DROWNING

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

HEATING - death from hypoxia, resulting from the closure of the respiratory tract fluid, most often water.

There are true and asphyxic types of drowning. The true type of drowning is characterized by a rapid filling of the airways up to the alveoli. Through the ruptured capillaries of the interalveolar septa, the liquid enters the blood, causing its dilution, disturbance of the water-salt balance, hemolysis of the erythrocytes, etc. In the asphyxiated type, at the very beginning of the fluid entering the respiratory tract, irritation of the larynx receptors causes laryngospasm , which prevents further entry of fluid into the lungs . Its consequence is the development of acute hypoxia. In the final stages of drowning laryngospasm disappears , and fluid enters the lungs. Sometimes when a person hits the water, death comes from reflex stopping of breathing and heart activity, which some authors see as an independent syncopal type of drowning. The division of drowning into types is conditional, as various combinations of them are often encountered, diverse mixed types.

Drowning belongs to the category of violent death. Typically, this is an accident when swimming in open reservoirs of persons who are intoxicated, patients suffering from cardiovascular and other diseases, as a result of damage to the cervical spine when the head strikes the bottom when diving in shallow places, with the death of sea and River vessels.

The bodies of persons who died from drowning are subject to compulsory forensic medical examination.

First aid to the victim should be started immediately after the person drowned is raised above the water, and continued during towing to the boat or to the shore. In this case, the rescuer throws the victim's head back, from time to time blowing air into the lungs from the mouth into the nose. After the delivery of the victim to shore, it is necessary to assess his condition. With preserved consciousness and breathing, it must be warmed and reassured (sedatives and tranquilizers are indicated). If consciousness is absent, but the pulse is rhythmic, satisfactory filling and self-contained breathing is saved, it is necessary to release the chest from shy clothes, to breathe in pairs of ammonia, and to activate the breath to tug at the tongue.

For those who are unconscious, if there are signs of breathing and circulatory disturbances (frequent or rare pulse , frequent or rare breathing, motor excitement, cyanosis) or if there is no independent breathing, it is necessary to urgently begin artificial ventilation of the lungs, without wasting time on attempts to remove all fluid From the respiratory tract, since this is impracticable. The victim is put on his back, trying to overcome the trismus of the masticatory muscles with a little opening of the mouth, clean the oral cavity with a finger wrapped in gauze or a handkerchief, and start artificial respiration (see Artificial ventilation of the lungs). If water is released from the respiratory tract, you need to turn your head to the side and raise the opposite shoulder, push the palm or fist into the epigastric region. Artificial respiration is carried out until the consciousness is completely restored. In the presence of trained medical staff and the necessary tools, it is recommended to intubate the trachea as early as possible and use a portable AMBU valve, which allows to create a regulated exhalation resistance (up to 10-20 cm H2O), which promotes alveolar expansion and a decrease in the intake of nonoxygenated Blood from the pulmonary artery system into the pulmonary veins. The timeliness of artificial respiration and the usefulness of its conduct determine the further course of the postresuscitation period and its outcome.

If there is no pulse on the major arteries, heartbeats are not heard, the pupils are dilated, the skin is pale or cyanotic, and indirect cardiac massage is performed simultaneously with artificial lung ventilation (IVL). After removal from the state of clinical death, the victim is warmed if the body temperature is below 30 - 32 ° C, and the upper and lower extremities are massaged. Body temperature is maintained within 32-33 ° C (moderate hypothermia increases the stability of the central nervous system to hypoxia).

In connection with the danger of developing late complications, even with minimal pathological symptoms, hospitalization and monitoring in a hospital environment is required for at least 24 hours. Resuscitation measures during transportation do not stop. When delivering to the hospital, a clear continuity must be ensured (detailed information on what happened and the fullness of the assistance rendered to the victim). Therapy in a hospital (better resuscitation) in the first place should be aimed at fighting hypoxia with oxygen inhalation or oxybarotherapy, and in the absence of effect, use ventilator (100% oxygen for the first 1-2 hours) with positive exhalation pressure or high-frequency ventilation . Early correction of metabolic acidosis, antihistamines are shown. In order to prevent acute renal failure, forced diuresis is carried out with lasix (with developed renal failure - extracorporeal hemodialysis). To prevent cerebral edema, local hypothermia is used, corticosteroids and barbiturates are administered; Inflammatory process in the lungs - parenterally prescribe broad-spectrum antibiotics. With true drowning in fresh water and the presence of a sharp cyanosis, indicating the overload of the right heart, carry out an urgent bloodletting. To excrete the hemolysis products, mannitol is dripped, to reduce hyperkalemia, glucose solution with insulin. With aspiration of sea water, fluid loss is compensated by intravenous injection of plasma-substituting solutions, glucose and sodium hydrogen carbonate. For high venous and arterial pressure, ganglion blockers and diuretics are recommended; With low blood pressure - glucocorticoids, dopamine. To improve metabolism and contractility of the myocardium, cardiac glycosides, panangin, cocarboxylase, vitamins C, group B are prescribed. When heart ventricular fibrillation occurs, defibrillation is indicated.

During the rehabilitation period, relapses of severe parenchymal respiratory failure, pulmonary edema and aspiration pneumonia are possible , and cerebral edema often occurs.