Drowning. Health care

FUNDAMENTALS OF FIRST AID
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Drowning. Health care

Fundamentals of First Aid (OPMP)

According to the type and reasons, the following types are distinguished drowning: true ("wet" - blue type), asphyxial ("dry" - pale type) and syncope. In case of accidents, death in water can occur, not associated with drowning (trauma, myocardial infarction, cerebrovascular accident, cryoshock).

True drowning accounts for 85-95% of all accidents on the water. A drowning person does not immediately plunge into the water, but tries to stay on its surface. When inhaling, he swallows a large amount of water, which fills the stomach and enters the respiratory tract. Aspiration of large amounts of water occurs, the liquid enters the lungs, and then into the blood. As a result, there are violations of gas exchange and water-salt balance. Oxygen starvation develops - hypoxia, which causes cyanosis of the skin.

When drowning in fresh water, hemolysis and severe arterial hypoxemia are characteristic. After removing the victim from the water and giving him first aid, pulmonary edema often develops with the release of bloody foam from the respiratory tract.

When drowning in sea water, which is hypertonic in relation to blood plasma, there is an exit of liquid and protein into the lumen of the alveoli, thickening of the blood and the rapid development of pulmonary edema with the release of white persistent "fluffy" foam from the respiratory tract.

Asphyxial drowning characterized by persistent reflex laryngospasm, as a result of which water aspiration does not occur, but asphyxia occurs. Asphyxial drowning occurs more often in women and children, as well as when the victim enters heavily polluted, chlorinated water containing chemical impurities or other suspended particles.

RџSЂRё syncopal drowning the death of the victim occurs from primary reflex cardiac and respiratory arrest due to the ingress of even small amounts of water into the upper respiratory tract against the background of a sharp peripheral vascular spasm. In this case, the initial onset of clinical death is characteristic, the duration of which is somewhat longer than with other types of drowning, and when drowning in ice water it increases by 2-3 times, since hyperthermia protects the brain from hypoxia.

Drowning can also be caused by ice (cryo) shock; associated with sudden changes in temperature. When immersed in cold water, as a result of exposure to low temperatures on skin thermoreceptors, generalized spasm, cerebral ischemia and reflex cardiac arrest are possible. In addition, exposure to cold water can lead to drowning without the development of cryoshock due to hypothermia. Water temperatures below +20°C cause intense heat transfer and a decrease in body temperature. At a water temperature of +4 to +6°C, a person loses motor activity after 15 minutes due to stiffness and convulsive muscle contraction. A decrease in body temperature to +30°C and below is accompanied by a loss of consciousness and the extinction of all vital functions of the body.

Often, circulatory arrest during a person's stay in water can occur from causes not related to the ingress of water into his respiratory tract. This can happen as a result of a myocardial infarction, a severe diving injury, an epileptic seizure, etc.

In case of loss of consciousness, artificial lung ventilation (ALV) should be carried out using the mouth-to-nose method. It is desirable to start it in the water, but only a well-trained physically strong rescuer can perform these techniques. ALV in this case is carried out as follows: the rescuer brings his right hand under the right hand of the victim, being behind his back and on the side. With his right hand, the rescuer closes the mouth of the victim, while pulling up and forward his chin. Air is blown into the nasal passages of the drowned.

After removing the victim to the boat, rescue boat or shore, it is necessary to continue mechanical ventilation. In the absence of a pulse in the carotid arteries, chest compressions should be started immediately.

Do not waste precious time trying to remove water from the lower respiratory tract.

With true drowning, removal of water from the stomach is indicated to prevent re-aspiration. To do this, the victim is placed with his stomach on the thigh of the rescuer's leg bent at the knee joint and, by pressing on the epigastric region, the contents are evacuated from the stomach. The indicated reception should be carried out with maximum speed (10-15 s), after which the victim is turned on his back. The oral cavity is cleaned with a finger wrapped in a handkerchief or gauze. If a spasm of the chewing muscles occurs, you should press your fingers on the corners of the lower jaw.

The appearance of individual respiratory movements in the victim, as a rule, does not indicate the restoration of full breathing, and mechanical ventilation must be continued.

Author: Mikhailov L.A.

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