.
It is imperative to call an ambulance, and before arrival to carry out all the necessary measures to maintain the vital signs of the body.
It is necessary to put a person on a horizontal surface on his back, carefully place his head, put a roller under his neck.
To rid the victim of the remnants of wet clothing, try to restore the disturbed heat exchange (if possible, warm the patient).
To cleanse the nose and mouth of an unconscious person, be sure to stretch out the tongue, thereby avoiding aggravating an attack of suffocation.
Implement one of the methods of artificial respiration - "mouth to mouth" and "mouth to nose" (if it is possible to unclench the victim's jaw during drowning).
It is important to carry out resuscitation measures for drowning with knowledge of the matter, otherwise a person can only be harmed, aggravated his condition.

Rescue of a man on the water

Rescue of a person takes place in two successive stages: quick extraction from the water and assistance to the drowning man already on the shore. In the first case, it is necessary to get the victim out of the reservoir as soon as possible and not drown himself. Therefore, it is very important to adhere to such activities:

When drowning, it is necessary to swim up to the person from behind and grab him so that he reflexively does not grab his savior. Otherwise, two people may die at once.
It is best to grab the hair and pull. This is the most convenient method, which is not very painful for the victim, but practical for the savior in order to quickly move along the water towards the shore. You can also comfortably grip the arm just above the elbow.
If the drowning victim nevertheless grabbed his savior at the reflex level, do not push him away and resist. It is necessary to draw as much air as possible into the lungs and dive deeply, then he reflexively unclenches his fingers and increases the chances of his salvation.
If the patient has already gone under the water, it is required to dive, grab by the hair or hands, and then raise to the surface of the water. The head should be raised to avoid further flow of excess water into the lungs and systemic circulation.
It is supposed to drag a drowning person through the water only face up, so that he does not gulp more water. Thus, it turns out to significantly increase the chances of the unfortunate person for salvation already on the shore of the reservoir.
Before first aid is given to a drowning man, it is necessary to assess the features of the reservoir - fresh or salty water. This is very important for the implementation of further actions of the rescuer.
Put the patient on his stomach, provide first aid, depending on the specific type of drowning (wet or dry).

First aid for dry drowning

This type of drowning is also called asphytic, pale. Progressive spasm of the glottis prevents water from entering the airways. All further pathological processes of the body are more associated with the onset of shock and attacks of suffocation; in the absence of the first resuscitation measures, they can cost the victim his life. In general, the clinical outcome is more favorable than with wet fatigue. The sequence of actions of the rescuer is as follows (there is only 6 minutes left):

First aid for drowning begins with the release of the tongue so that the person does not suffocate.
Next, clean the nasal and oral cavity (sand, mud, silt can accumulate in those).
Turn the patient face down so that water flows out of the lungs, be sure to check for a pulse and signs of respiratory function.
Lay on your back so that your head is tilted back, for example, place a roller of rolled clothes under your neck.
Perform respiratory resuscitation by performing mouth-to-nose or mouth-to-mouth artificial respiration.

It is necessary to talk in more detail about the technique of artificial respiration "mouth-to-mouth" with simultaneous chest compressions. So, lay the person on his back, free him from wet squeezing clothes, tilt his head back (the chin should rise) and pinch his nose. Perform two blows into the mouth, then place one palm over the other on the chest. Keeping the limbs straight, press on the sternum up to 15 times in 10 seconds. Then blow again through the mouth. Do 72 manipulations per minute - 12 exhalations, 60 presses.

If the person regained consciousness and coughed, quickly turn their head onto the side. Otherwise, he may again choke on the water leaving the lungs. When performing such complex measures to save the life of a drowning person, two people must be involved. First aid for drowning with vigilant pulse control is required until the person regains consciousness, or there are undeniable signs of death, for example, complete cardiac arrest, cadaveric spots on the skin, and symptoms of rigidity.

With wet drowning

In this case, we are talking about true drowning (also called "blue" asphyxia), when even with the provision of first aid, the chances of salvation are small. The main symptoms are cyanosis of the skin, reflex cardiac arrest (with syncope), cold sweat, the presence of white or pink foam from the mouth, clinical death, lack of pulse and signs of breathing. It is required to act in the following sequence:

Pull the victim onto the shore by grasping the hand, hair, head, or other part of the body.
Then lay on your stomach and thoroughly cleanse your mouth, nasal cavity from the accumulation of sand, silt.
Lift the patient and by pressing on the root of the tongue forcibly provoke a gag reflex.
Induce vomiting until residual fluid has cleared from the lungs, stomach, and systemic circulation. Additionally, you can pat the drowned man on the back.
Then turn over on its side, bend his knees, let him clear his throat after experiencing hypoxia of brain cells. The skin gradually takes on a natural color.
If the gag reflex does not appear, turn the drowned man onto his back, carry out resuscitation measures involving artificial respiration and chest compressions in several approaches.

Medical Precautions

If you want to save the life of another person, it is important not to unknowingly ruin your own. Therefore, it is necessary to swim up to the drowned man so that he does not drown his savior in fear. When moving to the shore, you will have to act with one hand, since the other limb keeps the patient unconscious or in shock. Other precautions on the part of the savior that relate to the topic "First aid for drowning" are presented below:

It is necessary to quickly remove wet and squeezing clothing, otherwise the clinical picture is noticeably complicated, while the patient's chances of salvation are reduced.
The termination of first aid is possible in three cases: if an ambulance arrived in time, when the drowned man came to his senses and coughed, if the signs of death are obvious.
Do not be surprised at the appearance of foam from the mouth. When drowning in seawater, it is white (fluffy), in fresh water drowned people - with impurities of blood.
If a child is injured, the rescuer should turn him face down, resting on his own thigh.
If it is possible to open the patient's jaw, artificial respiration can be performed using the mouth-nose technique.
When compressing the chest (pressure), the hands of both hands must be placed on the chest at a point that is located two fingers above the lower end of the sternum.
The arms during resuscitation should remain straight, the body weight is transferred to them. Pressing on the sternum is allowed only with the soft part of the palm.

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Signs of true drowning:

- cyanosis of the skin of the face,

- swelling of the vessels of the neck,

Turn on the stomach, clean the mouth and press on the root of the tongue.

If there is a gag reflex, continue removing water from the stomach (up to 2-3 minutes).

If there is no gag reflex, make sure that there is no pulse in the carotid artery and proceed to resuscitation.

If there is a pulse on the carotid artery, but there is no consciousness for more than 4 minutes, turn on the stomach and apply cold to the head.

In cases of shortness of breath, bubbling breathing - sit down the victim, apply warmth to the feet, apply tourniquets on the thigh for 20-30 minutes.

Attention! In the case of true drowning, death may occur in the coming hours from repeated cardiac arrest, pulmonary edema, and cerebral edema. Therefore, in each case of drowning, rescue services are called in, and the rescued person must be taken to the hospital. .

Actions in case of pale drowning

Signs of pale drowning:

- lack of consciousness,

- lack of pulse in the carotid artery,

- pallor of the skin,

- sometimes "dry" foam from the mouth,

- occurs more often after falling into icy water.

Move the victim to a safe distance from the hole.

Check for a pulse in the carotid artery.

If there is no pulse in the carotid artery, proceed to resuscitation.

If signs of life appear, transfer the rescued person to a warm room, change into dry clothes, and give a warm drink.

Attention! In the case of pale drowning, it is unacceptable to waste time removing water from the stomach.

Actions in case of the first stage of hypothermia

Signs of the first stage of hypothermia:

- blue lips and tip of the nose,

- chills, muscle tremors, goose bumps,

- copious frothy discharge from the mouth and nose.

If possible, wear additional warm clothes. Make you move.

Give 50-100 ml of wine or other sweet alcohol, provided that within 30 minutes the victim is taken to a warm room and there is no smell of alcohol from his mouth .

Attention! The first stage of hypothermia is protective and not life-threatening. It is enough to use additional warm clothes, make you move and take warm food or sweets to prevent the onset of a more dangerous stage of hypothermia.

If, after removing from the hole, there is no supply of dry clothes and the opportunity to make a fire, if possible, lay any paper between the body and wet clothes and continue moving to the village. After 5-7 minutes, the paper will begin to dry and become a good heat insulator.

Actions in case of the second and third stages of hypothermia

Signs of the second and third stages hypothermia (as it appears):

Pale skin

Loss of feeling of cold and feeling of comfort in the cold,

Complacency and euphoria or unmotivated aggression,

Loss of self-control and adequate attitude to danger,

The appearance of sound, and more often visual hallucinations,

Lethargy, lethargy, apathy,

Depression of consciousness and death.

Suggest warm sweet drinks, warm food, sweets.

Deliver to a warm room as soon as possible.

If there are no signs of frostbite in the extremities, remove clothing and place in a bath of warm water or cover with plenty of heating pads

Caution: Before immersing a victim in water, be sure to check the temperature with your elbow.

After the warming bath, put on dry clothes, cover with a warm blanket and continue to give warm sweet drinks until the arrival of the nursing staff.

Attention! It is unacceptable to offer alcohol to a victim lying in water.

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Drowning ranks 3rd among the causes of unintentional death and accounts for 7% of all deaths associated with injury. At least 1/3 of the survivors suffer from moderate to severe neurological complications. This water accident is a common cause of disability and death, especially in childhood.

At the 2002 World Congress on the subject in Amsterdam, a group of experts proposed a new consensus definition for drowning in order to reduce confusion over the number of terms in the literature over 20. to primary respiratory failure from immersion in a liquid medium. "

Table of contents:

We will use the old wording to make it easier for readers to understand the types of state.

Additionally, the type of water into which the immersion took place is considered: fresh or salty. This is important for the second stage of correction of the condition, since electrolyte disturbances in the blood serum are associated with the salinity of water, especially when a large amount of it is ingested.

The first step in helping a drowned man is to carry out resuscitation measures.

Drowning can be further classified as damage from cold (air temperature less than 20 ° C) or warm water (20 ° C or higher). Despite the fact that a low temperature leaves more chances for life, secondary hypothermia itself, with prolonged hypothermia, is often fatal.

Infectious complications are more often recorded when fluids are ingested from a natural or artificial fresh water body.

Prolonged stay in water without breathing affects the central nervous and cardiovascular systems, therefore, correction of hypoxemia (low oxygen content in the blood) and acidosis (violation of acid-base balance with a shift towards the acid side) is performed.

note

The degree of damage to the central nervous system depends on the severity and duration of hypoxia (pathological process in the tissues, oxygen starvation, a consequence of hypoxemia).

Prevention of impairment is key to reducing the morbidity and mortality from drowning.

Knowing the basics of resuscitation can save a person's life and prevent complications.

Breathing stops after 5-10 minutes, and the heart stops 15 minutes after being underwater.

Etiology

Drowning can be primary, or occur against the background of the following events:

acute condition (, etc.);
damage to the head or spine;
cardiac arrhythmia;
or drug intoxication;
hyperventilation;

The reasons vary depending on age.

Babies

Babies are more likely to drown in tubs or buckets of water. Most of them died during a brief (less than 5 minutes) lack of adult supervision.

Children aged 1-5 years

Tragedy occurs when using swimming pools, in ditches filled with water, garden ponds and water bodies located near the house.

Adequate childcare and limited access to hazardous areas can prevent tragedy in most cases.

Young people aged 15-19

Young people usually drown in ponds, lakes, rivers, seas. Death is caused by spinal and head injuries resulting from diving into an unknown body of water with a shallow depth or with a dangerous bottom (stones, driftwood, metal structures, broken glass, etc.).

Alcohol and, to a lesser extent, drugs were used on many occasions. Australian, Scottish and Canadian researchers showed that 30-50% of adolescents and adults who drowned in boat incidents were intoxicated, which was confirmed by special tests.

All age groups

Conditions that can lead to drowning of a person of any age:

some neurological diseases associated with loss of neuromuscular control (severe and other disorders);
water sports;
injury to the cervical spine and head trauma associated with surfing, water skiing, diving, diving, etc.
watercraft accidents and other injuries (bites, lacerations).

note

The appearance of a drowning person in life may differ from the "Hollywood" representations: the victim of water does not always shout, calls for help and waves his hands.

What happens to the human body when drowning

There are several options that lead to an unfavorable outcome without timely assistance.

First option: wet or blue drowning

Drowning in fresh water

Fresh water enters the respiratory tract, lungs and stomach, and then is actively absorbed into the blood, thinning it.

The electrolyte balance is disrupted, there is a massive destruction of red blood cells, the oxygen level decreases, and the content of carbon dioxide, toxic to the body, increases.

After resuscitation, the drowned man develops an acute one against the background, the leading symptom is the appearance of bloody foam from the mouth.

So, the changes against the background of fresh water ingress:

hemodelution;
hypervolemia, alternating with hypovolemia against the background of pulmonary edema and fluid redistribution;
hemolysis;
hyperkalemia;
hypoproteinemia;
hyponatremia;
hypochloremia;
hypocalcemia.

Drowning in sea water

Sea water has a higher concentration due to the contained salts, compared to fresh liquid and blood.

After the absorption of seawater, thickening occurs, which changes the rheological properties of the blood, and hypovolemia, hypernatremia, hypercalcemia and hyperchloremia also join.

Option two: dry drowning

The mechanism leading to acute hypoxia is different. When exposed to water, reflex closure of the glottis (laryngospasm) develops, which prevents air from entering the lungs.

note

There is no fluid in the respiratory tract.

More often, pathology is recorded in children and women, when immersed in dirty or chlorinated water.

Liquid is found in large quantities in the stomach.

Option 3: Secondary Drowning

Secondary drowning always accompanies some initial pathology. Loss of consciousness can be triggered, for example, by an epileptic seizure.

Option four: syncope drowning

Spasm of peripheral vessels reflexively leads to cardiac arrest even with minimal water ingress into the respiratory tract.

So, for example, with a sudden immersion in ice water, a spasm of peripheral blood vessels develops with cardiac arrest. Pulmonary edema is uncommon. The skin is pale, there is no bluish tint.

Symptoms and Signs

The clinical picture depends on the length of stay under water, its characteristics, the timeliness and quality of emergency care and the underlying cause.

If the pathological processes have not gone too far, the following symptoms and signs may appear immediately after extraction from the water:

agitation or lethargy;
cyanosis of the skin;
noisy breathing with coughing fits;
instability of blood pressure and heart rate.

Agony is characterized by the following symptoms:

loss of consciousness;
heart rhythm disturbance;
visualization of swollen cervical veins;
the appearance of foam from the mouth in a small amount with spasm of the glottis (with pulmonary edema - pink foam with blood);
spastic contractions of the masticatory muscles;
weak reaction of the pupils to light.

The condition can turn into clinical death: respiratory arrest and the absence of a pupillary reflex.

First aid for drowning: how to act

If a person has not yet disappeared under water, it is recommended to swim up to him from behind to prevent a dangerous capture from his side. In a state of shock with paralyzing fear, it is difficult to predict the victim's behavior, so you should not waste time talking, most likely, the potential drowned man no longer perceives the addressed speech.

If, nevertheless, you are captured and pulled down, dive with the drowning person, there is a chance that he will automatically relax his arms in order to make an attempt to stay on the surface.

If the drowning person has gone under water, hold your breath and dive, open your eyes, look around.

If found, take the victim by the hand or hair, push off the bottom and float.

Ask someone to call the resuscitation team.

Lack of breathing in the victim is an indication for artificial ventilation, it is recommended to perform it in water, subject to control over the situation and possession of the necessary skills.

note

The rule of 3 "Ps": look, listen, feel.

If there are no injuries, place the drowned person with his stomach on his thigh upside down and with both hands make several strong squeezing movements of the chest in the epigastric region to free the airways from fluid.

With pale (pale gray skin) drowning against the background of a reflex spasm of the glottis, there is practically no water, so immediately proceed to artificial respiration and chest compressions. It is better if you have an assistant: one does artificial respiration, the other does a closed heart massage.

Lay the victim on their back and wrap them in a blanket or blanket.

Often foreign objects (silt, algae, dirt, vomit, mucus, etc.) get into the oral cavity, they must be removed. To do this, wrap a scarf or bandage on 2 fingers and get rid of the excess in a circular motion.

Remove dentures if possible.

Remove clothing from the victim. Remember, even buttons can be traumatic when massaged, especially for a child.

Proceed with the primary complex of cardiopulmonary resuscitation.

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In a drowned person, paralysis of the respiratory center develops in 3-5 minutes, and the heart continues to work for 15 minutes. If the heartbeat persists, perform only artificial respiration: mouth to mouth, through a handkerchief, with a frequency of 15-18 breaths per minute. The victim's nose must be pinched.

If no heartbeat is heard, switch to chest compressions in combination with artificial respiration.

With any type of drowning, it is strictly forbidden to turn the victim's head, this contributes to increased trauma in case of a fracture of the cervical spine.

Transportation is possible only on a hard surface, it is better if a specialized team is engaged in this.

note

Drowning in ice water slows down metabolic processes throughout the body, including the brain. The chances of recovery in this case are the highest.

Do not waste time moving the victim to a warm room, start resuscitation measures on the spot.

Perform rescue actions before the arrival of an ambulance or until signs of biological death appear (rigor mortis, spots).

If no positive dynamics is observed within 30-40 minutes, there is a likelihood, even with the restoration of breathing and heartbeat, in the future development of severe paralysis and violations of higher brain activity (deep disability).

How are chest compressions and precordial strokes done?

Conditionally divide the sternum into 3 parts and find the border between the middle and lower. In this area, strike with your fist, it is possible that an independent heartbeat will be restored. If this did not happen, with the hands clasped in the lock (the leading hand from above), perform rocking movements (2 per second) on the lower region of the sternum.

The arms are perpendicular to the surface of the victim's chest.

For 30 compressions - 2 breaths, if CPR is performed by one person. At the time of the introduction of air, the stimulation of the heart is stopped.

The drowned man's head is thrown back as much as possible.

For preschool children, massage is carried out with one hand, and for infants - with 2 fingers (there is a high probability of rib fracture), the frequency is 100-120 movements per minute.

If 2 people are involved in the assistance, all actions must be coordinated: 4-5 pressures on the sternum on exhalation for one blowing of air into the lungs.

Drowning prognosis

Patients who are promptly resuscitated can fully recover.

Victims who were admitted to the intensive care unit in a coma, with dilated pupils and without breathing, have a serious prognosis.

According to statistics, 35-60% of people needed to continue cardiopulmonary resuscitation upon arrival at the hospital, and 60-100% of survivors in this group received neurological complications.

Pediatric studies show a 30% mortality rate in children who require specialized treatment for drowning in an intensive care unit. Serious brain damage was recorded in 10-30% of cases.

Mishina Victoria, doctor, medical commentator

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

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

Why do people drown?

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

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

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

Who is most at risk of drowning

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

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

Types of drowning

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

There are 4 main types of drowning:

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

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

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

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

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

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

Who is more likely to survive drowning

When rescuing a drowning person, a huge factor is the time that has passed since the moment of falling into the water. The earlier assistance is started, the greater the chances of saving a person.

The chances of saving a person increase if:

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

How to suspect that a person is drowning

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

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

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

Calling for help and purposefully waving your arms is what precedes drowning. When a person feels that he is drowning, he develops a panic state associated with a feeling of lack of air. At this moment, he is not able to think critically.

The fact that a person has experienced drowning is evidenced by the following signs:

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

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

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

Now we need to draw your attention twice:

Even if a person was reanimated, this does not mean that his nervous system will recover in full. He - immediately or after a while - may show the same symptoms that are characteristic of a stroke: loss of the ability to think and speak coherently, impaired speech (understanding or reproduction), impaired movement in the limbs, impaired sensitivity. A person may fall into a coma caused by cerebral edema due to hypoxia.

All people who have experienced drowning are subject to hospitalization and medical examination, even if they have not fainted and have a pulse and breathing. This is due to a complication of drowning called "secondary drowning".

Drowning periods

This life-threatening condition is divided into 3 periods:

Elementary.
Agonal.
Clinical death.

Initial period

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

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

Agonal period

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

The agonal period is characterized by:

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

The period of clinical death

It is characterized by a triad of symptoms:

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

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

Self-help algorithm for drowning

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

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

How to save a drowning man

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

Therefore, help with drowning is as follows:

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

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

First aid for drowning

First aid algorithm for true drowning:

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

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

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

What to do after the drowned man regained consciousness

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

What will they do in the hospital

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

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

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

Complications of drowning

Drowning is often complicated by one of these conditions:

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

Content

Relaxing by the pond is not always pleasant. Improper behavior in the water or emergencies can lead to drowning. Young children are especially at risk, but even adults who are good at swimming can become victims of strong currents, seizures, and whirlpools. The sooner the victim is removed from the water, and first aid is provided 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 respiratory distress caused by immersion or prolonged exposure to water. As a result, breathing disorder, asphyxia may occur. If first aid to a drowning man was not provided in 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 it is necessary to act very quickly, without waiting for the ambulance crew.

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

injuries from diving in shallow water, in unexplored places;
alcoholic intoxication;
emergencies (seizures, heart attack, diabetic or hypoglycemic coma, stroke);
inability to swim;
negligence towards the child (when children drown);
getting into whirlpools, storm.

Signs of drowning

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

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

Types of drowning

There are several types of drowning, each with its own characteristics. They include:

"Dry" (asphyxial) drowning. A person submerges 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 man begins to choke. Asphyxiation sets in.
"Wet" (true). Plunging into water, a person does not lose the respiratory instinct. The lungs and bronchi are filled with fluid, foam can be released from the mouth, cyanosis of the skin manifests itself.
Fainting (syncope). Another name is pale drowning. The skin acquires a characteristic white, gray-white, bluish color. The lethal outcome 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. Fainting, loss of consciousness, arrhythmia, epilepsy, heart attack, clinical death occurs.

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. While on the shore, the first thing to do is call a lifeguard for help. The specialist knows exactly how to act. If he is not around, you can try to pull the person out on your own, but you need to remember about the danger. The drowning person is in a stressful state, his coordination is impaired, so he can involuntarily grab onto the rescuer, not allowing him to grab himself. There is a high probability of drowning together (with improper behavior in the water).

Drowning emergency

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

Wrap the finger with a soft cloth, clean the mouth of the rescued with it.
If there is fluid in the lungs, you need to put the person on his knee with his stomach down, lower his head, make a few blows between the shoulder blades.
If necessary, do artificial respiration, heart massage. It is very important not to press too hard on the ribcage to avoid breaking the ribs.
When a person wakes up, you should free him from wet clothes, wrap him with a towel, and let him warm up.

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 less dangerous and has a better prognosis. The high concentration of salt prevents water from entering the lung tissue. However, the blood thickens, there is pressure on the circulatory system. Within 8-10 minutes, a complete cardiac arrest occurs, but during this time you can have time to reanimate a drowning person.

When it comes to fresh water drowning, the process is more complicated. When fluid enters the cells of the lungs, they swell, some cells burst. Fresh water can be absorbed into the blood, making it more liquid. Capillaries rupture, which interferes with cardiac activity. Ventricular fibrillation, cardiac arrest occurs. This entire process takes several minutes, so death in fresh water occurs much faster.

First aid on the water

A specially trained person should be involved in the rescue of a drowning person. However, he is not always nearby, or several people may drown in the water. Any vacationer who can swim well can provide first aid. To save someone's life, the following algorithm should be used:

It is necessary to gradually approach the victim from behind, dive in and cover the solar plexus, taking the drowning person by the right hand.
Swim to the shore on your back, paddle with your right hand.
It is important to ensure that the victim's head is above the water and does not swallow the liquid.
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. Inappropriate behavior by a stranger often only aggravates the problem. For this reason, first aid for drowning must be competent. What is the mechanism of PMP:

After the person is pulled out of the water and covered with a blanket, symptoms of hypothermia (hypothermia) should be checked.
Call an ambulance.
Avoid deformation of the spine or neck, do not cause damage.
Secure the cervical spine with a rolled-up towel.
If the victim does not breathe, you should start performing artificial respiration, heart massage

With true drowning

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

probing the pulse, examining the pupils;
warming the victim;
maintaining blood circulation (raising the legs, tilting the body);
the production of ventilation of the lungs with breathing apparatus;
if the person is not breathing, artificial respiration should be given.

With asphyxial drowning

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

immediately carry out cardiopulmonary resuscitation;
call an ambulance;
when the victim recovers, warm him up.

Artificial respiration and heart massage

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

The victim's lips should be parted, mucus, algae should be removed with a finger wrapped in a cloth. Allow the liquid to drain from the oral cavity.
Grasp your cheeks so that your mouth does not close, tilt your head back, raise your chin.
Pinch the nose of the rescued person, breathe air directly into his mouth. The process takes a split second. Number of repetitions: 12 times per minute.
Check the pulse in the neck.
After a while, the chest will lift (the lungs will begin to function).

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

Place the patient on a flat surface (floor, sand, ground).
Place one hand on the chest, cover with the other hand at an angle of approximately 90 degrees.
Press rhythmically on the body (approximately one pressure per second).
To start the baby's heart, press on the chest with 2 fingers (due to the baby's small stature and weight).
If there are two rescuers, artificial respiration and cardiac massage are performed at the same time. 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 has come to his senses, this does not mean that he does not need medical attention. 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 prolonged unconsciousness and oxygen, the following problems may arise:

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

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

learn to swim;
avoid drinking and bathing;
do not go into too cold water;
do not swim during a storm or at great depths;
do not walk on thin ice.

Video

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can diagnose and give recommendations for treatment, based on the individual characteristics of a particular patient.

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