Drowning is the 3rd leading cause of unintentional deaths and accounts for 7% of all deaths related to trauma. At least 1/3 of the survivors suffer from neurological complications, moderate to severe. This was an accident on the water is a frequent cause of disability and death, especially in children.
At the world Congress on this issue in 2002 in Amsterdam, the group of experts suggested a new consensus definition for drowning in order to reduce confusion in relation to the number of terms in the literature, there are more than 20. The definition given by the experts, is: “Drowning is a process resulting in primary respiratory failure from immersion in a liquid environment.”
We will use the old language to make it easier for readers to understand the types of condition.
Additionally, consider the type of water in which the dive: fresh or salt. It is important for the second stage of correction of the state, as electrolyte disturbances in the serum are associated with salinity, especially if it enters the large amount.
It is important
The first stage of helping the drowning – resuscitation.
Drowning can be further classified as cold damage (if the air temperature is less than 20 ° C) or warm water (20 ° C or above). Despite the fact that low temperature gives a better chance at life, secondary hypothermia itself with long-term hypothermia is often fatal.
Infectious complications are more often recorded if contact of natural or artificial freshwater lake.
Long stay in water without breathing affects the Central nervous and cardiovascular system, so do the correction of hypoxemia (low oxygen in the blood) and acidosis (disturbance of acid-alkaline balance shifted to the acid side).
The degree of CNS injury depends on the severity and duration of hypoxia (a pathological process in the tissue, oxygen starvation, the consequence of hypoxemia).
Prevention is key to reducing morbidity and mortality from drowning.
Knowledge of the basics of resuscitation can save a person’s life and prevent complications.
It is important
Breathing stops after 5-10 minutes, and the heart – after 15 minutes of being under water.
Drowning can be primary or occur against the background of the following events:
Causes of variability depending on age.
Infants often drown in bathtubs or buckets of water. Most of them died during a brief (less than 5 minutes) absence of adult supervision.
Children aged 1-5 years
The tragedy occurs when you use of the pools, in ditches filled with water, garden ponds and water bodies located close to home.
It is important
Adequate supervision for the child and restrict access to dangerous places can prevent a tragedy in most cases.
Young people aged 15-19 years
Young people typically drown in ponds, lakes, rivers, seas. Cause of death injuries of the spine and head, resulting from diving into an unknown body of water with a little depth or hazardous bottom (rocks, driftwood, metal structures, broken glass, etc.).
Alcohol and, to a lesser extent, drugs used in many cases. Australian, Scottish and canadian researchers have shown that 30-50% of adolescents and adults who drowned in incidents involving boats were in a condition of alcoholic intoxication, which was confirmed by special tests.
All age groups
Condition that can lead to the drowning person of any age:
- some neurologic diseases associated with loss of neuromuscular control (Parkinson’s disease, severe arthritis and other disorders);
- water sports;
- damage to the cervical spine and head trauma associated with surfing, water skiing, snorkeling, diving, etc.
- accidents on boats and other traumas (bites, lacerations).
View a drowning person in life may be different from the “Hollywood” representations: the water is not always shouting, calling for help and waving his arms.
What happens to the human body when drowning
There are several options leading without timely relief to an unfavorable outcome.
First option: wet or blue drowning
Drowning in fresh water
Fresh water gets into the respiratory tract, lungs and stomach, and then actively absorbed into the blood, diluting it.
Disturbed electrolyte balance, there is a massive destruction of red blood cells, the oxygen level decreases and carbon dioxide that are toxic to the body, increases.
After resuscitation of the drowned man develops acute respiratory failure on a background of pulmonary edema, the main symptom is the appearance of the bloody foam from his mouth.
So change on the background of falling fresh water:
- hypervolemia, shifting hypovolemia on the background of pulmonary edema and redistribution of the liquid;
Drowning in sea water
Sea water has a higher concentration due to the contained salts, in comparison with fresh fluid and blood.
After the intake seawater is the concentration, changing the rheological properties of blood, and joined by hypovolemia, hypernatremia, hypercalcemia and hyperchloremia.
Second option: dry drowning
The mechanism that leads to acute hypoxia, other. When exposed to water develops the reflex closure of the glottis (laryngospasm), which prevents the entry of air into the lungs.
Fluid in the respiratory tract no.
Often pathology is recorded in children and women, when diving in dirty or chlorinated water.
Liquid in large quantity found in the stomach.
Third option: secondary drowning
Secondary drowning is always accompanied by any original disease. Loss of consciousness may provoke, for example, an epileptic seizure.
Fourth option: syncope drowning
Spasm of peripheral vessels leads to reflex cardiac arrest even with minimal water penetration into the respiratory tract.
So, for example, the sudden immersion in ice water, develop a spasm of peripheral blood vessels in cardiac arrest. Pulmonary edema is not typical. Pale skin, bluish tint no.
Symptoms and signs
The clinical picture depends on the duration of stay under water, its performance, timeliness and quality of emergency care and the underlying cause.
If the pathological process has not gone too far, immediately after extraction from water can be the following symptoms and signs:
- agitation or retardation;
- lividity of the skin;
- noisy breathing with coughing;
- instability of blood pressure and heart rate.
For agony is characterized by the following signs:
- loss of consciousness;
- abnormal heart rhythm;
- the visualization of swollen neck veins;
- the emergence of foam from his mouth in a small amount when spasm of the glottis (pulmonary edema – pink froth of blood);
- spastic contraction of the masticatory muscles;
- the weak response of pupils to light.
The condition can lead to clinical death: cessation of breathing and absence of pupillary reflex.
First aid for the drowning: how to act
If one has not yet disappeared under the water, to swim for it back is recommended to prevent dangerous seizure on his part. In a state of shock when a paralyzing fear of the victim’s conduct difficult to predict, so do not waste time talking, most likely, is addressed to potential floater is not perceived.
If still you are captured and pulled down dive together with the drowning, there’s a chance that he will automatically relax the arms to make an attempt to stay on the surface.
If the sinking went under water, hold your breath and dive, open your eyes, look around.
When detected, take the victim’s arm or hair, push off from the bottom and POPs.
Ask someone to call intensive care team.
The absence of the victim breathing, indication for mechanical ventilation, it is recommended to perform in the water, subject to the control and possession of the necessary skills.
On the banks initially rate the condition of the victim: inspect the head, cervical spine for damage, determine if there is heartbeat and breathing.
Rule 3, “P”: to see, to hear, to feel.
If no trauma, place the drowned stomach to her thigh upside down and with two hands, make some strong pressing movements of the chest, in the epigastric region, to liberate the Airways of fluid.
It is important
If you have a pale (skin is a pale shade of gray) drowning in the background of reflex spasm of the glottis, the water is practically absent, therefore, immediately proceed to artificial respiration and indirect heart massage. Better if you have an assistant: one does CPR, the other compressions.
Place the victim on his back and wrap a blanket or plaid.
Often in the oral cavity fall foreign matter (silt, algae, dirt, vomit, mucus, etc.), they should be removed. To do this, wrap a scarf or bandage on 2 fingers and circular motions to get rid of excess.
Remove dentures, if possible.
Loosen the clothes from the victim. Remember, even the buttons are able to cause injuries for massage, especially a child.
Proceed to the primary complex of cardiopulmonary resuscitation.
We recommend you to read: Algorithm of cardiopulmonary resuscitation in children and adults: the rules of first aid
It is important
From drowning paralysis of the respiratory center develops in 3-5 minutes, and the heart continues to work within 15 minutes. If the heartbeat is saved, only perform artificial respiration: mouth-to-mouth, using a handkerchief, with a frequency of 15-18 breaths per minute. The person’s nose should be pinched.
Any kind of drowning strictly forbidden to turn the head of the victim, it contributes to trauma with fracture of the cervical spine.
Transport is possible only on a hard surface, better if it is done by a specialized team.
When drowning in the icy water slows metabolism throughout the body, including in the brain. The chances of recovery in this case is the highest.
Don’t waste time to move the victim into a warm room, begin resuscitation on the spot.
The rescue operation to follow the arrival of the ambulance or until the biological signs of death (rigor Mortis, spots).
If within 30-40 minutes of positive dynamics is not observed, there is a possibility, even when restoring breathing and heartbeat, in the future, the development of severe paralysis and disorders of higher brain activity (profound disability).
How to do chest compressions and precordial blow
Divide the chest into 3 parts and locate the boundary between the middle and bottom. In this area, apply a punch may be restored independent heartbeat. If not chained to the castle by hand (leading arm from the top) follow the rocking motion (2 sec) lower area of the sternum.
Hands perpendicular to the surface of the chest of the victim.
30 compression 2 breaths, if CPR does one person. At the time of the introduction of air stimulation of the heart is stopped.
Drowned the maximum head thrown back.
Children of preschool age massage is performed with one hand, and the infant – 2 fingers (high probability of broken ribs), frequency of 100-120 strokes per minute.
If 2 people are involved, all actions must be coordinated: 4-5 pressure on the sternum on the exhale, one blowing air into the lungs.
The prognosis for drowning
Patients who were resuscitated promptly can recover completely.
Victims who had been 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 the people needed to continue cardiopulmonary resuscitation on arrival to the hospital, and 60-100% of survivors in this group was neurologic complications.
Pediatric research shows that the mortality rate is 30% in children who required specialized treatment for drowning in the ICU. Serious brain damage was recorded in 10-30% of cases.
Victoria Mishina, doctor, medical commentator