Rules for rescuing and providing emergency first aid to a drowning person - an algorithm for resuscitation actions. Providing assistance to a drowning person Message on the topic of first aid for drowning
The concept of drowning and its types
By drowning called the state when respiratory tract clogged with water, silt or dirt and air cannot penetrate into the lungs and saturate the blood with oxygen.
Distinguish three types of drowning:
- white asphyxia(imaginary drowning) - characterized by a reflex cessation of breathing and heart function. The reason for this is a slight ingress of water into the inhalation tract, which causes spasm of the glottis. With white asphyxia, a person can sometimes be saved even 20-30 minutes after drowning;
- blue asphyxia(drowning itself) - occurs as a result of the penetration of water into the alveoli; in these drowned people, the face and especially the ears, fingertips and mucous membrane of the lips are violet-blue in color; the victim can be revived if his stay under water lasted no more than 4-6 minutes;
- drowning due to depression of function nervous system - can occur as a result of cold shock, as well as alcohol intoxication; cardiac arrest occurs after 5-12 minutes and coincides with the cessation of breathing. This type of drowning is kind of intermediate between white and blue asphyxia.
Providing first aid for drowning
Immediately after removing the victim from the water, you should pull his tongue out of his mouth, clean his mouth and nose, place his stomach on the rolled-up clothing or knee of the person providing assistance and, pressing on his back, release the lungs from the trapped water. After this, I turn the victim onto his back, place a cushion of clothing under his head so that the head is thrown back, and begin artificial respiration. In order to avoid the tongue from sinking, which can close the entrance to the larynx, it is pulled out of the mouth and held with a loop made of a bandage, handkerchief, etc.
Most in an efficient way artificial respiration for drowning is considered to be a “mouth-to-mouth” method. The “mouth to nose” method is used when, for some reason, it was not possible to open the victim’s convulsively clenched jaws.
Carrying out artificial respirationThey're starting artificial respiration with exhalation. The volume of blown air is 1 - 1.5 liters. A sign that the air has passed is the rise of the victim's chest. Insufflation frequency - 12-15 per minute. After insufflation, you can lightly press on the victim’s abdomen, thereby helping the air escape.
If the heartbeat cannot be heard, indirect cardiac massage should be performed simultaneously with artificial respiration. To do this, place one palm at a distance of two fingers from the base of the sternum, then place the other on it perpendicularly, and, using body weight, apply 4-5 pressures on the sternum per injection (for children under 8 years of age, pressure is applied with one palm at a frequency of 100 pressures per minute , and for an infant - two fingers with a frequency of 120 pressures per minute). In this case, the sternum in an adult should bend by 4-5 cm when performing indirect cardiac massage, in a child under 8 years old - by 3-4 cm, and in infant up to 1 year - by 1.5-2 cm.
Artificial respiration and chest compressions should be performed until spontaneous breathing and pulse appear.
This section is for parents so that they can right moment quickly and without unnecessary confusion to respond to extraordinary events that may happen to children and provide them with first aid.
First aid for drowning
Remember! When near the water, never forget about your own safety and be ready to help someone in trouble. When rescuing a drowning person, use any available means.
Stages of assistance
There are two stages of providing assistance in case of drowning. The first is the actions of the rescuer directly in the water, when the drowning person is still conscious, takes active actions and is able to independently stay on the surface.
In this case, there is a real opportunity to prevent a tragedy and get away with only a “slight fright.” But it is precisely this option that poses the greatest danger to the rescuer and requires, first of all, the ability to swim, good physical fitness and knowledge of special techniques for approaching a drowning person, and most importantly, the ability to free oneself from “dead” grips.
Remember! Panic fear of drowning - mortal danger for the rescuer. Don't give up trying to save a drowned person.
In the case when a “lifeless body” is removed from the water - the victim is unconscious, and often without signs of life - the rescuer, as a rule, has no problems with his own safety, but the chances of rescue are significantly reduced.
If a person has been under water for more than 5-10 minutes, he is unlikely to be brought back to life. Although in each specific case the outcome will depend on the time of year, the temperature and composition of the water, the characteristics of the body, and most importantly, on the type of drowning and the correctly chosen tactics of providing assistance.
Remember! Success can only be hoped for if assistance is provided correctly, taking into account the type of drowning.
Signs of true ("blue") drowning
This type of drowning is easily identified by appearance drowned - his face and neck are blue-gray, and pinkish foam comes out of his mouth and nose. The swollen vessels of the neck confirm this assumption. "Blue" drowning is most common in children and adults who cannot swim, in people under the influence of alcohol, and even in good swimmers when there is a break. eardrum when they suddenly lose coordination.
In the same way those who last minute fought for his life. While underwater, they continued to move actively, holding their breath as much as possible. This very quickly led to brain hypoxia and loss of consciousness.
As soon as a person lost consciousness, water immediately began to flow into the stomach and lungs in large quantities. This volume was quickly absorbed and passed into the bloodstream, significantly filling it with liquefied blood.
Causes of death in the first minutes after rescue
1. Pulmonary edema
When drowning, there is such a sharp increase in the volume of circulating blood (HYPERVOLEMIA) that even the athlete’s heart is not able to cope with it. The left ventricle is not able to pump such an amount of liquefied blood through itself into the aorta and literally choke on its excess. This leads to a sharp increase in hydrodynamic pressure in the pulmonary circulation and the pulmonary venous system.
It is squeezed out of the bloodstream into the alveoli liquid part blood - plasma, which, entering their lumen, instantly foams. A large amount of pinkish foam is released from the upper respiratory tract, which, filling the lumen of the alveoli and airways, stops gas exchange. A condition develops that is medically called pulmonary edema.
Remember! Without timely delivery emergency assistance Pulmonary edema ends only in death.
Most reliable sign This formidable condition is bubbling breathing. This bubbling sound, clearly audible over several steps, resembles the “bubbling” of bubbles in boiling water. It seems as if something is “boiling” inside the patient.
Another symptom of pulmonary edema is frequent coughing with pinkish foamy sputum. In extremely severe cases, so much foam is formed that it begins to come out of the mouth and nose.
The severity of the condition will be aggravated by the fact that aspiration of water will very quickly lead to mechanical asphyxia, which can only be eliminated by removing water and foam from the respiratory tract. But even in the case of successful resuscitation, the formation of a large number of ATELECTASES (zones of incomplete expansion or collapse of the alveoli that are not filled with air) will certainly occur.
This will result in a sharp increase in the degree pulmonary insufficiency and hypoxia, which will persist for several days.
2. Brain edema
Profound hypoxia of the brain and a sharp increase in circulating blood volume will cause cerebral edema. This is extremely dangerous condition, as a rule, is difficult to recognize in the first stages of care, but coma, frequent vomiting and the appearance of seizures worsen the prognosis.
3. Sudden cardiac arrest
Entry into the blood large quantities water will significantly reduce its viscosity and change electrolyte balance, which will provoke severe heart rhythm disturbances and sudden cardiac arrest. To full recovery Due to the electrolyte composition of the blood and its normal viscosity, the threat of repeated cardiac arrest constantly hangs over the victim.
4. Spicy renal failure
In the next 24 hours after rescue, victims most often die from acute renal failure, which develops due to massive hemolysis (destruction) of red blood cells. due to excessive blood thinning and a gross imbalance between the pressure inside the “plate” of the red blood cell and the surrounding plasma, it literally explodes from the inside.
Free hemoglobin is released into the blood, which should only be found inside red blood cells. The presence of free hemoglobin in the blood leads to severe impairment of kidney function: their delicate filtration membranes of the tubules are easily damaged by giant hemoglobin molecules. Kidney failure develops.
Remember! Within 3-5 days after rescue, the threat of repeated cardiac arrest, development of pulmonary and cerebral edema and acute renal failure remains.
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, as well as searching for the pulse on carotid artery. 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.
Before the doctors arrive, do not leave the drowned person unattended for a second: something can happen every minute. sudden stop hearts.
Remember! First stage done correctly urgent measures will prevent the development of many dangerous 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 onto his back, look at the reaction of the pupils to light and check the pulsation in the carotid artery. If they are missing, proceed immediately cardiopulmonary resuscitation.
Remember! If there are no signs of life, it is unacceptable to waste time on complete removal 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.
Providing assistance after recovery
Even when the drowned person has a heartbeat and spontaneous breathing, his consciousness has returned, do not fall into the euphoria that so quickly covers those around you. Only the first step was taken in a whole complex of measures necessary to preserve his life.
To prevent most complications, it is necessary, immediately after restoration of independent breathing and heartbeat, to turn the rescued person back onto his stomach and try to remove the water more thoroughly.
Everything that will be said below relates to the actions of medical specialists and may seem unnecessary to a lay person. But if you want to have at least the slightest idea about the further problems of rescuing a drowned person, understand the reasons for the failures of medical teams and get rid of the illusions of the uninitiated, and most importantly, take the initiative in rescue and not make unforgivable mistakes, I recommend that you carefully read the following set of measures.
1. Complex medical measures in the first hours after rescue
To eliminate hypoxia, you should start oxygen therapy as quickly as possible - inhaling oxygen or its mixture with air using portable oxygen devices (at the scene of an incident, their function will be successfully replaced by an oxygen cushion).
To reduce the increased volume of circulating blood, dehydrate - remove fluid from the body. The victim is given intravenous large doses of potent diuretics (Lasix, urea, mannitol or glucose).
To reduce the likelihood of developing cerebral edema, 10 ml of 25% magnesium sulfate is injected intramuscularly.
For stimulation respiratory center and rapid normalization of blood pressure levels, subcutaneous administration of solutions of cardamine and caffeine is prescribed.
If the victim has suffered a condition clinical death, then to this therapy you will need to add intravenous drip administration of alkalizing solutions: soda solution or trisamine.
2. Assisting with pulmonary edema
If signs of pulmonary edema appear, the victim must immediately sit down or put his body in a position with the head end raised, apply tourniquets to the hips, and then inhale oxygen from an oxygen bag through alcohol vapor.
These quite accessible manipulations can have an effect in relieving pulmonary edema. By elevating the head end or sitting the patient down, you will ensure that most of the blood is deposited in the lower extremities, intestines, and pelvis. This simplest measure alone can not only alleviate his condition, but also completely eliminate pulmonary edema.
Remember! The first thing you need to do if your breathing is bubbling and foamy discharge from the respiratory tract, - sit the patient down as quickly as possible or raise his head end.
Tourniquets on the thighs will allow for so-called “bloodless bloodletting.” To make this method more effective, it is advisable to apply a warm heating pad to the feet or immerse them in warm water and only then apply tourniquets to the upper third of the thighs.
Under the influence hot water blood will rush into lower limbs, and the applied tourniquets will prevent its return. (Tourniquets on the thighs will not compress the arteries, but will make it difficult venous drainage: The blood will be trapped.)
Remember! The tourniquets are applied for no more than 40 minutes and removed from the right and left legs alternately with an interval of 15-20 minutes.
Inhaling oxygen through alcohol vapor (to do this, just put a piece of cotton wool with alcohol into the mask at the level of the lower lip) is one of the most effective means combating foaming during pulmonary edema. Alcohol vapor significantly reduces the surface tension of the shell of microscopic bubbles that make up the foam formed in the alveoli.
Destroying the bubble shells and preventing the formation of new ones will turn the entire volume of the foamed mass into small quantity sputum, which can be easily removed with a cough, a rubber balloon or a special device for sucking fluid from the respiratory tract - a vacuum extractor.
Remember! In no case should defoaming be considered the only and main method in the fight against pulmonary edema. Although it is very effective, it inherently eliminates only the consequences, and not the cause of a life-threatening condition.
3. Rules for hospitalization
Remember! You cannot take your eyes off the patient for a moment: at any moment, repeated cardiac and respiratory arrest may occur, and pulmonary or cerebral edema may develop.
Unfortunately, the lion's share of water accidents occur in places where it is very difficult to call an ambulance. And then you are faced with a whole range of intractable problems, which are sometimes difficult for even a professional to cope with. Therefore, it is my duty to try to warn you against those gross tactical mistakes that can no longer be corrected.
Before you decide to transport a rescued person using random transport, imagine this situation: on the way to the hospital somewhere on an abandoned road, the victim’s heart suddenly stopped. Even if you manage to react in time and quickly pull him out of the back seat, lay him on his back and begin cardiopulmonary resuscitation, what will you do when its effectiveness is obvious, but an independent heartbeat does not appear? Wait for a random passer-by or a driver on a cart, who appear in this wilderness no more than twice a week? Once saved by you, this time is doomed!
Remember! To avoid becoming a hostage to criminal initiative, do not try to transport the victim yourself when there is even the slightest opportunity to call the rescue service.
Only in situations where the accident occurred far from populated areas and busy highways, will you have to transport the drowned person in a randomly available vehicle. In this case, preference should be given to a bus or a covered truck, in which you can place the rescued person on the floor and take with you two or three accompanying persons, whose help may be required at any moment.
"Pale" drowning
This type of drowning occurs when water does not reach the lungs and stomach. This happens when drowning in very cold or chlorinated water. In these cases, the irritating effect of ice water in an ice hole or highly chlorinated water in a pool causes a reflex spasm of the glottis, which prevents its penetration into the lungs.
In addition, unexpected contact with cold water often leads to reflex cardiac arrest. In each of these cases, a state of clinical death develops. Skin acquire a pale gray color, without pronounced cyanosis (blue discoloration). Hence the name of this type of drowning.
The nature of foamy secretions from the respiratory tract will also differ markedly from the abundant discharge during true “blue” drowning. "Pale" drowning is very rarely accompanied by the release of foam. Even if a small amount of “fluffy” foam appears, after removing it there are no wet marks left on the skin or napkin. This type of foam is called “dry”.
The appearance of such foam is explained by the fact that the small amount of water that enters oral cavity and the larynx to the level of the glottis, upon contact with saliva mucin, forms a fluffy air mass. These secretions are easily removed with a napkin and do not interfere with the passage of air. Therefore, there is no need to worry about their complete removal.
Features of first aid for “pale” drowning
In case of “pale” drowning, there is no need to remove water from the respiratory tract and stomach. Moreover, it is unacceptable to waste time on this. Immediately after removing the body from the water and establishing signs of clinical death, begin cardiopulmonary resuscitation. Decisive factor rescue in the cold season will be not so much the time spent under water, but the delay in starting assistance on the shore.
The paradox of revival after drowning in cold water is explained by the fact that a person in a state of clinical death finds himself in such a deep hypothermia (lower temperature), which only science fiction writers in novels about “frozen” people can dream of.
In the brain, as indeed in the entire body, immersed in ice water, metabolic processes almost completely stop. Low environmental temperature significantly delays the onset of biological death. If you read in the newspaper that they managed to save a boy who fell into an ice hole and was under the ice for more than an hour, this is not a journalist’s invention.
Remember! If you drown in cold water, there is every reason to expect salvation even if you stay under water for a long time.
Moreover, with successful resuscitation, one can hope for favorable course post-resuscitation period, which, as a rule, is not accompanied by such serious complications as pulmonary and cerebral edema, renal failure and repeated cardiac arrest, characteristic of true drowning.
After removing a drowned person from an ice hole, it is unacceptable to waste time transferring him to warm room to begin providing emergency assistance there. The absurdity of such an act is more than obvious: after all, it is first necessary to revive the person, and only then take care of the prevention of colds.
When you need to free your chest to perform chest compressions, don’t even let the severe frost and icy clothes stop you. This is especially true for children: their sternum, which has a cartilaginous base, is easily injured during resuscitation even by ordinary buttons.
Only after signs of life appear, the victim should be transferred to a warm place and general warming and rubbing should be carried out there. Then he should be changed into dry clothes or wrapped in a warm blanket. The rescued person will need plenty of warm drinks and drip injections of heated plasma-substituting fluids.
Remember! After any case of drowning, the victim must be hospitalized, regardless of his condition and well-being.
The victim must be taken to medical institution, even if he says he feels fine. this is important because he may develop the so-called secondary drowning syndrome: pulmonary edema, oxygen starvation of the brain, cardiac arrest.
How long does a person remain alive if he loses the ability to breathe? Brain cells remain viable under hypoxic conditions for no more than 5-6 minutes. Although when drowning in cold water, this time may increase. In any case, assistance to the victim must be provided before the medical team arrives. In this situation, minutes matter. This is why knowing how to provide help is very important.
Not all people, however, are ready to answer the question, much less show in practice how to act correctly in the event of drowning. And this is very sad. For some reason, many people believe that only employees of specialized services should have such skills, but an ordinary person far from medicine does not need to know this. But life sometimes puts people in difficult situations. It's very scary to see someone die close person, and don’t know how to help him.
What is drowning?
This is a life-threatening condition characterized by the inability to breathe as a result of a person falling into water or other liquid. This often causes the airways to fill with water, although this is not strictly necessary. Death by respiratory failure may occur even if the lungs remain “dry”. On this basis, by the way, they distinguish different types drowning.
Classification by mechanism leading to death
- True drowning. It is called that because in this case water (or other liquid) enters the lungs. Pathological processes The factors underlying true drowning vary depending on whether the drowning occurred in fresh or salt water. In the first case, water quickly penetrates from the alveoli into the vascular bed, thinning the blood and destroying red blood cells. Salt water, on the contrary, promotes the release of plasma from the vessels, which is accompanied by thickening of the blood, as well as the development of pulmonary edema.
- Asphyxial drowning. In this case, water does not enter the lungs, since the glottis closes, protecting the airways from liquid penetration into them. However, breathing still becomes impossible, because with laryngospasm, air is also not allowed to pass through. A person dies from suffocation.
- Syncopal drowning. The main cause of death is reflex cardiac arrest. The lungs remain “dry”. Similar situation possible when drowning in very cold water.
Classification according to the color of the victim’s skin
Types of drowning based on skin color:
- White asphyxia. As the name suggests, it is characterized by pronounced pallor of the skin. Occurs when the respiratory tract is not flooded with liquid. This type is most typical for the syncope mechanism of drowning, when death occurs as a result of cessation of cardiac activity.
- Blue asphyxia. Occurs when the victim commits breathing movements, causing the lungs to fill with water. The skin becomes bluish due to severe hypoxia. Death occurs due to respiratory failure. Cardiac arrest occurs after breathing has stopped.
Appearance of the victim
Different types of drowning have certain differences in clinical manifestations.
If the victim was conscious at the time of immersion in water, the scenario for the development of events looks something like this. A man tries to escape by swallowing water. Breathing becomes impossible, the body experiences hypoxia, as a result of which a characteristic bluish coloration of the skin appears. Dilatation of the veins of the neck is often observed. Foaming at the mouth pink color. If a person is removed from the water during the agony stage, breathing and cardiac activity may still persist.
If drowning was preceded by depression of central nervous system functions, laryngospasm often occurs. The lungs do not fill with water, but death also occurs as a result of asphyxia. The skin acquires a bluish tint.
Occurs against the background of severe fright or cold shock. The cessation of cardiac activity comes first in the pathogenesis. The skin is pale, there is no discharge of fluid and foam from the victim’s nose and mouth, which is typical for other types of drowning. White asphyxia is most favorable for resuscitation; the time with it can be significantly longer.
Basic principles of drowning rescue
Types of drowning are varied and require different approaches to assistance, however general principles in all cases remain unchanged.
All activities include 2 stages:
- Removing the victim from the water.
- Providing assistance on shore.
How to save a drowning person?
No matter how different the types of drowning are, first aid for drowning should begin with ensuring the safety of the rescuer himself. A drowning person (if he is still conscious) can behave extremely inappropriately. That is why, when pulling a victim out of the water, you should be careful. Otherwise, the rescuer risks finding himself in the role of a drowning person.
If the person is close enough to the shore, you can try to reach him with a stick, use a rope or other devices to pull him out. If the victim is too far away, you will have to swim to get to him. The main thing in this situation is not to forget about the danger, because the victim can drown his savior. Therefore, you need to act quickly and unceremoniously. It is best to swim up to the drowning person from behind and wrap one arm around his neck, you can grab his hair (this is even safer), and then pull him to land as quickly as possible.
Remember: you don’t need to get into the water if you’re not a good swimmer!
There are different types of drowning, and their signs are discussed above. This knowledge must be taken into account when providing assistance to the victim.
- Everything is extremely simple if the person removed from the water is conscious. The main actions will be aimed at warming him up and calming him down.
- If a person is unconscious, the first thing to do is remove water from the respiratory tract. In case of white asphyxia, this is not necessary (the mechanism of this type of drowning is discussed above), you can immediately begin resuscitation.
- For the blue type of drowning, we first clear the mouth and nose of algae, sand, etc. Then we press on the root of the tongue, thereby determining the presence of a gag reflex. The preservation of the latter means that the victim is alive, so the primary task will be to remove water from the lungs and stomach. To do this, we turn the victim onto his stomach, turn his head to the side, induce vomiting several times, and press on his chest. Then we repeat these steps every 5-10 minutes until water stops coming out of the mouth and nose. It is necessary to monitor breathing and pulse, and be prepared to perform resuscitation.
- If there is no gag reflex, it is necessary to urgently check the presence of vital functions. Most likely there won't be any. Therefore, you should not spend a lot of time removing water from the lungs (no more than 1-2 minutes), but begin resuscitation as quickly as possible.
The above were given different approaches to assist the victim. There are different types of drowning; it is not surprising that they require different measures. However, it is always carried out according to a specific plan, which is not influenced by the causes that led to clinical death.
What is included in the revitalization package?
- Restoration of airway patency.
- Artificial respiration.
- Indirect cardiac massage.
No matter how different the types of drowning, first aid always begins with clearing the mouth and nose of sand, algae, vomit, etc. Then water is removed from the lungs. For this purpose, the victim should be turned face down and placed with his stomach on his knee. The head will thus be lower than the body. Now you can press on the chest, stimulating the flow of fluid from the lungs. If help is provided small child, you can throw it over your shoulder head down or even take it by the legs and turn it over, thereby creating more favorable conditions for the flow of water from the lungs.
Next, we proceed to the implementation. The victim should be laid on a hard surface, head thrown back, fingers pushed forward lower jaw and, pressing on the chin, open your mouth. Now you can begin to press your lips tightly to the victim’s mouth and exhale. The criterion for effectiveness will be the rise of the chest. After two exhalations, we begin to place the base of the right hand on lower third sternum, left hand put it on top of the right one. We begin to perform chest compressions, making sure that the arms remain straight and do not bend at the elbows. By latest recommendations(2015) the exhalation to compression ratio should be 2:30 regardless of whether one or two rescuers are performing resuscitation.
And in conclusion
Never forget about the rules of behavior on the water. It is easier to prevent a tragedy than to try to correct it. Remember: life is given only once. Take care of her and don't play with death.
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Drowning, like other causes of accidental death, is often reported in young and healthy individuals.
The prognosis for drowning depends on the timeliness of removing the victim from the water and carrying out resuscitation measures.
Definition
There are many definitions of the concept of drowning, probably no less than authors dealing with this problem.
Some authors define drowning as death from suffocation when immersed in water. Some authors use the more general term "immersion syndrome", although it is also used to describe sudden death due to immersion in cold water. The occurrence of post-immersion syndrome, or secondary drowning, is associated with a deterioration in the condition of a seemingly healthy patient, which occurs as a result of immersion under water.
Epidemiology
About 4,500 people drown in the United States each year; Drowning is the third leading cause of accidental death.
Much more victims (their exact number is unknown) can be saved even in the most severe cases of drowning. Drowning in fresh water, especially in whirlpools, occurs more often than in salt water. The highest incidence of death from drowning occurs in adolescence and young adulthood, although children under 4 years of age represent a group increased risk. In young children, drowning is not always associated with certain injuries, which is due to high degree responsibility of their parents (or loved ones) and timely assistance in case of an accident.
Alcohol or drugs often play a major role in drowning.
In some cases, drowning can occur due to trauma, especially when the cervical spine is damaged. Factors such as overestimation of swimming or diving ability, hypothermia, and convulsions often contribute to drowning.
Clinical picture
After a critical incident occurs, panic often sets in, followed by intense movements in the water and hopeless holding of breath or hyperventilation.
All this quickly leads to vomiting and aspiration of water and vomit. Dry drowning without aspiration is the result of laryngospasm and glottic closure, which is believed to be the cause of death in 10-15% of cases. Whatever the development mechanism critical condition, the general outcome is deep hypoxemia.
Both seawater and freshwater wash surfactant out of the alveoli, but freshwater also changes the surface tension properties of the surfactant. Loss of surfactant leads to atelectasis, disruption of the ventilation-perfusion relationship and damage to the alveolar-capillary membrane. Hypoxemia occurs when even small amounts of water are aspirated; in the experiment, it is observed with aspiration of 2.2 ml/kg of fresh or salt water. Aspiration of bacteria, algae, sand, particulate matter, vomit, and chemical irritants may contribute to hypoxemia.
Noncardiogenic pulmonary edema occurs as a result of direct pulmonary injury, loss of surfactant, inflammatory changes, and cerebral hypoxia.
The occurrence of respiratory failure and cerebral ischemia after a dive poses a threat to life.
According to Modell et al., in 40 patients who suffered from drowning, the mean arterial pressure PO1 during spontaneous breathing of room air was 67 mmHg. More than 1/3 (of 91) of their patients were intubated; most of them required artificial ventilation with positive pressure at the end of exhalation. Despite such a high incidence of pulmonary dysfunction, death was observed in only one patient who had a Pa02 FiO of more than 150; death occurred as a result of neurological disorders.
Poor tissue perfusion and hypoxemia in the vast majority of patients lead to metabolic acidosis, however the condition cardiovascular system can be surprisingly stable, which is probably explained by the young age of the victims. Changes in blood volume depend on the nature and amount of fluid aspirated, but life-threatening changes are uncommon. Electrolyte imbalances in drowning victims are rarely significant; hematological parameters usually remain normal, although in some cases hemolysis occurs, leading to anemia. Rarely, disseminated intravascular coagulation occurs.
Renal function is usually not affected, although proteinuria and (as a consequence of hemolysis) hemoglobinuria may occur. As a result of hypoxia or myoglobinuria, acute necrosis tubules.
Treatment
Prehospital care
Treatment for drowning begins at the scene of the incident with the quick but careful removal of the victim from the water (Table 1).
Some caution must be taken to account for the possible damage to the spinal cord when diving or surfing. In the vast majority of cases, damage to the cervical spinal cord occurs during diving, when a vertebral fracture occurs when the head hits a solid obstacle, especially C5.
Diagnostic signs of spinal cord injury may include paradoxical breathing, lethargy, priapism, unexplained hypotension, or bradycardia. Rescuers and paramedics must support the victim’s neck, taking the necessary precautions when providing first aid. History of the mechanism of injury may be unreliable, so the physician should be sure to obtain radiographs of the cervical spine.
Table 1. Prehospital care for victims of drowning
Airway patency and (if necessary) artificial ventilation should be ensured; all patients should receive supplemental oxygen. Cardiopulmonary resuscitation should be started in any victim who has stopped breathing and heartbeat, even if the chances of success are minimal.
Patients with moderate symptoms are given a sodium bicarbonate solution, while more severely affected patients are hospitalized for examination.
Cardiopulmonary resuscitation on water is usually ineffective and even dangerous for the rescuer; it can only be attempted if there is a hard and stable surface. Postural drainage or abdominal compression (Heimlich maneuver) has not been proven to be effective in removing water from the lungs and improving oxygenation.
As experimental studies show, fresh water can be removed from the trachea in only a very small amount, while salt water is removed in a significant amount. more. Drowning victims aspirate small amounts of water, and there is little evidence that this water interferes with ventilation. At the scene of an accident, the victim should not be kept in a head-down position for long periods of time, as this will limit airway control, force interruption of ventilation or cardiopulmonary resuscitation, and pose a risk of spinal cord injury and deterioration due to other unrecognized injuries.
Hospital treatment
When assessing the condition and providing care to the victim, special emphasis is placed on initial resuscitation, recognizing associated injuries, treating respiratory failure, and taking measures to protect the brain from hypoxia (Table 2).
Table 2. Hospital treatment of drowning victims
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Determining the condition of the cervical spine Laboratory research
Maintaining lung function
Nasogastric tube Foley catheter Monitoring
Volume status
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The advisability of performing resuscitation in the ED, especially in children for whom CPR does not stop until they are admitted to the department, has been discussed since the 70s. Peterson reports that all surviving children who required CPR on hospital admission had severe anoxic encephalopathy.
At the same time, they claim that this does not create any serious consequences.
Recent studies show that about 20% of patients admitted to comatose, with fixed and dilated pupils, survive without significant neurological impairment. Unfortunately, the incidence of persistent vegetative state was approximately the same (15%). Allman et al. noted a good outcome in 24% of patients requiring full cardiopulmonary resuscitation in the emergency department.
Once the patient is admitted to the ED, adequate oxygenation should be ensured, the integrity of the cervical spine should be confirmed, and associated injuries should be identified.
Pulmonary insufficiency can be judged by dyspnea, tachypnea, or the participation of accessory muscles in breathing. On examination, wheezing or wheezing may be noted, although auscultation after aspiration of water from the lungs does not reveal any abnormalities.
During evaluation, all patients should receive supplemental oxygen, and those with moderate symptoms should receive 100% oxygen until adequate oxygenation (documented) is achieved. If the high oxygen flow (40-50%) cannot maintain arterial POl at a sufficient level (above 60 mmHg in adults and 80 mmHg in children), then the patient is intubated and mechanically ventilated.
Some patients may require only increased oxygenation and continuous positive airway pressure (CPAP) without mechanical ventilation.
Only awake patients who are not retching are candidates for mask ventilation with CPAP. Most intubated patients require some form of mechanical ventilation, such as intermittent mandatory ventilation with CPAP or regular mechanical ventilation with positive end-expiratory pressure.
Patients whose temperature register is at the low end of a standard thermometer require further evaluation.
It is best to have a hypothermic thermometer, but emergency departments may use thermometers to measure low temperatures, which are available in the clinical laboratory and operating room. Hypothermia can immobilize a swimmer, leading to drowning, causing primary ventricular fibrillation, or causing various violations metabolism.
Severe hypothermia often indicates prolonged diving and is a poor prognostic sign.
Despite this, many patients survive even after a long (more than 40 minutes) stay in cold water. Their body temperature was less than 30 °C, and after immersion in water - less than 20 °C. The nature of the protective effect of hypothermia is unclear; it is possible that hypothermia slows metabolism or promotes preferential shunting of blood to the brain, heart, and lungs (dipping reflex). The similarity between severe hypothermia and death has given rise to the famous aphorism: “no one should be considered dead while he is dead but warm.” Drowning victims who develop hypothermia should be warmed to at least 30-32.5°C before resuscitation attempts are abandoned.
Appropriate laboratory data should be obtained (see Table 2).
In intubated patients, Gram staining and tracheal culture are appropriate. Direct measurement oxygenation and assessment of the acid-base state during the analysis of arterial blood gases make it possible to correct the treatment of pulmonary complications and determine the need for the administration of sodium bicarbonate.
X-ray changes in the lungs do not correlate well with POl, therefore direct definition arterial blood gases have important. Despite this, X-ray examination may have prognostic value. Almost 50% of patients with significant abnormalities on pulmonary imaging require intubation, which is very rarely necessary in patients with normal X-ray picture. A chest radiograph after a severe drowning incident may remain normal or reveal generalized pulmonary edema, hilar infiltrates, or other changes.
For patients with severe symptoms or instability, NaHCO3 (initial dose 1 mEq/kg) is given before blood gas results are available if this is not available at the scene.
If necessary, carried out standard therapy bronchospasm, as well as correction of electrolyte imbalance, hypoglycemia, hypothermia, arrhythmia and hypotension. To avoid inducing arrhythmias in hypothermic patients, a central venous catheter (if used) should not be inserted into the heart. Gastric emptying with a nasogastric tube helps prevent vomiting, and insertion of a Foley catheter helps monitor urine output.
In case of drowning, neither antibiotics nor steroid drugs do not change the course of aspiration pneumonia or pulmonary edema, and they should not be prescribed for prophylactic purposes.
Post-immersion syndrome
In the past, many publications have reported on post-immersion syndrome, or “secondary drowning,” in which 2–25% of patients experienced deterioration followed by death after seemingly successful resuscitation.
Most victims of secondary drowning have progressive pulmonary insufficiency. The vast majority of these patients have symptoms or signs that can now be easily identified with adequate testing. Despite this, the concept of secondary drowning has led to numerous recommendations for monitoring the condition of all victims in a hospital setting.
It is important to correctly determine which of the victims needs hospitalization.
Those at risk for developing pulmonary failure include patients with severe transient hypoxia, aspiration or pre-existing cardiopulmonary disease. These patients have a “significant” drowning incident and symptoms such as cough, dyspnea, or tachypnea; they may have a history of losing consciousness in water. More information is needed to identify asymptomatic patients who require evaluation in the emergency department and to determine the appropriate length of evaluation and follow-up in the ED for patients with significant impairment.
Prognosis and resuscitation for cerebral disorders
Interpretation of statistics on survival and the incidence of severe neurological impairment after drowning poses certain difficulties.
These data vary depending on the definition of the patient's condition, their age, water temperature, the nature of the treatment performed and many other factors. Row latest research indicates good consequences treatment in 2/3 of patients, while approximately 20% of patients die, and 15% have severe neurological disorders, including persistent vegetative state.
Almost all patients who were awake and fully conscious survive without serious consequences.
According to Allman et al., 24% of their patients who required full cardiopulmonary resuscitation and had a Glasgow score of 3 at the start of their stay in the ED survived with intact neurological function. Patients who had a score of 3 on the coma scale and were treated in the department intensive care(ICU) either died or (if they survived) fell into a vegetative state, while patients who had an ICU score of 4 to 5 were divided into those who survived without serious consequences, those who died, and those who survived but fell into a vegetative state. The deaths of patients with scores above 5 in the ICU were unlikely to be due to neurological complications.
Conn et al. treated children who were in in serious condition after drowning, according to a scheme based on the principles of cerebral resuscitation.
This regimen includes moderate dehydration with fluid restriction and the use of diuretics, artificial ventilation when FH > 150 mm Hg. and PCOj = 30 mmHg, hypothermia up to 30 °C, muscle relaxation, use of corticosteroids and switching off consciousness with barbiturates. The authors report improved outcomes in patients with decortication and decerebrate compared with a retrospective control group of the same category of victims.
Despite wide application methods of cerebral resuscitation in pediatric drowning victims, a recent randomized prospective trial using thiopental loading in comatose patients who survived cardiac arrest showed that thiopental did not improve survival or increase the number of patients with good recovery brain functions.
Patients who developed intracranial hypertension(intracranial pressure more than 20 mm Hg) after severe cerebral ischemia, almost always die or remain permanently in a vegetative state.
However, the prognosis in patients with normal intracranial pressure(ICP) may vary, i.e. victims may survive without serious consequences or may end up in a vegetative state; therefore, ICP monitoring does not differentiate between these two groups. ICP monitoring can predict survival fairly accurately, although it is of little help in prognosis for those who remain with severe neurological impairment.
Conclusion
Drowning is a common cause accidental death, especially among young people.
The prehospital care system should ensure the quick and safe removal of the victim from the water and the implementation of activities at the scene of the incident that support his basic functions. vital signs, including adequate artificial ventilation. Victims with severe impairments should be taken to hospital.
The focus of prehospital care should be on the treatment of noncardiogenic pulmonary edema and pulmonary insufficiency. Approach to emergency care medical care depends on the severity of the victim's condition and the degree of respiratory distress.
Patients can be divided into four groups.
The first group includes victims who do not show signs of significant immersion in water, and who can be released after short-term observation. Arterial blood gas analysis and chest x-ray are not mandatory if the medical history is favorable, but they can help justify the decision to discharge patients from the ED.
The second group includes victims who do not have severe symptoms after a significant episode of immersion; they require hospitalization for observation to identify possible development late symptoms.
Patients in the third group have moderately severe hypoxemia, which can be corrected with oxygen therapy. They are hospitalized and discharged from the hospital after elimination of hypoxemia and in the absence of complications.
The fourth group consists of patients with respiratory distress, which require tracheal intubation and artificial ventilation. The prognosis of such patients usually depends mainly on their neurological status and to a lesser extent - from changes in the lungs.
Summer is a long-awaited time for many, but it is in summer that situations occur that are dangerous best case scenario allows you to get rid of it later with fear, and in the worst case it even leads to death; drowning, in fact, is one of such situations. First medical aid for drowning, provided promptly and competently, can save a person’s life, and this, as you can guess, is by no means an exaggeration.
A man drowns: what happens to him?
At the moment when a person drowns, water enters through the upper respiratory tract, which, in turn, causes air to be pushed out. Therefore, the first event in drowning is laryngospasm, that is, spasm of the area vocal folds, as a result of which the path to the trachea is closed while breathing stops. This type choking is defined as “dry choking.”
If the victim remains in the water for too long and if a significant volume of liquid enters his respiratory tract, oxygen starvation occurs. This, in turn, leads to the exclusion of the possibility of action important reflex, which in this case is cessation of breathing, and therefore a drowning person simply “inhales” water, which subsequently ends up in his lungs. Failure to provide first aid in case of drowning can result in the death of the victim before rescuers arrive at the scene.
Difference between sea and fresh water
Undoubtedly, it exists, no matter how you look at it. Thus, when more than one liter of water enters the human body, a number of its functions are disrupted, which is relevant regardless of the water options under consideration.
If it enters the body fresh water, then it ends up in the blood. This, in turn, leads to a change in its composition, which is especially reflected in the amount of protein and salt. In turn, this leads to trembling of the ventricles of the heart, a kind of “rupture” occurs.
In front of the assembled sea water in the lungs, blood plasma enters the pulmonary alveoli with subsequent accumulation there. Subsequently this leads to.
Regardless of what kind of water is in the human body, its presence in it during such manifestations has an extremely negative effect on the condition of the victim and is dangerous for his life.
In case of severe overheating in the sun, overeating, or fatigue, you should refrain from swimming for a while. The fact is that a jump into cold water can lead to so-called reflex cardiac arrest, which can cause sudden death.
