Help with drowning: types, signs, colorskin

Update: October 2018 Water is a serious element from which not
joking. In it, a person obtains food, with its help he waters
planted plants and water animals, and also uses it to
entertainment: swimming, diving, engaged in various sports.
All of this carries the potential danger of drowning in water.
Moreover, children are more likely to drown and, no matter how
strange, good swimmers: both those and others neglect the danger and
dive, jump into the water from a height, go swimming in the storm.

Drowning is an insidious state. First, almost the whole body
he hides a person with water, and even those who are swimming nearby do not see how he
badly. Secondly, a drowning person never stretches his arms or
calls for help: he fights for his life and is busy only to
inhale some more air. From the side – especially if it sinks
baby – it looks like it is being played: bounces over
water and dives again. Third, there is a condition such as
secondary drowning. In this case, the person has long been on
drier, but the water entering its airway continues its
destructive action and can kill him if not to start in time
treatment.

Why do people drown?

Drowning people is a life-threatening condition associated with
попаданием человека в water It results from:

  • panic when overwhelming the wave at depth
  • emergency situations: flooding, shipwreck;
  • swimming in the storm;
  • Violations of the rules of swimming, including when diving;
  • swimming in the area of ​​a strong current;
  • buying faulty diving equipment;
  • falling into the swamps and swamps;
  • the occurrence or exacerbation of diseases during bathing. it
    fainting, epileptic seizure, acute cerebral
    blood circulation (stroke), heart attack, hypothermia, due to which
    reduces the muscles of the legs;
  • suicide when a person either swims very deeply or
    dives to the depth, or jumps into the water from a height. In the latter case
    death can be triggered by three mechanisms:

    1. loss of consciousness due to brain contusion;
    2. paralysis of all limbs due to neck fracture
      vertebrae;
    3. reflex heart failure triggered or abrupt
      immersion in cold water, or pain from hitting the water;
  • killings.

Not all people die as a result of water entering the respiratory system.
ways: there is such a view of it when the air stops flowing in
lungs due to the fact that a person has a reflex in the water
spasm of the larynx. This type of drowning is called “dry.”

Who is most at risk of drowning

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

  • after taking a large amount of alcohol that dulls
    human reactions and “inspire” him fearlessness. Also when
    Spirits “push” a person into the water, they contribute
    hypothermia, which increases the chance of drowning even more
    (with strong cooling, the body “throws” all the blood to the internal
    organs, leaving working muscles with a minimum
    blood supply);
  • when hit in a strong or breakaway (reverse) flow: it does not
    gives a person to reach the shore;
  • when wave is overwhelmed when water enters the respiratory
    ways, and, moreover, causes a person to panic;
  • if a person suffers from epilepsy or it happens
    fainting. In this case, loss of consciousness leads to
    water entering the respiratory tract;
  • when swimming alone: ​​in this case, the chance for
    rendering first aid if a person gets hurt underwater,
    will fall into the area of ​​the flow or he will keep his foot from the cold
    water;
  • when bathing on a full stomach. In this case, the deterioration
    human condition that can lead to drowning occurs
    on one of three mechanisms:

    1. the main amount of blood after eating rushes to the stomach and
      intestine. Under these conditions, the heart itself begins to be supplied worse
      by blood – his work deteriorates, his heart may develop
      attack;
    2. water squeezes the filled stomach, as a result of it
      the contents of the esophagus rises to the top. At the moment of inhaling food
      mixed with gastric juice, can get into the respiratory tract
      (especially those who are in a state of alcoholic
      intoxication). This is the development of inflammation of the lung tissue, which
      poorly treatable – pneumonitis;
    3. deterioration of the condition may develop in the previous scenario,
      only the airways (bronchi or trachea) can become blocked
      large piece of food. Even if this food can not fully
      will block the diameter of the bronchus or trachea, it is still dangerous: it
      will cause a coughing fit, and in water it may result in a hit
      fluid in the respiratory tract;
  • with existing heart diseases: muscle work in water
    makes the heart work harder, which can make it worse
    state. If bathing occurs in cold water, then the load
    on the heart increases even more: he has to process
    greater due to narrowing skin vessels, blood volume.

Types of drowning

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

There are 4 main types of drowning:

  1. �”Wet” or true drowning. It develops due to
    ingress of water – sea or fresh – into the respiratory tract;
    occurs in 30-80% of cases. The true kind of drowning suggests
    that man resisted for some time the action of water. Color of the skin
    when drowning this type – blue. This is due to venous stasis.
    in the skin. Very seriously, the condition worsens when it enters the lungs.
    10 ml of water for each kg of body weight. Deadly is hit
    more than 22 ml / kg.
  2. �“Dry” drowning. It occurs when in contact with water
    of a person reflexively spasms (shrinks) the glottis,
    the result is that neither water nor air enters the lungs. This view
    drowning occurs in every third drowned. Color of the skin при
    This drowning is white, associated with a spasm of skin vessels.
  3. Drowning syncopal type occurs when when released into
    water (usually from a height and in cold) is reflexive in a person
    heart stops. Then he does not flounder and swallows water,
    and immediately goes to the bottom. Syncopal drowning occurs less frequently than all –
    in every 10 cases, it is more typical for people with heart
    diseases.
  4. Drowning mixed type. In this case, the airway
    first water enters, as in true drowning, and because of this
    the glottis spasm (as with its “dry” form). Then,
    when the consciousness is already lost, the larynx relaxes, and the water again
    numb in the lungs. This type is found in every fifth
    drowned.

The mechanisms leading to death during wet drowning depend on
what kind of water got into the lungs – sea or fresh.

So, when drowning has occurred in fresh water,
processes associated with the fact that water, compared with liquids
our body is hypotonic. This means that in her
less salt is dissolved and because of this it penetrates into the region where
contains biological fluids, and dilutes them. As a result
water entering the airway:

  • first fills the alveoli – those structures of the lungs in which and
    gas is exchanged — oxygen and carbon dioxide — between
    blood and respiratory tract. These are respiratory “bags” that
    the norm always remain unclosed and contain air that
    due to the presence in them of a substance called
    �”Surfactant”;
  • being hypotensive, fresh water (and with it bacteria, and
    plankton) quickly passes from the alveoli into the blood: the vessel is located with
    the outer side of each alveoli;
  • fresh water destroys surfactant;
  • fluid in the vessels becomes a lot and she goes back to
    alveoli, causing pulmonary edema. Since from freshwater red blood cells
    burst, and the fluid in the alveoli becomes saturated
    �”Debris”. It makes foam that is released from respiratory
    ways, red;
  • when water dilutes the blood, it decreases the concentration
    electrolytes (potassium, sodium, chlorine, magnesium). It breaks work
    internal organs.

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

  • seawater that has fallen into the alveoli “attracts” liquid from
    lung tissue and blood in the alveoli;
  • due to the glut of alveoli fluid develops pulmonary edema.
    Allocated foam (it turns out because of surfactant) has white
    Colour. At the same time, each breath inhades the foam even more;
  • as part of the fluid leaves the blood, the blood becomes more
    concentrated;
  • heart difficult to pump thick blood;
  • thick blood cannot reach the small capillaries, since
    here it is not the force of the heart that pushes her, but the wave that was formed on
    previous stage arteries of medium caliber;
  • such a high concentration of potassium in the blood, which causes
    heart failure.

Who is more likely to survive drowning

When saving a drowning man, time is
которое прошло с момента попадания в water The earlier started
helping is more likely to save a person.

The chances of saving a person increase if:

  • drowning occurred in icy water. Although such a drowning,
    most likely, is of a “dry” nature, when exposed to conditions
    low temperatures all biochemical processes in the body are strongly
    slow down. It gives a chance to even restore the body,
    when the heart for some time (up to 10-20 minutes, depending on
    water temperature) did not beat;
  • is it a child or young person without chronic diseases: their
    the ability to regenerate, including brain tissue, is higher.

How to suspect that a person is drowning

It’s only in movies that show signs of drowning are
when the victim shouts “Tonu!” or “Save!”. Actually
a drowning person does not have the time and energy for this – he is trying to survive.
Therefore, you can see how:

  • it rises above the water, then again it sinks into it;
  • his head rises above the water, thrown back, his eyes
    covered up;
  • arms and legs move erratically, trying to swim;
  • drowning coughs, spits water

Symptoms of drowning children do look like a game: a child
jumps over the water (each time – all below), frantically
gulping air, and from the outside it seems that he is all right.

Call for help and purposeful waving your arms – this is what
что предшествует  утоплению. When a person feels that he
drowning, he develops a panic condition associated with
feeling short of breath. At that moment he does not think critically
is able to.

The fact that a person survived drowning, show such
signs:

  • severe cough, cough, with foam or sputum –
    white or reddish;
  • rapid breathing;
  • muscle tremors;
  • rapid pulse;
  • pale or bluish skin;
  • wheezing when breathing;
  • vomiting, in which a rather large volume of fluid is released.
    This is swallowed water;
  • excitement or, on the contrary, drowsiness when getting on
    Coast;
  • convulsions are not the reduction of limbs in the presence of consciousness, but
    full body flexing or uncontrolled limb movements – in
    unconscious.

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

  • loses consciousness (it must be removed from the water);
  • he has no breathing movements of the abdomen or chest;
  • breath can be, but it can be “sobbing” or
    similar to gasping by mouth;
  • no pulse in the carotid artery;
  • discharge from the mouth and nose of the foam when drowning in fresh water
    – pink.

Now you need to pay your attention twice:

  • Even if a person was able to reanimate, it does not mean that
    his nervous system will recover in full. He – immediately
    or after a time – the same symptoms may be noticeable.
    characteristic of stroke: loss of ability to think coherently and
    speak, speech disorder (understanding or reproduction), violation
    movements in the limbs, impaired sensitivity. Human can
    falling into a coma caused by swelling of the brain due to
    hypoxia.
  • Hospitalization and medical examination are subject to all people
    who survived drowning, even if they did not lose consciousness, and
    there is a pulse and breathing. This is due to a complication
    drowning called “secondary drowning.”

Drowning periods

This life-threatening condition is divided into 3 periods:

  1. Elementary.
  2. Agonal.
  3. Clinical death.

Initial period

With true drowning, the initial period is when water is only
a little started to flow into the lungs and it activated all the defensive
mechanisms of the body. When asphyxial – is from the moment it gets into
water to the cramp of the respiratory gap (very short).

The man coughs and spits, strenuously rows his hands and
trying to push off legs. Vomiting may occur. Cough and vomiting
lead to even more water entering the lungs, which accelerates
occurrence of the next period

Agonical period

In this period, defenses are depleted, there is a loss
of consciousness. With asphyxial drowning, this causes arrest.
spasm of glottis, and water enters the lungs.

For the agonal period are characteristic:

  • loss of consciousness;
  • �”Sobbing” breath with its gradual disappearance;
  • tachycardia, which is replaced by an arrhythmic pulse and his
    slowdown;
  • discoloration of the skin.

Clinical death period

It is characterized by a triad of symptoms:

  1. lack of consciousness;
  2. lack of breathing;
  3. lack of pulse, which is checked by pressing
    index and middle fingers to the thyroid cartilage (“Adam’s apple”) with
    one side.

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

Algorithm of self-help when drowning

All that a person can do when released into the water is:

  • Do not panic. Although it is very difficult, but we must try
    calm down, for panic only takes away those necessary for
    survival power.
  • Look around. If some water floats on the surface of the water
    wooden or plastic items of sufficient size
    try to grab them.
  • As calmly as possible, saving power, to row in one direction
    (optimally – to the coast or to some vessel).
  • Rest, lying on your back.
  • Periodically call for help (if it is dark). Happy
    in the absence of visibility of people or ships, you need to save power and not
    call for.
  • Try to breathe as calmly as possible.
  • Turn your back to the waves (if possible).

How to save a drowning man

This also requires a separate algorithm. If try
to heroize and, without knowing the rules, to float to the aid of a drowning man,
you can easily die yourself: if the drowning sees or feels
the presence of another person, he is in a panic to survive himself,
will drown a lifeguard.

Therefore, assistance with drowning is the following:

  1. Before you swim to save, take off the interfering clothes and
    footwear.
  2. Swim up to the drowning man just from the back. Next you need to grab
    his one shoulder with one hand and his other hand lift
    head for the chin so that it can breathe. At the same time, the second hand
    lifeguard must press the shoulder of the drowning man so that he cannot
    turn over to the one who saves him. In this position and
    need to swim to the shore. The same position is used when
    транспортировке человека без of consciousness.
  3. If you want to give a drowning hand, make sure that the second
    hand you hold tight to some kind of support.
  4. Do not neglect the call for help.
  5. A drowning person can throw a floating object (for example,
    lifebuoy), monosyllabically several times informing him about it:
    �“Hold!”, “Grab!”, “Catch!” And so on.
  6. If a person lies motionless on the bottom, then his important correctly
    raise:

    • to the face lying down swim up from the side of the legs, wrap around
      his armpits, and so raised up;
    • face upward swim up from the side of the head. Now
      you need to clasp it from the back so that the lifeguard’s palms are on
      chest injured, and lift the drowned to the surface.

The main thing at this stage is to take a person out of the water. Evaluating him
state should be dealt with ashore.

First aid for drowning

Algorithm first aid for true drowning:

  1. Call the ambulance brigade.
  2. We put the sick person in his stomach on his bent knee so that
    so that his belly was higher than his head and chest.
  3. Take a piece of cloth, a scarf or clothes, open your mouth
    injured and remove everything in your mouth. If the skin integument
    blue, while you need to additionally press on the root of the tongue: this
    will induce vomiting, which will remove water from both the lungs and the stomach.
  4. In the “head down” position, we squeeze the chest well,
    to all the water out.
  5. Quickly turn the victim on his back and start
    Cardiopulmonary resuscitation:

    • 100 pressure per minute on the rib cage superimposed on each
      other palms of direct hands;
    • every 30 presses – 2 breaths into the open mouth (nose while
      clamped) or in the open nose (mouth is closed).
  6. To continue resuscitation until the pulse is restored and
    breath. If there is only one rescuer, do not be distracted by checking
    of these parameters every minute, but to continue quite a long
    время, пока не появятся признаки of consciousness.

All listed items refer to first aid as
children and adults alike. It is only necessary to take into account that children click on
chest needs more (the smaller the child, the more often), and strength
apply less pressure. The order of inhalation and depression
the chest is the same – 30 presses, 2 breaths.

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

What to do after the drowned man regained consciousness

After drowning, whether true or “dry,”
in no case should one let go of the victim. To avoid
complications he needs to be hospitalized and examined.

What to do in the hospital

In the hospital, a person will be carefully examined: in his blood (in
venous and arterial separately) oxygen will be determined and
carbon dioxide. A blood test will be performed for potassium,
sodium, chlorine and other indicators. Be sure to perform an ECG and
radiograph of the lungs.

If the patient is unconscious, intensive therapy will be initiated,
which will be to:

  • ensuring its increased oxygen content (so that
    go through the thickness of the foam and water in the alveoli – in the blood);
  • foam quenching in the lungs;
  • removing excess fluid from the lungs;
  • normalization of heartbeat;
  • normalization of electrolytes, in particular – potassium and
    sodium;
  • bringing the temperature to normal numbers;
  • administering antibiotics
  • other events selected individually.

Drowning complications

Drowning is often complicated by one of these conditions:

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

Автор: Кривега Мария Салаватовна врач-реаниматолог

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