Summer is a time for water recreation. However, many dangerous situations can occur, such as drowning. According to the statistics of the Belarusian Republican Society for Rescue on Waters, every year water takes the lives of more than one hundred people. Moreover, most of them become its victims during the swimming season.
Dmitry Nikolaev, lieutenant-colonel of the medical service, deputy head of the BSMU Department of organization of troops medical support and extreme medicine of the Faculty of Military Medicine, spoke about drowning and victims rescue.
What is drowning?
Drowning is a form of mechanical suffocation or death that results from filling the lungs and airways with water or other fluids.
Types of drowning.
There are true ("wet"), asphyxial ("dry"), syncope and secondary ("death on water") drowning.
True drowning develops when a large amount of fluid enters the victim's lungs. It can be drowning in fresh or seawater. When it enters the lungs, fresh water is rapidly absorbed into the blood, since the concentration of salts in fresh water is much lower than in blood. As a result, the blood thins, its volume increases, and erythrocytes are destroyed. If we talk about seawater, the concentration of substances dissolved in it is higher than in the blood. Therefore, when seawater enters the lungs, the liquid part of the blood, together with proteins, penetrates from the blood vessels into the alveoli. This leads to a blood thickening, an increase in the concentration of potassium, sodium, calcium, magnesium and chlorine ions. A large amount of fluid accumulates in the alveoli, which leads to its stretching up to rupture.
In true drowning, there are three periods of its development. During the first (initial) the victim is conscious. However, he does not adequately respond to the situation (behaves indifferently or overactive). His skin is cyanotic. Breathing is rapid, noisy, can be interrupted by coughing fit. Primary tachycardia and arterial hypertension are soon replaced by bradycardia and a decrease in blood pressure. Vomiting may occur.
At the onset of the second (agonal) period, the victim loses consciousness, there is no breathing, but cardiac activity remains. Heartbeats are weak, deaf. Often, the pulse is determined only on the carotid and femoral arteries. The skin is bluish and cold to the touch (therefore, in everyday life, true drowning is called blue). Pink foam comes out of the mouth and nose.
A distinctive feature of a drowned man in a state of clinical death (this is the third period of true drowning) is the absence of consciousness, pulse and breathing. His pupils are dilated, as a rule, they do not respond to light.
Asphyxia ("dry") drowning occurs as a result of an acute reflex spasm of the larynx muscles and can cause asphyxia even without water entering the upper respiratory tract or if a small amount of it gets in. This condition, as a rule, is preceded by central nervous system depression as a result of alcohol or other intoxication, a blow to the stomach or head on water or some kind of underwater object. Such victims have a rare pulse, respiratory and circulatory depression gradually occurs, and then clinical death may occur.
Syncope drowning is characterized by primary reflex cardiac arrest and respiratory arrest, which is caused by the ingress of even small amounts of water into the upper respiratory tract. With this drowning, the pulse and breathing are absent, the pupils are dilated and do not respond to light. The skin is pale. Syncope drowning is similar to the so-called cryoshock, which develops due to reflex cardiac arrest during a sudden immersion in cold water.
Secondary drowning (“death on water”) occurs as a result of primary arrest of blood circulation and respiration (myocardial infarction, epileptic seizure, etc.). The ingress of water into the respiratory tract occurs secondarily and unhindered (when the person is already in an unconscious state).
How to save a drowning man correctly?
When rescuing a drowning man, it is necessary to act as quickly as possible, because any delay can cost life. However, it is important not to panic. Of course, it is better that this process is carried out by professional rescuers, but if they are not around, you should try to help the victim as much as possible. It is advisable to gain support of people around you and work with them in a team.
The rescue of a drowning person takes place in two stages. The first is the search and retrieval of the victim from the water. You should know that a person can drown a few meters from those who could help him. Therefore, it is important to pay attention to the behavior of the bather. He can submerge under water, float up, trying to swallow a portion of air, and often cannot call for help.
Rescuing a drowning person is a very responsible decision, since he is a mortal danger. There are many known cases when even experienced swimmers died when rescuing a drowning man, who were drowned by the victims themselves, behaving inadequately in a critical situation. Therefore, for the sake of personal safety, it is necessary to swim up to the drowning person from the back and, grabbing him by the hair or armpits, transport him face up to the shore. Ideally, it is better to throw a non-sinking object (board, stick or life buoy) to the victim and drag him.
If a hitch with a drowning person still occurs, you should take a deep breath and dive under the water. The drowning man will lose his support and open his arms.
If a spinal injury is suspected, all manipulations must be performed carefully, fixing the victim's head and cervical spine.
Changes in the body during drowning, in particular, the timing of dying under water, depend on a number of factors: on the nature of the water (fresh, salty, chlorinated fresh water in swimming pools), on its temperature, on the presence of impurities, on the state of the victim's body at the time drowning (overwork, intoxication, etc.). Therefore, after removing the drowned man from the water, it is necessary to start first aid measures.
If a person is conscious, he must be laid on a hard surface with his head down. Remove embarrassing clothing. To clear the water from the stomach, upper respiratory tract and lungs, induce vomiting by pressing on the root of the tongue. Then the victim is rubbed with a dry towel, covered and given a hot drink.
In the absence of consciousness, but the presence of a pulse and spontaneous breathing, the victim is placed in a stable lateral position. And before the arrival of doctors, called immediately, they monitor his condition.
Lack of consciousness, spontaneous breathing and heartbeat indicates the onset of clinical death. This means that the counting goes by minutes. First of all, you need to lay the victim on his back on a flat, hard (!) surface. Help begins with the restoration of airway patency, for which it is necessary to turn the victim's head and shoulders to the side, open his mouth and remove foreign bodies from the mouth, including dentures, with a finger wrapped in a handkerchief or bandage.
As for the release of the upper respiratory tract from water and foam, the victim is placed with his stomach down on the rescuer's thigh, bent at the knee joint. Then sharply, vigorously squeeze the chest or slap on the back. This activity must be performed when drowning in sea water. Fresh water is quickly absorbed from the lungs into the bloodstream, and, according to a number of experts, spending time to extract it is an unacceptable luxury.
Cardiopulmonary and cerebral resuscitation.
Further it is necessary to start cardiopulmonary and cerebral resuscitation. And you need to start with a closed heart massage. It is performed by pressing on the chest in the lower third of the sternum 2–3 cm above the base of the xiphoid process, located at the edge of the costal arches convergence. Pressing is performed with the base of the palm (crossed palms) with arms straightened at the elbows rhythmically with a frequency of 100-120 bpm in adults and 120-140 bpm in children using the weight of the body (the shoulders of the caregiver should hang over the victim's sternum). Moreover, the sternum should go down to the spine in adults by 5-6 cm, in children - by 4-5 cm. Resuscitators should often replace each other without stopping the rhythmic heart massage, because resuscitation requires large physical costs.
Artificial ventilation of the lungs should be performed alternately with a closed heart massage. Air is blown into the lungs of the victim through the upper respiratory tract from mouth to mouth - this is the most effective method. To prevent transmission of infection, you must use an airway, breathing tube, face mask with a valve, or a two-layer gauze pad. After this procedure, you should cough well and rinse your mouth with any antiseptic solution or water.
The person providing assistance, being on the side of the victim's head, holds it with one hand in a thrown back position and simultaneously holds the nose with his index and thumb. Taking a deep breath, tightly covers the victim's mouth with his lips and blows his exhaled air into his lungs through his mouth. The inhalation should be uniform and equal in time to the exhalation. Exhalation occurs passively, and during this period the "rescuer" takes another deep breath.
During artificial lung ventilation in patients with injured cervical spine it is prohibited to throw his head back. To restore airway patency, the lower jaw is moved forward and the mouth is opened. In order to avoid any movements in the cervical spine, it is necessary for another person to fix the victim's head, clasping it with his hands.
In addition, artificial ventilation of the lungs can be carried out from the mouth to the nose. In this case, during inhalation, it is necessary to close your mouth with your palm or press your lower lip with your upper finger, and during exhalation, open your mouth. Inhalation in adults is carried out at a frequency of 8-10 times per minute.
Closed heart massage and artificial lung ventilation are performed sequentially, for 30 compressions there should be 2 breaths (one cycle). And it doesn't matter how many people are helping. Monitoring the effectiveness of assistance for the appearance of independent pulse and breathing, pupillary reflex is performed every two cycles of cardiopulmonary and cerebral resuscitation.
Steps after we brought the victim back to life.
After reversal of the clinically dead state, the victim is warmed up (wrapped, covered with warm heating pads) and massage of the upper and lower extremities from the periphery to the center is performed.
In all cases, after rendering assistance, the victim must be hospitalized, since there is a risk of the development of the drowning consequences (pulmonary edema, cardiac arrest, acute renal failure, etc.). Only after one week it will be possible to say with confidence that the state of health of the victim is out of danger.
How to prevent water from causing trouble.
Certain rules should be strictly observed so that rest on the water did not turn into sad consequences,. You need to swim in calm, sunny weather at an air temperature of + 20–25 ° C and a water temperature of + 17–19 ° C. A bathing session should not exceed 10–15 minutes. You can swim only in specially equipped places, where the bottom is sandy or pebble, there are no silt deposits, snags, etc. In no case should you swim behind the buoys. Before diving into water bodies, you must be sure that the bottom is safe, otherwise damage to the cervical spine cannot be avoided.
According to statistics, about half of the drowned were in one stage or another of alcoholic intoxication. Therefore, before entering the water, it is strictly forbidden to consume alcoholic beverages. It is not recommended to immerse yourself in water immediately after sunbathing, playing sports, eating, etc.
In addition, cramps may occur when swimming in cold water or prolonged swimming. In order to cope with it, it is necessary, firstly, to change the swimming style (it is better to continue swimming on the back), secondly, to try to counteract the spasmodic muscle, straightening it as much as possible, and thirdly, to prick the “frozen” muscle with a pin, which is better to have with yourself.
And, of course, children should not be left unattended by the reservoir. And the rule for people who cannot swim should be: if you don't know how to stay on the water, don't dive into it more than waist-deep.
Be healthy and take care of yourself!
Authors: Oksana Kurbeko, spokesperson – interviewer; Dmitry Nikolaev, lieutenant-colonel of the medical service, deputy head of the BSMU Department of organization of troops medical support and extreme medicine of the Faculty of Military Medicine – interviewee.
Photos are taken from the archive of the Faculty of Military Medicine and public sources.
Translation: Anastasiya Karnacheva.