Drowning is a type of mechanical asphyxia (suffocation) as a result of water entering the respiratory tract.
The changes that occur in the body during drowning, in particular, the period of dying under water, depend on a number of factors: on the nature of the water (fresh, salty, chlorinated fresh water in pools), on its temperature (ice, cold, warm), on the presence of impurities (silt, mud, etc.), from the state of the body of the victim at the time of drowning (overwork, agitation, alcohol intoxication, etc.).
True drowningoccurs when water enters the trachea, bronchi and alveoli. Usually a drowning person has a powerful nervous excitement; he expends colossal energy to resist the elements. Taking deep breaths during this struggle, the drowning person swallows a certain amount of water along with the air, which disrupts the rhythm of breathing and increases body weight. When a person in exhaustion plunges into water, there is a delay in breathing as a result of a reflex spasm of the larynx (closing of the glottis). At the same time, carbon dioxide quickly accumulates in the blood, which is a specific irritant of the respiratory center. Loss of consciousness sets in, and the drowning person makes deep breathing movements under water for several minutes. As a result, the lungs are filled with water, sand and air is forced out of them. The level of carbon dioxide in the blood rises even more, a repeated holding of the breath begins, and then deep death breaths for 30-40 seconds. Examples of true drowning are fresh water and sea water drowning.
Drowning in fresh water.
Upon penetration into the lungs, fresh water is quickly absorbed into the blood, since the concentration of salts in fresh water is much lower than in the blood. This leads to blood thinning, an increase in its volume and the destruction of red blood cells. Sometimes pulmonary edema develops. A large amount of stable pink foam is formed, which further disrupts gas exchange. The function of blood circulation stops as a result of impaired contractility of the ventricles of the heart.
Drowning in sea water.
Due to the fact that the concentration of dissolved substances in sea water is higher than in the blood, when sea water enters the lungs, the liquid part of the blood, together with proteins, penetrates from the blood vessels into the alveoli. This leads to thickening of the blood, an increase in the concentration of potassium, sodium, calcium, magnesium and chlorine ions in it. A large amount of fluid is heated in the alveoli, which leads to their stretching up to rupture. As a rule, pulmonary edema develops when drowning in sea water. That small amount of air that is in the alveoli contributes to the whipping of the liquid during respiratory movements with the formation of a persistent protein foam. Gas exchange is sharply disturbed, cardiac arrest occurs.
When carrying out resuscitation, the time factor is extremely important. The earlier the revival is started, the greater the chance of success. Based on this, it is advisable to start artificial respiration already on the water. To do this, carry out periodic blowing of air into the mouth or nose of the victim during his transportation to the shore or to the boat. On the shore, the victim is examined. If the victim did not lose consciousness or is in a state of slight fainting, then in order to eliminate the consequences of drowning, it is enough to smell ammonia and warm the victim.
If the circulatory function is preserved (pulsation in the carotid arteries), there is no breathing, the oral cavity is freed from foreign bodies. To do this, it is cleaned with a finger wrapped in a bandage, removable dentures are removed. It is not often that the affected person’s mouth is unbelievably open due to spasm of the masticatory muscles. In these cases, carry out artificial respiration “mouth to nose”; if this method is ineffective, a mouth expander is used, and if it is not available, then some flat metal object is used (do not break your teeth!). As for the release of the upper respiratory tract from water and foam, it is best to use suction for these purposes. If it is not there, the victim is laid with his stomach down on the rescuer’s thigh, bent at the knee joint. Then sharply, vigorously compress his chest. These manipulations are necessary in those cases of resuscitation, when to carry out artificial ventilation of the lungs is improbable due to the blockage of the airways by water or foam. This procedure must be carried out quickly and vigorously. If there is no effect for several seconds, it is necessary to start artificial ventilation of the lungs. If the skin is pale, then it is necessary to proceed directly to artificial ventilation of the lungs after cleansing the oral cavity.
The victim is laid on his back, freed from restrictive clothing, his head is thrown back, placing one hand under the neck, and the other is placed on the forehead. Then the lower jaw of the victim is pushed forward and up so that the lower incisors are ahead of the upper ones. These techniques are performed in order to restore the patency of the upper respiratory tract. After that, the rescuer takes a deep breath, holds his breath a little and, pressing his lips tightly against the mouth (or nose) of the victim, exhales. In this case, it is recommended to pinch the nose (when breathing mouth to mouth) or mouth (when breathing mouth to nose) of the person being revived. Exhalation is carried out passively, while the airways must be open.
It is difficult to carry out artificial ventilation of the lungs for a long time using the method described above, since the rescuer may develop unwanted disorders from the cardiovascular system. Based on this, when carrying out artificial ventilation of the lungs, it is better to use apparatus breathing.
If, during artificial ventilation of the lungs, water is released from the respiratory tract of the victim, which makes it difficult to ventilate the lungs, you need to turn your head to the side and raise the opposite shoulder; with all this, the mouth of the drowned person will be lower than the chest and the liquid will pour out. After that, you can continue artificial ventilation of the lungs. In no case should artificial ventilation of the lungs be stopped when independent respiratory movements appear in the victim, if his consciousness has not yet recovered or if the rhythm of breathing is disturbed or sharply accelerated, which indicates an incomplete restoration of respiratory function.
In the event that there is no effective blood circulation (there is no pulse in large arteries, heart beats are not heard, blood pressure is not determined, the skin is pale or cyanotic), an indirect heart massage is performed simultaneously with artificial ventilation of the lungs. The person assisting stands on the side of the victim so that his arms are perpendicular to the plane of the chest of the drowned person. The resuscitator places one hand perpendicular to the sternum in its lower third, and puts the other on top of the first hand, parallel to the plane of the sternum. The essence of an indirect heart massage is a sharp compression between the sternum and the spine; with all this, blood from the ventricles of the heart enters the systemic and pulmonary circulation. Massage should be performed in the form of sharp jerks: do not strain the muscles of the hands, but should, as it were, “dump” weight of your body down – leads to the deflection of the sternum by 3-4 cm and corresponds to the contraction of the heart. In the intervals between pushes, the hands cannot be torn off the sternum, but there should not be any pressure – this period corresponds to the relaxation of the heart. The movements of the resuscitator should be rhythmic with a frequency of 60-70 shocks per minute.
Massage is effective if the pulsation of the carotid arteries begins to be determined, the dilated pupils narrow to that extent, cyanosis is reduced. When these first signs of life appear, indirect heart massage should be continued until the heartbeat begins to be heard.
If resuscitation is carried out by one person, then it is recommended to alternate chest compressions and artificial respiration as follows: for 4-5 pressures on the sternum, 1 air is blown. If there are two rescuers, then one is engaged in indirect heart massage, and the other is in artificial ventilation of the lungs. At the same time, 1 air blowing is alternated with 5 massage movements.
It should be borne in mind that the victim’s stomach can be filled with water, food masses; this makes it difficult to carry out artificial ventilation of the lungs, chest compressions, provokes vomiting.
After removing the victim from the state of clinical death, he is warmed (wrapped in a blanket, covered with warm heating pads) and the upper and lower extremities are massaged from the periphery to the center.
When drowning, the time during which a person is likely to be revived after being removed from the water is 3-6 minutes.
The temperature of the water is of great importance during the recovery period of the victim. When drowning in ice water, when the body temperature drops, recovery is likely after 30 minutes. after an accident.
No matter how quickly the saved person regains consciousness, no matter how prosperous his condition may seem, placing the victim in a hospital is an indispensable condition.
Transportation is carried out on a stretcher – the victim is laid on his stomach or on his side with his head down. With the development of pulmonary edema, the position of the body on the stretcher is horizontal with the head end raised. During transportation continue artificial ventilation of the lungs.