Types of drowning: characteristics, photos, how to provide first aid for drowning (rules and main stages)

Types of drowning

Depending on external factors, the condition and reaction of the body, there are several main types of drowning:

True (aspiration, “wet”) drowning is characterized by the entry of a large amount of fluid into the lungs and respiratory tract. Accounts for about 20% of the total number of drowning cases.
False (asphyxial, “dry”) drowning – a spasm of the respiratory tract occurs, which results in a lack of oxygen. In the final stages of dry drowning, the airways relax and fluid fills the lungs. This type of drowning is considered the most common and occurs in approximately 35% of cases.
Syncopal (reflex) drowning is characterized by vascular spasm, which leads to cardiac and respiratory arrest. On average, this type of drowning occurs in 10% of cases.
Mixed type of drowning - combines the signs of true and false drowning. Occurs in approximately 20% of cases.

Notes

Akopov V.I. Forensic medicine: A practical guide for lawyers and doctors. — 3rd ed., revised. and additional - M.: Publishing and trading corporation "Dashkov and K", 2005. - P. 335-336.
Akopov V.I. Forensic medicine: A practical guide for lawyers and doctors. — 3rd ed., revised. and additional - M.: Publishing and trading corporation "Dashkov and K", 2005. - P. 337-340.
Forensic medicine: answers to the exam. question / Yu. V. Kuharkov. - Minsk: TetraSystems, 2010. - P. 103-104.
Forensic medicine: Textbook / Under. ed. V. M. Smolyaninov. — 2nd ed. reworked and additional - M.: Medicine, 1982. - P. 88-96.
Khokhlov, V. E., Kuznetsov L. E. Forensic medicine: Guide. - Smolensk, 1998. - P. 334-342.
Norton, Rictor
.
Homosexuality in Eighteenth-Century England: A Sourcebook
(17 November 2011).
Drowning and Life Saving, Encyclopædia Britannica
, vol. 08 (11th ed.), 1911

Causes of drowning and risk factors

The most common cause of drowning is failure to take basic safety precautions. People drown because of swimming in questionable waters and places where entry into the water is prohibited, as well as because of swimming during a storm. Quite common causes of drowning are swimming behind buoys and swimming while intoxicated.

The so-called fear factor also plays a significant role. A person who is a poor swimmer or does not know how to swim may accidentally fall into deep water and panic. As a rule, this is accompanied by chaotic movements and screams, as a result of which the air leaves the lungs, and the person actually begins to drown.

Other risk factors include high current speed, whirlpools, and the presence of cardiovascular disease. Drowning can also be caused by fatigue, injuries sustained during diving, and sudden changes in temperature.

Asphyxial or “dry”

Pale skin and fine pink foam from the lungs are indicators of dry drowning. The reasons preceding this are severe relaxation of the nervous system in a state of alcoholic intoxication, or any other disturbances in the functioning of the central nervous system. “Dry” is a fairly common type, caused by an involuntary spasm of the glottis due to liquid entering it, causing irritation.

Figure 3. Scheme of manifestation of laryngospasm during “dry” drowning

By closing the entrance to the lungs, laryngospasm leads to suffocation due to oxygen deficiency (Figure 3). However, the liquid does not penetrate the lungs until the person loses consciousness and the relaxation phase sets in, making rescue many times easier. Therefore, you can skip the phase of squeezing fluid out of the lungs and immediately move on to more necessary procedures.

The first aid that should be provided to a drowned person will be very simple, but requires preliminary training or experience:

Lay the victim stomach up on a hard surface. For example, on a hard wooden bed or concrete slabs;
Begin the resuscitation procedure;
Without bending your elbows, place your hands on the victim’s chest;
Push with your entire body every half second;
Tilt the victim's head back until an obtuse angle is formed between the chin and neck;
Alternate compressions with artificial ventilation using the mouth-to-mouth principle (Figure 4);
Pinch the patient's nose and take a sharp breath;
Exhale sharply into his mouth and open his nose;
Carry out the procedure at intervals of 4-5 seconds. The recommended frequency is 2 exhalations per 30 compressions;
When a pulse appears and spontaneous breathing appears, you can calm down and provide further assistance: help the victim get to the nearest warm room for further warming with tea and a warm blanket.

Figure 4. First aid steps for dry drowning

Mechanism of drowning and signs of drowning

It is believed that a drowning person always screams and waves his arms, so it is very easy to identify such a critical situation. In fact, much more often there are cases when a drowning person does not look like a drowning person at all, and the signs of drowning are invisible even from a fairly close distance.

A person actively waving his arms and calling for help is most likely under the influence of panic, when real signs of drowning do not appear. He is able to provide assistance to his rescuers, such as grasping rescue equipment.

Unlike cases of sudden panic on the water, a truly drowning person may appear as if he is floating normally. He is unable to call for help because his breathing is impaired. When surfacing, he only has time to quickly exhale and inhale, after which the drowning person goes under the water again and does not have enough time to call for help.

Before completely immersing yourself in water, a drowning person can stay at the surface of the water for 20 to 60 seconds. At the same time, his body is positioned vertically, his legs are motionless, and his arm movements are instinctively aimed at pushing off from the water.

Other signs of drowning include:

the characteristic position of the head, when it is thrown back, and the mouth is open, or completely immersed in water, and the mouth is located directly at the surface;
the person's eyes are closed or not visible under the hair;
“glassy” look;
a person takes frequent breaths, capturing air with his mouth;
the victim tries to roll over on its back or swim, but to no avail.

. Laboratory research methods for drowning

Research on diatom plankton

. Plankton are the smallest animal and plant organisms that live in the water of natural reservoirs. Of all plankton, diatoms are of greatest forensic importance - a type of phytoplankton (plant plankton), since they have a shell of inorganic silicon compounds. Together with water, plankton enters the bloodstream and spreads throughout the body, lingering in parenchymal organs (liver, kidneys, etc.) and bone marrow.

The discovery of diatom shells in the kidney, liver, bone marrow, and long tubular bones is a reliable sign of drowning in water, their composition matching the plankton of the reservoir from which the corpse was extracted. For a comparative study of the characteristics of the plankton found in the corpse, it is necessary to simultaneously examine the water from which the corpse was extracted.

Histological examination

. Histological examination of the internal organs of corpses removed from water is mandatory. In the lungs, microscopic examination reveals a predominance of emphysema (bloating) over small foci of atelectasis (collapse), which are located mainly in the central areas of the lungs.

Oil sample

. The test is based on the ability of oil and petroleum products to produce bright fluorescence in ultraviolet rays: from greenish-blue, blue to yellow-brown. Fluorescence is detected in the contents and on the mucous membrane of the stomach and duodenum. A reliable sign of drowning is a positive oil sample in cases of drowning in navigable rivers.

Other physical and technical research methods

. Determination of blood electrolyte concentrations, measurement of electrical conductivity, viscosity, blood density. Determining the freezing point of blood in the left half, the blood is diluted with water, so the freezing point of the blood will be different, which is determined by cryoscopy.

Forensic chemical research. Taking blood and urine for quantitative determination of ethyl alcohol using gas chromatography.

All of these methods help to establish with greater objectivity the fact of death from drowning.

Forensic-medical examination

Syncopal drowning leaves behind characteristic signs that can be seen at an autopsy at the medical examiner's office.
Among others, signs of rapid death prevail, such as bright bluish diffuse cadaveric spots, liquid blood in the cavities of the heart and great vessels, as well as the absence of pink persistent foam at the mouth. In addition, with true drowning, fluid is found in the terminal sections of the bronchioles and in the sphenoid bone of the skull, the lungs are swollen, ribs are imprinted on them, and there are hemorrhages under the pleura. Plankton living in a reservoir is found not only in the stomach and lungs, but also in other organs, which indicates that it got there through the bloodstream.

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

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

What will they do at the hospital?

In the hospital, the person will be thoroughly examined: oxygen and carbon dioxide will be determined in his blood (venous and arterial separately). An analysis will be performed to determine the content of potassium, sodium, chlorine and other indicators in the blood. An ECG and chest X-ray will be performed.

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 thickness of foam and water in the alveoli - into the blood);
extinguishing foam in the lungs;
removing excess fluid from the lungs;
normalization of heartbeat;
normalization of electrolyte levels, especially potassium and sodium;
bringing the temperature to normal levels;
administration of antibiotics,
other events selected individually.

Treatment

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

Critical periods

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

Initial, during which the victim can still hold his breath. If a person is saved at this moment, he will react inadequately to the situation, his skin and mucous membranes are cyanotic, his breathing is rapid, shallow, and noisy. There may be a cough. High blood pressure gives way to hypotension and bradycardia. There may be a significant amount of water in the stomach, which may cause vomiting. A person usually recovers quickly after an incident.
The agonal period is characterized by the fact that the victim is unconscious. He still has a heartbeat and breathing, but muscle activity is fading. The skin is bluish and cold. At this moment, pulmonary edema occurs, and dense pink foam emerges from the mouth.
Clinical death does not outwardly differ from the agonal period. The person is motionless, there is no pulse even in large arteries, and cardiac arrest is observed. The pupils are dilated, without reaction to light. If you pull a person out of the water at this moment, cardiopulmonary resuscitation is unlikely to be successful.

symptoms

One of the key characteristics of dry drowning in toddlers is that initially after drowning or submersion, the child appears fine. There is no need for CPR or other rescue attempts to revive the child, and he or she can behave completely normally. However, symptoms will appear much later after the incident.

In toddlers, dry drowning may be more difficult to detect than in an older child because he or she may not be able to communicate with you as well. For example, you may not be able to ask your child how they are feeling, so you need to look for signs and symptoms of dry drowning, which may include:

Lethargy and extreme fatigue
coughing
Chest pain and/or abdominal pain
Headache
Labored breathing
Flu symptoms and not acting like

Lung damage caused by water immersion can also lead to pneumonia, which can further reduce oxygen levels in the body

If the body's oxygen metabolism is disrupted, the baby's organs may eventually shut down, so it is important to recognize the symptoms as soon as possible

Why do people drown?

Drowning is a life-threatening condition that occurs when a person falls into water. It occurs as a result of:

panic when being overwhelmed by a wave at depth
emergency situations: floods, sinking of a ship;
swimming in a storm;
violations of swimming rules, including diving;
swimming in areas with strong currents;
purchasing faulty diving equipment;
falling into swamps and swamps;
occurrence or exacerbation of diseases during bathing. This is fainting, epileptic attack, acute cerebrovascular accident (stroke), heart attack, hypothermia, which causes leg muscles to cramp;
suicide, when a person either swims very deep, or dives into the depths, or jumps into the water from a height. In the latter case, death can be caused by three mechanisms:
paralysis of all limbs due to fracture of the cervical vertebrae;
reflex cardiac arrest, provoked either by sudden immersion in cold water, or pain from hitting the water;
murders.

Not all people die as a result of water entering the respiratory tract: there is a type of it when air stops passing into the lungs due to the fact that a person experienced 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 engage in extreme water sports are at risk of drowning. But such activities increase the risk of only a small number of people. In most cases, drowning occurs:

after drinking a large amount of alcohol, which dulls a person’s reactions and “instills” fearlessness in him. 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 severe cooling, the body “throws” all the blood to the internal organs, leaving working muscles with minimal blood supply);
when caught in a strong or rip 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 experiences fainting. In this case, loss of consciousness leads to water entering the respiratory tract;
when swimming alone: in this case, the chance of providing first aid is reduced if a person is injured under water, falls into a current area, or has a leg cramped 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 through one of three mechanisms:
The water compresses the full stomach, causing its contents to rise up the esophagus. At the moment of inhalation, food mixed with gastric juice can enter the respiratory tract (people who are intoxicated are especially at risk for this). This is how inflammation of the lung tissue develops, which is difficult to treat - pneumonitis;
deterioration of the condition may develop according to the previous scenario, only the airways (bronchi or trachea) may become clogged with a large piece of food. Even if this food does 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 result in liquid entering the respiratory tract;
with existing heart disease: working muscles in water makes the heart work harder, which can worsen its condition. If swimming 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 the narrowing of the skin vessels.

Emergency assistance for true drowning

The first thing to do is to turn the drowned person onto his stomach so that the head is below the level of his pelvis. The baby can be placed with his stomach on his thigh. Do not waste time determining the pupillary and corneal reflexes, or searching for the carotid pulse. The main thing is to insert two fingers into the victim’s mouth as soon as possible and remove the contents of the oral cavity in a circular motion.

After cleansing the mouth, apply sharp pressure to the root of the tongue to provoke the gag reflex and stimulate breathing. The presence or absence of this reflex will be the most important test for determining further tactics.1. First aid for maintaining gag and cough reflexes

If, after pressing on the root of the tongue, you heard the characteristic sound “E” and this was followed by gagging movements; if you see the remains of eaten food in the water pouring out of your mouth, then in front of you is a living person with a preserved gag reflex. Indisputable evidence of this will be a reduction in the intercostal spaces and the appearance of a cough.

Remember! In the event of a gag reflex and cough, the main task is to remove WATER from the lungs and stomach as quickly and thoroughly as possible. This will avoid many dangerous complications.

To do this, periodically press firmly on the root of the tongue for 5-10 minutes until water stops coming out of the mouth and upper respiratory tract. (Remember that this procedure is performed in the drowned position, face down.)

To better drain water from the lungs, you can slap your palms on the back, and also squeeze the chest from the sides with intense movements while exhaling. After removing water from the upper respiratory tract, lungs and stomach, lay the victim on his side and try to call an ambulance.

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

Until doctors arrive, do not leave the drowned person unattended for a second: sudden cardiac arrest can occur every minute.

Remember! A correctly carried out first stage of emergency measures will prevent the development of many serious complications.

2. First aid for a victim without signs of life

If, when pressing on the root of the tongue, the gag reflex did not appear, and you did not see any remnants of eaten food in the liquid flowing from the mouth; if there is no coughing or breathing movements, then under no circumstances should you waste time further extracting water from the drowned person, but immediately turn him on his back, look at the reaction of the pupils to light and check the pulsation in the carotid artery. If they are absent, immediately begin cardiopulmonary resuscitation.

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

But since resuscitation of a drowned person is impossible without periodically removing water, foam and mucus from the upper respiratory tract, every 3-4 minutes you will have to interrupt artificial ventilation and chest compressions, quickly turn the victim onto his stomach and remove the contents using a napkin oral and nasal cavity. (This task will be greatly simplified by using a rubber balloon, which can be used to quickly suction out secretions from the upper respiratory tract.)

Remember! In case of drowning, resuscitation is carried out for 30-40 minutes, even in the absence of signs of its effectiveness.

How to save a drowning person

This also requires a separate algorithm. If you try to be a hero and, without knowing the rules, swim to the aid of a drowning person, you can easily die yourself: if a drowning person sees or feels the presence of another person, he will panic and drown the rescuer in order to survive himself.

Therefore, help for drowning is as follows:

Before swimming to rescue, remove obstructive clothing and shoes.
Approach a drowning person only from behind. Next you need to grab him by one shoulder with one hand, and with the other hand lift his head by the chin so that he can breathe. In this case, the rescuer’s second hand should press the drowning person’s shoulder so that he cannot turn over to face the person who is saving him. In this position you need to swim to the shore. The same position is used when transporting an unconscious person.
If you want to extend your hand to a drowning person, make sure that with your other hand you are firmly holding on to some kind of support.
Do not ignore the call for help.
You can throw some kind of floating object (for example, a lifebuoy) to a drowning person, notifying him about it several times in monosyllables: “Hold!”, “Grab!”, “Catch!” and so on.
If a person lies motionless at the bottom, then it is important to lift him up correctly:
They 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 rescuer’s palms are on the victim’s chest, and lift the drowned person to the surface.

The main thing at this stage is to remove the person from the water. An assessment of its condition must be done on the shore.

Drowning in the bathtub. Is it possible to drown in a bathtub?

Is it possible to drown in a bathtub?

Alas. Most people drown not in rivers, seas and oceans, but at home in their own bathtubs.

My former student V.L. lived in the next entrance with his friend and classmate S.K. Their apartments in neighboring entrances on the 5th floor were in contact with partitions between the apartments. The guys graduated from 10th grade in 1982. V.L. discovered that the wall in his bathroom was impossibly hot. He knocked on the wall. Nothing. I called my friend on the phone. Nothing. I went up to the next entrance to the 5th floor and rang the doorbell for a friend. Silence. Then he went up to the attic, the roof, went down from the roof to the balcony, knocked down the door to the bathroom and, in the clouds of hot steam, discovered a friend drowned in the bathtub.

My work friend lived in a private house with a bathroom and toilet. The eldest daughter, 14 years old, went to take a bath, and the youngest daughter, 6 years old, having nothing better to do, began to peek through the crack of the door. She went up to her mother and father and said: “And Olya is lying in the bathtub and not moving.” The parents knocked down the door, but it was too late. The eldest daughter, not quite 14 years old, died in the bathtub of her own home.

My older brother came to visit and decided to take a bath (they didn’t have water at home). Suddenly I heard him scream. I rushed to the bathroom, kicked the door and pulled my brother out of the water, he had almost lost consciousness. I switched the water dispenser to the shower and ran cold water over his face and head. He woke up. It turns out that while warming himself in the bathtub, into which hot water was flowing from the tap, he felt that he was losing consciousness and managed to scream. What if I left the apartment or didn’t pay attention to my brother’s scream? It's scary to even think about.

But, in my memory there were already two tragic stories of a former student and workmate, and my reaction, fortunately, worked instantly.

Unfortunately, such cases are not talked about in life safety classes at school, and people are not prepared for such emergencies. But in vain.

Therefore, in order not to drown in your own bath, it is best to take only a shower, since hot water can dilate your blood vessels and the blood vessels of your brain so much that you can lose consciousness and drown from overheating of the body (heatstroke).

If you still decide to warm your frozen body parts in the bath, then the water temperature should not be higher than 36-38 degrees. A water temperature of 40 degrees is already so hot that it feels almost like boiling water. This temperature can cause the body to overheat.

In addition, if you dared to get into a bathtub with hot water, then your relatives should know about it, and you need to maintain constant voice contact with them throughout your stay in the bathtub.

And do not close the door to the bathroom from the inside - just close it tightly and draw a curtain in the bathtub.

If my recommendations help at least one person not to drown in a bathtub, then the goal of my article has been achieved.