Drilling happens. Rules for extracting victim from water

Date: 09.04.2019

Rest at the reservoir is not always enjoyable. Wrong behavior in water or emergencies Can lead to drowning. These risks are especially susceptible to small children, but even adults who know how to swim well, can become victims of a strong current, the occurrence of convulsions, water films. The sooner the victim is removed from the water, and it will be rendered to the first assistance in drowning (removal of fluid from respiratory tract), the higher the chance to save the life of a person.

What is drowning

The World Health Organization (WHO) determines the drowning as respiratory disorders caused by immersion or long stay under water. As a result, a respiratory disorder may occur, asphyxia. If the first help is immentable not been rendered on time, death comes. How long can a person do without air? The brain is able to function only 5-6 minutes in hypoxia, so it is necessary to act very quickly, without waiting for an ambulance brigade.

There are several reasons for such a situation, but not all of them are random. Sometimes the wrong behavior of the person on the surface of the water leads to undesirable consequences. The main factors include:

injuries from immersion in shallow water, in the unexplored places;
alcoholic intoxication;
emergency situations (cramps, heart attack, diabetic or hypoglycemic coma, stroke);
inability to float;
negligent attitude towards the child (when children are drown);
getting into the waterproofs, storm.

Signs of drowning

Symptoms of drowning to notice easily. The victim begins to flounder, or swallows the mouth of the air as a fish. Often, a person spends all his energy to keep his head over water and breathe, so can't shout about help. There may also be spasm of voice ligaments. Importing covers panic, it is lost, which reduces his chances of self-esteem. When the victim has already been pulled out of the water, the fact that it is silent, you can determine by the following symptoms:

bloating;
breast pain;
blue or bluish tint of the skin;
cough;
shortness of breath or shortness of breathing;
vomit.

Types of drowning

There are several types of drowning, each of which is characterized by its peculiarities. They include:

"Dry" (asphisical) drowning. A person is immersed under water and loses orientation. Often there is a spasm of larynx, the water fills the stomach. The upper respiratory tract is blocked, and the drowning begins to choke. Asfix occurs.
"Wet" (true). Immersing into the water, a person does not lose their breathing instinct. Lightweight and bronchi are filled with liquid, foam can be released from the mouth, cyanosis of the skin is manifested.
Fund (syncopal). Another name is pale drowning. The skin acquires a characteristic white, white-gray, bluish color. Female outcome occurs as a result of reflex cessation of light, hearts. It often happens due to the temperature difference (when the drowning is immersed in the ice water), the impact of the surface. Syncnich arises, loss of consciousness, arrhythmia, epilepsy, heart attack, clinical death.

Salvation of drowning

Anyone can notice the victim, but it is important to provide first aid in a short time, because someone's life depends on it. Being on the shore, the first thing to do is call for helping the rescue. The specialist knows exactly how to act. If it is not near, you can try to pull out a person yourself, but you need to remember the danger. The drowning is in a stressful state, it has a coordination, so he may involuntarily cling to the rescuer, not allowing him to grasp himself. The likelihood of drowning together (with incorrect behavior in water).

Emergency care when drowning

When an accident occurs, you need to act quickly. If there was no professional rescuer or a medical worker nearby, then the first assistance in drowning should be provided to others. The following steps should be performed:

Wrap your finger soft cloth, Clear the oral cavity of the saved.
If there is a liquid in the lungs, you need to put a person on your knee abdomen down, lower his head, make a few blows between the blades.
If necessary, make artificial respiration, heart massage. It is very important not to put on the chest too much so as not to break the ribs.
When a person woke up, he should be released him from wet clothes, wrap a towel, let it warm up.

The difference between sea and fresh water when drowning

The accident may occur in various water sources (sea, river, pool), but the drowning in fresh water differs from the immersion in the salt environment. What is the difference? Inhalation of sea fluid is not as dangerous and has a more favorable forecast. High salt concentration prevents water from entering light fabric. However, blood is thickened, pressure occurs on the circulatory system. Within 8-10 minutes, a complete stop of the heart occurs, but during this time you can have time to reanimate the drowning.

As for drowning in fresh water, the process is more complicated. When the liquid enters the lung cells, their swelling occurs, some cells are bursting. Freshwater can be bored in blood, make it more liquid. Capillaries break out, which violates heart activities. The ventricular fibrillation occurs, stop the heart. This whole process takes a few minutes, so death in fresh water comes much faster.

First Aid on Water

A specially trained person should be saved by the drowning person. However, it is not always near, or several people may suffer in water. Any holidaymaker can provide first help. To save someone's life, it is worth using the following algorithm:

It is necessary to gradually approach the victim behind the rear, to dive and produce the coverage of solar plexus, taking a sinking person behind my right hand.
Switch to the shore on the back, row right hand.
It is important to ensure that the head of the victim was over the water, and it does not swallow the liquid.
On the shore should put a person on the stomach, to provide first aid.

First Aid Rules

The desire to help the drowning does not always benefit. Incorrect persecution behavior often only aggravates the problem. For this reason, first aid for drowning should be competent. What is the mechanism of PMP:

After the person was pulled out of the water and covered the blanket, you need to check the symptoms of hypothermia (supercooling).
Call an ambulance.
Avoid deformation of the spine or neck, not damage.
Fix cervicalBy laying a rolled towel.
If the victim does not breathe, you should proceed artificial respiratory, Massage of the heart

With true drowning

About 70 percent cases, water falls directly into the lungs, a true or "wet" drowning occurs. It can happen to a child or a man who does not know how to swim. The first medical care during drowning includes the following steps:

turning the pulse, inspection of pupils;
warming the victim;
maintenance of blood circulation (raising legs, tilting of the body);
production of light ventilation using breathing apparatus;
if a person does not breathe, it is necessary to make artificial respiration.

With asphisic drowning

Dry drowning is somewhat atypical. Water never reaches the lungs, but instead there is a spasm of voice ligaments. Death may come due to hypoxia. How to give first aid to a person in this case:

immediately hold cardiovascular resuscitation;
call an ambulance;
when the victim came to himself, he warm him.

Artificial Breathing and Heart Massage

In most cases, when drowning, a person stops breathing. To return it to life, you should immediately begin active steps: make a heart massage, make artificial respiration. It is necessary to observe a clear sequence of actions. How to perform the breath "mouth in the mouth":

It is necessary to push the lips of the victim, remove the mucus, algae with a finger wrapped with a cloth. Give a track of the fluid from the oral cavity.
Cook your cheeks so that the mouth does not close, tilt the head back, raise the chin.
Click the nose of saved, breathe the air directly into his mouth. The process takes the split second. The amounts of repetition: 12 times per minute.
Check the pulse on the neck.
After some time, the chest will be lifted (the lungs will start functioning).

The breath of "mouth in the mouth" is often accompanied by a heart massage. This procedure should be performed very carefully not to damage the ribs. How to act:

Place the patient on a flat surface (floor, sand, ground).
Put one hand on the chest, cover the second hand at an angle of about 90 degrees.
Rhythmically pressed on the body (approximately one pressure per second).
To start the child's heart, the chest should be pressed with 2 fingers (due to the small growth and weight of the baby).
If the rescuers two, artificial respiration and heart massage are performed simultaneously. If the rescuer is one, then every 30 seconds you need to alternate these two processes.

Actions after first aid

Even if a person came to himself, it does not mean that he does not need health care. It should be left with the victims, call the urgent or seek help to the doctor. It is worthwhile that when drowning in fresh water, death can come even after a few hours (secondary drowning), so they should keep the situation under control. With long stay without consciousness and oxygen, the following problems may arise:

disorders of the brain, internal organs;
neuralgia;
pneumonia;
chemical imbalance in the body;
permanent vegetative state.

In order not to have a complication, it should be health care as quickly as possible. Rescued when drowning should be observed the following measures Precautions:

learn to swim;
avoid bathing B. drunk;
don't go into cold water;
do not swim during the storm or at great depth;
do not walk on thin ice.

Video

Drowning develops with random or intentional immersion of the victim into a liquid (mainly in water) and is characterized by difficulty or complete cessation of light gas exchange. Causes of this critical state, and accordingly, the types of drowning are as follows:

Aspiration of fluid into the respiratory paths of the victim with saved breathing - true drowning;

The cessation of a mellow gas exchange due to laryngospasm when the first portions of water in the respiratory tract - asphisical drowning;

Primary blood circulation stop (asistolia, fibrillation of heart ventricles) leads to development syncopal drowning;

The so-called "death in water" - the reason for the terminal state of the victim in water is not connected with the falling fluid in its respiratory tract, but with another reason (coronary attack, acute violation brain circulation Or suddenly developed epileptic seizures).

True drowning

True drowning It occurs in the absolute majority with accidents on water. At the same time, the strength of the respiratory tract is preserved and a large amount of water is aspiration, followed by a violation of gas exchange.

For true drowning is characterized by a more or less long struggle for life with irregular breathing, swallowing water and stomach overflow.

It should be distinguished by true drowning in fresh and sea water. The nature of pathological changes due to different osmotic activity of liquids determines changes in the electrolyte composition and volume of blood and their consequences in the injury body. However, with true drowning, severity respiratory failure is a more significant factor, and therefore the nature of the liquid (fresh or marine water) is not significant in clinical picture, forecast of the defeat and the nature of the assistance of the victim.

In the clinical picture, three periods are distinguished: initial, agonual and period clinical death.

In the initial period, with true drowning, consciousness and arbitrary movements are preserved, the ability to delay their breathing during repeated immersion under water. Saved in this period are excited or inhibited, they have inadequate reactions to the situation. In the subsequent one of them apatic, fall into depression

up to the somnolence, others, on the contrary, are long been excited, unmotivated active: trying to get up, leave, refuse medical care. When drowning even in warm water (18-24 ° C), many saved chills occur.

Skin Covers and visible mucous membranes of saved with true drowning in this period of blue. Breathing frequent, noisy, interrupts cough attacks. Initial tachycardia I. arterial hypertension Soon they are replaced by bradycardia and arterial hypotension. The upper body of the belly in such a saved will be transmitted due to the swallowing of a significant amount of water. After some time, after salvation, it may be vomiting by stigled water and gastric content. Sharp clinical manifestations drowning are quickly resolved, the ability to navigate or move, but weakness, headache And the cough is saved for several days.

In the agonal period of true drowning, the affected consciousness is lost, but breathing and heart abbreviations are saved. Cold skin cold, sharply blue. Fitting liquid flows from mouth and nose pink colour. Cardiac abbreviations are weak, rare, arrhythmical. The pulsation of vessels is determined only on sleepy and femoral arteries. There are, although not always, signs of increasing venous pressure: the expansion and swelling of the subcutaneous veins on the neck and forearms. The pupil and corneal reflexes are sluggish, often happens triumph: open the mouth of the immentable does not succeed.

In the period of clinical death appearance The victim is the same, but breathing and ripple on sleepy arteries No pupils are expanded and not react to light. Opportunities for successful resuscitation are minimal: all the energy resources of the body are exhausted in the struggle for life.

Asphisic drowning

Asphisical (dry) drowning It occurs due to the occurrence of the acute reflex spasm of the muscles of the larynx and may cause asphyxia even without aspiration of water into the upper respiratory tract or with aspiration of its insignificant number. This state, as rules before, is preceded by a pronounced oppression of the central nervous system due to alcohol or other intoxication, fright, shock belly or head about water or underwater object.

With asphycical drowning of the initial period, there is no or it is very short. In the agonal period, consciousness persistently lost, the skin is sharply cyanotic, the ripple on peripheral arteries is significantly weakened. There may be the so-called "false research" breaths, but the air paths at this time are free from the content. Trismism and laryngospasm first make it difficult to conduct expiratory artificial respiration, but still intense exhalation of the rescuer in the nose

the victim in most cases manage to overcome laryngospasm.

As the asphyxia continued, the "false research" courses are stopped, cardiac activity will fuss, the voice gap opens, the period of clinical death occurs.

The period of clinical death during asphisic drowning lasts slightly longer than with true drowning: at a temperature of water 18-22 ° C, its duration is 4-6 minutes. Blue skin surfaces and the appearance of a foam liquid from airway paths during this period do not allow differentiate two main versions of drowning.

Syncopal drowning

For syncopal drowning The death of the victim comes from the primary reflex stop of the heart and respiration due to even a small amount of water in the upper respiratory tract.

For syncopal drowning, the initial offensive of clinical death is characteristic. There is a sharp pallor of the skin, there are no respiratory movements and heartbeat. Pupils are extended, not react to light.

The duration of clinical death is somewhat larger than with other types of drowning, and when drowning in ice water increases by 2-3 times, since hypothermia significantly protects the brain from hypoxia.

The causes of drowning can be the so-called ice ("cryo" -) shock, "immersion syndrome" associated with a sharp drop of temperature.

When immersed in cold water, a reflex stop of the heart is possible.

The development of such a shock can provoke preceding overheating or intensive exercise stressleading to the restructuring of adaptation systems of the body. Allocating factors can be overwriting, stomach overflow, intoxication.

"Death in the water"

Often, blood circulation stop during staying in water may occur from acute myocardial infarction, severe injury obtained by diving, suddenly developed epileptic status, etc. In this case, it should be told about death in water, for it is not related to drowning, but water getting into Lights is secondary, passive against the background of the terminal state already developed.

The possibility of survival after drowning depends on the duration of the stay under water, water temperature, the age of the affected, concomitant diseases and injuries. If the water temperature is low, resuscitation activities may be successful (especially in children) even after staying under water for a long time.

Initial period of true drowning

In the initial period of true drowning, first aid is aimed at calming the immentable and use of appropriate drugs, improving blood oxygenation in lungs, prevention of aspiration with possible vomiting, to stabilize blood circulation, stimulation of breathing and warming the victim.

Drowning is often combined with a supercooling, which may continue to be the main determinant threatening state. Restriction of heat loss: removal of wet clothes, wrathing saved, hot drink, trituration of the body with ethanol solution, etc. - continue during the transportation of saved in the hospital. Atropine should not be used to relieve bradycardia, as well as chills can not be stopped by narcotic and sedatives.

Agonal period

In the agonal period, it is necessary to ensure the restoration of the airways, artificial respiration from the mouth to the mouth, if necessary, directly in water. The maintenance of blood circulation is provided by strengthening blood flow to the heart (oblique position, raising legs). If the pulse wave is not determined, then the closed heart massage is proceeded. It follows as early as possible to start ventilation of the lungs using breathing apparatus to create high concentrations oxygen. No need to lose precious time to remove water from the lower respiratory tract.

To prevent regurgitation and re-aspiration, the removal of water from the stomach is shown. For this injured, put the stomach on the front surface of the hip bending legs Help and, moderately pressing on the assfront, evacuate the contents of the stomach.

Hypovolemia and hemoconcentration are eliminated by intravenous infusion of hydroxyethyl starch, crystalloids (400), and 5-10% of the declaration of dextrose. Upon explicit improvement of blood circulation indicators, the further maintenance of the immentable is carried out according to the standard assistance in the initial period of true drowning.

The period of clinical death

For a period of clinical death, with any embodiment, the early start of cardiovascular resuscitation is important. The first two stages of the ABCD scheme in the form of periodic exhalations in the nose of the sinking start immediately after his face will be raised by the rescueer over the water, while towing it to the shore or to the rescue category. In the rescue boat (boat) or on the shore, an artificial expiratory breathing in the nose immediately continues, a closed heart massage is started after the restoration of effective blood circulation (the appearance of the peripheral pulse, the disappearance of the cyanosis, the narrowing of pupils, especially self-breathing) of the sinking transportation in the resuscitation department and intensive therapy The nearest hospital, better specialized transport, accompanied by an experienced health worker. Significant violations Breathing and blood circulation can be repeated during the transportation of the patient, therefore the accompanying medical workers should be prepared for the intubation of the trachea, carrying out the handmade IVL, the intravenous introduction of the necessary drugs. State

the nutrition is required. A short-term loss of consciousness or respiratory impairment after drowning should be considered as a serious warning about the possibility of developing fatal outcome due to brain hypoxia.

The procedure for providing medical care

Starting period: Ensuring the maintenance of the upper respiratory tract; short-term IVL method of mouth in mouth or mouth into the nose; oxygenation of 100% oxygen; active warming; Catheterization of veins.

The intravenous administration of 4% of sodium bicarbonate - 200 ml is shown; 6% p-ra hydroxyethyl stroke 500 ml or 5-10% Р ra dextrose - 400 ml.

When exciting, benzodiazepines (for example, diazepams) are shown - 0.2-0.3 mg / kg in / in; 20% sodium oxybate (according to indications) - 80-100 mg / kg in / in; Antioxidants 15-20 minutes after the start of oxygenaterapics - 5% P-p dimmerkaprol 1 ml / 10 kg in / in, 5% rr ascorbic acid 0.3 ml / 10 kg in / c, vitamin E 20-40 mg / kg in / m.

Agonal period and clinical death: ensuring the undergoing of the upper respiratory tract; short-term IVL method of mouth in mouth or mouth into the nose; Trachea intubation (according to indications), continuation of IVL oxygen-air mixture (with maximum inhalation up to 100%).

In the absence of a pulse wave begins a closed heart massage.

In condition of clinical death - vehicle catheterization and medication therapy.

After recovering cardiac activity:

Continue IVL 100% oxygen at least 2 hours (use PDKV mode, moderate hyperventilation mode);

IVL should continue to restore adequate spontaneous breathing;

Events to combat the eightie and brain and brain: glucocorticoids in terms of prednisone - 30 mg / kg (dexamethasone, me-tilprednisolone); sodium oxybat - 20% rr 80-100 mg / kg; Diuretics (furosemid 20-40 mg in / c);

All victims are subject to hospitalization to the branch of resuscitation and intensive therapy.

I want to consider the basics of rendering first aid when drowningEspecially if you are engaged in water tourism, fish from the boat, well, or just survive near the river or the sea).

The causes of death when drowning, as a rule, is the penetration of fluid into the respiratory tract, hypoxia, pulmonary edema, heart stop in cold water, voice gap spasm.

There are several types of drowning:

True, or wet, blue (primary)
Asfactic, pale (dry)
Syncopal drowning
Secondary drowning

First Aid in True Drown

The reason for the true drowning is to enter the fluid into the lungs, which happens in more than 70% of cases of drowning, as a result of a long-term struggle for life with periodic immersion in water and swallowing water. Often it happens in people who do not know how to swim.

The initial period of true drowning is characterized by the fact that the drowning is in consciousness, while most behave not adequately, which represents a greater danger to the saving, since drowning in this state can drown and saving, especially if he is not a professional rescuer. Face and neck of the impeding characteristic of blue colorTherefore, this type of drowning is called even blue. From the nose and the mouth can be allocated foam pink, which is a liquid part of the blood (plasma), which falls into the voice slots and foams, stopping gas exchange in the lungs, which causes the removal of the lungs. Frequent breathing is accompanied by strong coughs and vomiting. After some time, the symptoms of the true drowning of the initial period are quickly passing.

First aid at the initial period of true drowning: to bust the victim, warm, in vomiting, not allow chilli.

The aginal period of drowning is characterized by the absence of consciousness, but the presence of a weak pulse and weak breathing. Pulse manages only for carotid arteries. Doodling foam can be distinguished from the mouth and nose.

First assistance in the agonal period of initial drowning:
As soon as possible ensure the loss of respiratory tract.
Artificial respiration to mouth in the mouth, if necessary, even in water.
Maintain the correct blood circulation, shall be counteding the legs or inclined position.
With the loss of the pulse to make a closed heart massage.

With aggregative drowning, it is necessary to start ventilation of the lungs with breathing apparatus as soon as possible to increase the oxygen concentration in the body. It is also necessary to remove the liquid from the stomach, for which the victim should be flounded through the knee bent legs, patted on the back between the blades and release the contents of the stomach.

The clinical period is similar to the aggregative, with the exception of the absence of a pulse and breathing. Pupils of victim expanded and do not react to light.

First aid for the clinical period of true drowning:
Extremely beginning of eurordial and pulmonary resuscitation
Cuts in the nose can be done immediately as soon as the face of the immersion removed from the water
Breathing from mouth into the nose
Closed heart massage
Mandatory hospitalization.

Overall, as soon as you removed the victim from the water, without losing the valued seconds on the tackling of the pulse and inspection of the pupils, put the victim, so that the head is below the pelvis and enter the two fingers in the mouth and try to remove the contents of the mouth, and then press the root of the language for Calculation of vomit reflex. If after this was followed by vomit movement, then it is necessary to remove the liquid from the lungs and the stomach as soon as possible, for which it is for 5-10 minutes to push the root of the tongue, and patted the palm between the blades. It can be intensively pressing on the chest from the sides during the exhalation, for better removal of water. After removing water from the body, carve the victim on the side

If, after pressing the head of the language of vomit and cough movements, it does not occur, then it is necessary to immediately shift the victim on the back and start cardiovascular resuscitation, by carrying out artificial winding and indirect heart massage. That is, the first thing is not to remove water, but to reanimate respiratory and cardiac activity. But at the same time every 3-4 minutes it is necessary to turn the victim to the stomach for partial removal of water from the respiratory tract.

This assistance must be carried out within 30-40 minutes, even if there is no sign of efficiency.

After the revival, the appearance of the pulse and respiration will have a number of first aid measures during drowning. First of all, turn over the victim of the victim on the stomach. Further activities should have physicians.

The main causes of death in the true drowning is the edema of the lungs, the hypoxia of the brain, the heart stop and renal failure, which manifests itself during the next day.

Elevation of the lungs is characterized by a bubble breathing, as if inside the victim bouffroins and boils water, coughs with the release of pinkish foam. Emails are very dangerous and must be treated with doctors.But to help the victim in this case, it is necessary to take the victim or lift your head, impose on the hips of the harnesses to drive the blood to the lower limbs and the pelvis, and establish an inhalation of oxygen from an oxygen pillow through alcohol pairs. To do this, it is enough in a mask to put a piece of cotton wool, impregnated with alcohol, at the level of the bottom lip, which will prevent the foaming in the lungs, which occurs when the edema of the lungs. Only these manipulations can make a significant contribution to the salvation of the injured in the edema of the lungs. The harnesses must be applied at more than 40 minutes, every 15-20 minutes is shot alternately.

If there is a chance to save and there is an opportunity to call an ambulance or rescue service, then it is better to do this than trying to transport the victim on a random transport, because, by the subgeneration, the deterioration of the state, stop the heart or something like that in this way. Only in the case when there is no such possibility, it is necessary to decide on self-transportation, it is desirable on a large transport so that you can put the victim to the floor.

First aid with asphyned drowning

Asphyxic drowning occurs in 10-30% of cases when the victim cannot resist drowning, for example, in alcoholic intoxication, with a strong blow of water. Due to irritating action, for example, ice water, the spasm of the voice slot occurs, and water does not go into the lungs and stomach. Death comes because of all the spasms of the voice gap, that is, due to hypoxia. Therefore, asphyned drowning is called dry.

First aid with asphyned drowning. Since the water did not get into the respiratory tract, it is necessary to immediately start cardiopulmonary resuscitation. Some experts believe that with an asphyned drowning in ice water with the onset of clinical death, the chances of salvation are greater than when drowning in warm water. This fact is explained, the fact that in the Lyedyan water, the body is in a state of the strongest gopothermia, including the brain, as a result of which the metabolism (metabolism) is almost stopped, which increases the stock price for salvation, and of course, timely and properly rendered assistance on the shore.

Those, with asphy, in the absence of pulse and respiration, it is impossible to slow a second in ice water, and immediately begin the decimation of the pulse and breathing. Also, with successful resuscitation of victim, further complications are usually less. After the revival, it is necessary to transfer or could warm the victim.

First aid for syncopal drowning

Syncopal drowning is characterized by the primary stop of the heart and respiration, and the onset of clinical death, as a result, for example, a sharp temperature difference caused by an unexpected immersion. The period of clinical death with this drowning is slightly higher than with other types of drums, especially in ice water counted deep hypothermia. The main thing external honors Syncopal drowning, is an external pale appearance and lack of liquid release from respiratory tract.

Conclusion: It is necessary to understand the causes of death at different types Drownings, do not fall into panic, and have resuscitation, even if there are no improvements, not less than 40 minutes.

Drowning is the type of mechanical asphyxia (choking) as a result of water from entering the respiratory tract.

Changes occurring in the body when drowning, in particular, the duration of dying under water, depend on a number of factors: on the nature of water (fresh, salt, chlorinated fresh water in the pools), from its temperature (ice, cold, warm), from the presence of impurities (Il, Tina, etc.), from the condition of the body of the victim at the time of drowning (overwork, excitation, alcoholic intoxication, etc.).

There are three types of drowning: primary (true, or "wet"), asphisical ("dry") and syncopal. In addition, with accidents, death may occur in water, not caused by drowning (injury, myocardial infarction, violation of cerebral circulation, etc.).

Primary drowning It is most common (75-95% of all accidents in water). With it, there is an aspiration of fluid into the respiratory tract and the lungs, and then entering it into the blood. When drowning in fresh water, severe hemodilution and hypervolemia, hemolysis, hypocalemia, hypoproteinemia, hypoprotemia, reduced the concentration of calcium ions and chlorine in plasma developing, develops. Characteristic sharp arterial hypoxemia. After extracting the victim from the water and the provision of first aid, the swelling of the lungs is often developing with the release of bloody foam from the respiratory tract. When drowning in sea water, which is hypertonic with respect to blood plasma, hypovolemia is developing, hypernatremia, hypercalcemia, hyperchloremia, thickening of blood arises. For true drowning in seawater, the rapid development of edema is characterized by the release of white or pink, rack, "fluffy" foam from the respiratory tract.

Asphisic drowning It is found in 5-20% of all cases. With it, reflex laryngospasm and water aspiration does not occur, but asphyxia comes. Asphisic drowning occurs more often in children and women, as well as when hitting the injured in polluted, chlorinated water. At the same time, water in large quantities enters the stomach. May develop swelling of the lungs, but not hemorrhagic.

Syncopal drowning Developed as a result of the head of the heart due to hitting the injured in cold water ("ice shock", "immersion syndrome"), a reflex reaction to the water in the respiratory tract or the cavity of the middle ear with a damaged eardrum. For syncopal drowning, a pronounced spasm of peripheral vessels is characteristic. The swelling of the lungs, as a rule, does not occur.

The state of the victims extracted from the water is largely determined by the duration of stay under water and view of drowning, the presence of mental injury and cooling. In light cases, consciousness can be preserved, but the patients are excited, a trembling, frequent vomiting marks. With a relatively long true or asphisical drowning consciousness, confidential or absent, sharp motor arousal, convulsions. Citanotic skin. For syncopal drowning, a sharp pallor of the skin is characteristic. Pupils are usually expanded. Break bubbling, rapid or long-term stay under water is rare with the participation of auxiliary muscles. When drowning in seawater, swelling of the lungs rapidly. Pronounced tachycardia, sometimes extrasystolia. With long and secondary drowning, the victim can be removed from the water without signs of breathing and cardiac activity.

Complications. With true drowning in fresh water, at the end of the first hour, sometimes hematuria is developing later. Pneumonia and the atelectases of the lungs can develop very quickly, at the end of the first day after drowning. In pronounced hemolysis, hemoglobinurion nephrisosis and acute renal failure can occur.

First aid The victim should be started immediately after the face of the drowned raised over the water, and continued during towing to the category or ashore. At the same time, the rescuer throws the head of the victim back, from time to time blowing the air into the lungs of mouth into the nose. After delivering the victim to the shore, it is necessary to estimate its condition. With the saved consciousness and breath, it must be warm and calmed down (sedatives and tranquilizers are shown). If consciousness is absent, but the pulse is rhythmic, satisfactory filling and self-breathing is preserved, it is necessary to free up the chest from the shocking clothes, give rise to vapors of ammonia alcohol, to activate the breath to fade in the language. Victims, located in an unconscious state, if there are signs of respiratory impairment and blood circulation (frequent or rare pulse, frequent or rare breathing, motor excitation, cyanosis) or in the absence of self-breathing, it is necessary to urgently start artificial ventilation of the lungs, without losing time on attempts to remove all liquid From the respiratory tract, as it is impracticable. The victim is put on the back, try to overcome the trisms of chewing muscles by opening the mouth, purify the oral cavity with a finger, wrapped with gauze or a nose scarf, and begin to carry out artificial respiration. If water is distinguished from the respiratory tract, it is necessary to turn the head to the side and raise the opposite shoulder, palm or a fist to the epigastric area. Artificial respiration is carried out until a complete recovery of consciousness. In the presence of trained medical staff and the necessary toolkit already on chipboard It is recommended to intubate the trachea as soon as possible and use the ABU portable valve, which allows you to create an adjustable resistance to exhale (up to 10 to 20 cm of water. Art.), which contributes to the separation of alveoli and reduce the receipt of non-perjenated blood from the system pulmonary artery In pulmonary veins. The timeliness of artificial respiration and the usefulness of it determine the further course of the post-indignance period and its outcome. If there is no pulse on large arteries, the heartbeat is not listened, the pupils are expanded, the skin is pale or cyanotic, simultaneously with artificial ventilation Lungs (IVL) carry out indirect heart massage. After removal from the state of the clinical death of the victim, heated if the body temperature is below 30 - 32 ° C, and the upper massage is carried out lower extremities. The body temperature is maintained in the range of 32-33 ° C (moderate hypothermia increases the resistance of the CNS to hypoxia). Due to the danger of the development of late complications, even with minimal pathological symptoms, hospitalization and observation in hospital conditions are needed at least 24 hours. Resuscitation activities during transportation are not terminated. When delivery to the hospital, clear continuity should be ensured. Therapy in the hospital (better resuscitation separation) must first of all be aimed at combating hypoxia using oxygen inhalation or oxybarotherapy, and in the absence of effect, an IVL (100% oxygen is first 1-2 h) with positive pressure on exhalation or high-frequency zl . The early correction of metabolic acidosis is shown, antihistamines. In order to prevent acute renal failure, a forced diurez lazic (with developed renal failure - extracorporeal hemodialysis). To prevent brain edema use local hypothermia, corticosteroids and barbiturates are introduced; inflammatory process In the lungs - parenterally prescribed antibiotics wide spectrum actions. With true drowning in fresh water and the presence of a sharp cyanosis, indicating the overload of the right-hand heart departments, conduct urgent bloodletting. For the removal of hemolysis products, mannitis is injected drip, to reduce hypercalemia - a solution of glucose with insulin. With the aspiration of seawater, the liquid loss compensate intravenous administration plasma-substituting solutions, glucose and sodium bicarbonate. With high venous and arterial pressure Gangliblocators and diuretics are recommended; With low blood pressure glucocorticoids, dopamine. To improve the metabolism and the contractile ability of the myocardium, cardiac glycosides, panangin, cocarboxylase, vitamins C, group V. In the event of fibrillation of the ventricles of the heart, defibrillation is shown.

During the period of rehabilitation, recurrence of severe parenchymal respiratory failure, pulmonary edema and aspiration pneumonia, often occurs edema of the brain.

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How to save the drowning? How effective are prefigured resuscitation actions? What needs to be done after providing prefigure help before the arrival of doctors? You will read about this and many other things in our article.

Almost always, the right provision of first aid to the drowning, saves the life of the victim, as the professional team of physicians will not have time to arrive at the scene in time, even if it was caused directly immediately after the formation of such a situation.

How to pull the victim to the shore?

It should be noted that an important element of the potential salvation of a sinking person, if he has not yet managed to plunge into the water for a long period of time, is its proper pulling, providing not only the possibility of resuscitation of the victim, but also the safety of helping.

Basic Saving Salvation Under:

First help drowning

After the victim was taken to the shore, it is necessary to proceed to the necessary resuscitation actions.

First Aid Action Algorithm during drowning (briefly on points):

From liquid or foreign substances. The roth cavity of the victim opens, dentures, vomit, tina, liquid are made of it. When drowning directly in the water, the rescuer places a person's belly on his knee face down to enable fluid to flow freely. Two fingers are laid in his mouth and put pressure on the root of the tongue to call vomiting, helping to free the respiratory tract and the stomach from the waters did not have time;
Active pre-intentional actions. As part of the first aid, it is necessary to continue the induction of the call of vomiting near the victim in the initial postal position from 1 point until the cough appears. If effect this process does not give, then in the overwhelming majority of cases of free fluid in the respiratory tract and there is no stomach, because it managed to suck;
Direct resuscitation. The victim turns over to the back and is placed in a horizontal position, after which the saving starts to the massage of the heart and artificial respiration.

How to give first aid when drowning Look at the video:

With true (wet) drowning

How to render first help drowning? As part of the provision of a prefigured first aid in the rescue of the immentable, when the incident occurred directly within the reservoir and a large amount of water fell in the human body, the previously described measures described above.

Their average duration occupies from 2 to 3 minutes to primary two stages. At the same time, directly artificial respiration and indirect heart massage is effective on average 6-8 minutes. After 10 minutes and the absence of any signs of heartbeat and breathing, it is impossible to save with a high share of the likelihood of a person.

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An important factor in true drowning is also the circumstances of the incident. So in salty water, the chances of a person survive in the absence of breathing and heartbeat higher, since irreversible processes occur later than in case of chilling freshwater - Restore life processes are possible within 10-15 minutes.

In addition, the water temperature also makes a certain contribution. When drowning in a cold or ice fluid, irreversible destruction processes slow down. IN some cases Resuscitation practice fixed the situation when a person was returned in life by conducting an indirect massage of the heart and artificial respiration after 20, and sometimes 30 minutes after drowning.

With asphisical (dry) drowning

Asphisic or dry drowning is a pathological circumstance that is forming as a result of spasm of voice gap and choking, when water in the respiratory tract does not penetrate.

In general, a similar type of incident is considered more favorable in the context of the potential human resuscitation possibility.

What to do with dry drowning? The first assistance in dry drowning as a whole coincides with the preferences, as for classic drowning, but the second stage (attempts to call vomiting and freeing the respiratory tract with the stomach from the accumulated fluid) is skipped and direct resuscitation actions apply to the victim.

Reanimating actions

As part of rendering actions to provide emergency care When drowning a manual nature, two main procedures are produced - it is an indirect heart massage and artificial respiration. The basic rules for assistance to the drowning are presented below.

Artificial respiration

The victim stacked on the backThe respiratory tract opens as wide as possible, from the oral cavity is extracted by any foreign objects that make breathing. In the presence of a duct of the medical construction he in obligatory It is used as part of the first aid of a sinking person.

Rescuer makes a deep breath And he exhales the air into the mouth of the victim, the wings of the nose and keeping his chin, tightly pressing the lips to the mouth of the victim. As part of forced ventilation, a man's breast should be lifted.

The average swing time is about 2 seconds, after which it follows 4 seconds by a pause for slow reflector lowering chest drowned. Artificial respiration during drowning is repeated regularly before the emergence of stable signs of respiration or the arrival of the ambulance brigade.

Indirect heart massage

Events on the launch of cardiac activity can be combined with the implementation of artificial respiration within their alternate shift. To begin with, you should pre-strike a fist in the heart projection area - It must be the middle strength, but sharp enough and fast. In some cases, it helps instantly start the functioning of the heart.

In the absence of effect, you need to count the two fingers down from the sternum to the center of the chest, straighten your hands, putting one palm to another, orient to the connection of the lower edges with the sternum, after which the pressure is strictly perpendicular to the heart with two hands. The heart itself is squeezed between the sternum and the spine. Major efforts are carried out to all the torso, and not just hands

The average depth of indulgence should not exceed 5 cm, and the estimated pressure rate is about 100 manipulations per minute, cycles 30 times with a combination of lung ventilation.

The total cycle, thus, looks like this: 2 seconds inhalation of air in the affected, 4 seconds to its spontaneous output, 30 massage manipulations in the heart area and repetition of the cyclic dual procedure.

First aid to children

It is worth noting that the chances of reanimating the child when drowning substantially less than an adult, since it is much faster developing irreversible processes leading to death.

On average, there are about 5 minutes to try to save the drowned baby.

Algorithm of first aid actions when drowning to a child:

Stretching the victim to the shore. It is carried out as quickly as possible, while complied with general rules Precautions described earlier;
Liberation of the upper respiratory tract From foreign substances. It is necessary to open the child to the mouth, try to free it from any kinds of foreign substances, including water, after which put the knee and put the baby's belly on it, in parallel, causing the last vomit reflex by pressing the root of the language. The event is repeated until the child does not show an active cough, and water together with the lots will not cease to actively flow out;
Resuscitation events. In the absence of an effect, the procedure from the previous point or the presence of signs of "dry" type of drowning, the child turns onto the back, stacked in a horizontal position and is carried out by an indirect heart massage, as well as artificial respiration.

Further rescue steps

If the victim managed to launch the breath of heartbeat, then it stacked on the side, while continuing to stay in horizontal position. A person is covered with a plaid or a heated towel, while its condition is constantly monitored and in the case of re-stopping the respiratory or heartbeat, the manual resuscitation resumes.

It should be understood that regardless of the circumstances, even when a person is in satisfactory condition, it is necessary to wait for the arrival of the ambulance brigade, which will be the first medical care When drowning. Profile experts qualified will appreciate potential risks for the victim and will decide on the need or the absence of such in hospitalization.

In some cases, a significant amount of water in the lungsThe secondary brain edema and other symptoms appear after a certain period of time, the medium-term health does not exist only when after drowning it happened more than 5 days, while no pathological symptomatics has manifested itself.

Types of drowning

In general modern medicine Disasters three types of drowning:

True drowning. The main sign of this incident is the hitting of a large amount of water into the lungs and stomach, against the background of which the echo of the corresponding tissues and the irreversible destruction of their structure occurs. Occurs in each of the 5 recorded cases;
Asphisic drowning. It can also occur on the water, but the liquid itself in light stomach does not penetrate, since a pronounced spasm of voice ligaments are formed to this process with a complete stopping of respiratory activities. All basic pathological processes are associated with direct suffocation and shock. Occurs in 40 percent cases;
Syncopal drowning. It is characterized by a reflex stop of cardiac activity, in the overwhelming majority causes a practically instant fatal outcome. Occurs in 10 percent cases;
Mixed drowning. It has signs of both classic "wet" and asphisic drowning. Diagnosed on average in 15 percent of victims.

The difference between sea and fresh water

Classical medicine distinguishes drowning in fresh and sea water for a number of characteristic features:

Fresh water. Alvetol stretching and penetration of the corresponding fluid into the blood circuit through direct diffusion through the integrity of the alveolar-capillary membrane. Hypotonic hypotical hypotonic developed sharply, the functioning of blood flow is disturbed.
Due to the absorption of hypotonic waters in the vascular channel, eaters, hypervolemia, hyperosmolarity, blood dilution, with an increase in its volume are formed.
There are fibrillation of ventricles, not cope with large quantity "Diluted" biological fluid. In general, irreversible disorders are fast;
Salty water. The liquid enters the alveoli, which leads to hypertensive dehydration, increasing the amount of sodium, potassium, magnesium and calcium, as well as chlorine in blood plasma. In fact, there is no discharge, but on the contrary - thickening of blood, while irreversible disorders for the body comes slower, compared with fresh water (up to 25 percent).

The processes described above are often distinguished in separate categories Descriptive characteristics medical literature XX century.

Modern large-scale studies show that the pathogenesis process during drowning in fresh and salt water is not significantly different in the context of clinical danger.

Accordingly, the difference in potential resuscitation is actually insignificant and is only a few minutes. As real practice shows, the chances of restoring the function of the brain and the vital indicators of drowning cases at very low temperatures are significantly increasing, especially in children with a small mass body.

Separate doctors recorded cases of complete resumption of vital activity 30 minutes after drowning, while all the time the victim was missing breathing and heartbeat.