Drowning: emergency care for drowning

Drowning is death from asphyxiation due to immersion in water. Drowning is most often combined with the trauma of the cervical spine (especially the fifth cervical vertebra), obtained by diving, and alcoholic or narcotic intoxication is also a common cause of drowning.

Distinguish also incomplete drowning - survival after asphyxiation due to immersion in the liquid. Most often death from drowning is recorded in adolescence and adolescence, as well as in children of the first years of life.

The risk factors for drowning are also:

• Children's games near the water.
• Accidents resulting from immersion, exposure to poisons (eg pesticides or toxic gases) near water bodies or in rural mud.

In the pathogenesis of drowning in fresh water, two factors are important: washing surfactant from pulmonary alveoli and rapid absorption of hypotonic water from the alveoli into the vascular bed (hypervolemia). Which leads to micro-telecases, hypoxia, pulmonary edema, and in the postresuscitation period to acute renal failure and hemolysis. With prolonged exposure to warm water, energy depletion, collapse, hypysystole and bradycardia develop. Long exposure to cold water leads to peripheral vascular spasm, muscle stiffness, ventricular fibrillation. The more aspirated water, the greater the likelihood of fibrillation. Drowning in sea water is accompanied by similar disorders, but with the sweat of water into the lumen of the alveoli and the development of hypovolemia, arterial hypotension after salvage. With a "dry" drowning, i.e. Due to laryngospasm, acute asphyxia and hypoxia, fibrillation also develops.

[1], [2], [3], [4]

How to recognize a drowning?

Recognize the drowning help the following symptoms: anamnesis of immersion in the fluid with a stop of breathing or heart and breathing. Deep hypothermia is possible. Often damage to the neck and spine.

With what it is necessary to make a differential diagnosis?

• Accidents when diving with a head injury.
• The impact of toxic waste and chemicals in the water.
• Poisoning.
• Intentional harm (nonrandom damage).

Emergency assistance for drowning in children

Help in drowning the victim in the mind, without disturbing hemodynamics and breathing, is limited by warming and taking valokordin 1 drop per year of life.

If the victim develops tachypnea, bradycardia, impaired consciousness and convulsions, help is to purify the oropharynx from mucus and to ensure the maintenance of airway patency after removing water from the lungs and stomach. The victim should be laid on his side and press the palm over the upper abdomen or put his face down and. Embracing the body with his hands in the abdomen, raise it up, squeezing out the water. Oxygen therapy is then carried out through the mask, beginning with the introduction of pure oxygen (100%). Convulsions are stopped by intramuscular or intravenous injection of a 0.5% solution of diazepam (seduxen) at a dose of 0.3-0.5 mg per kg of body weight or midazolam at a dose of 0.1-0.15 mg per kg of body weight. With bradycardia intramuscularly administered 0.1% solution of atropine at a dose of 0.1 ml per year of life or 10-15 μg per 1 kg of body weight with an emergency intubation of the trachea (together with diazepam). The contents of the stomach must be removed with a probe to prevent aspiration. The nasogastric tube is left in the stomach for decompression. It is necessary to exclude the trauma of the cervical spine, characteristic signs of which can be paradoxical breathing, lethargy, arterial hypotension, bradycardia.

If spontaneous breathing is maintained, ventilation is carried out through the mask under constant positive pressure in the respiratory tract, using pure oxygen (100%). When the respiration is stopped, the trachea is intubated, the ventilator with a positive end-expiratory pressure of 4-6 cm of water. Then 1% solution of furosemide (lazix) is injected intravenously intravenously from the calculation of 0.5-1 mg per 1 kg of body weight again and 2.4% solution of aminophylline (euphyllin) at a dose of 2-3 mg to 4-6 mg per 1 kg body weight intravenously struino or drip. Inhalation is carried out with 100% oxygen, passed through a 33% solution of ethanol.

Victims with hypothermia help to carry out cardiopulmonary resuscitation in parallel with warming up to a body temperature of more than 32 ° C.

With true drowning after cardiopulmonary resuscitation, children are observed cyanosis, swelling of the veins of the neck and extremities, the release of foam masses (sometimes pink) from the oral cavity and nasal passages, arterial hypertension, ventricular fibrillation, pulmonary edema.

With asphyxia (dry) drowning, the skin is pale, the pupils are dilated, reflex stopping of the heart or fibrillation occurs quickly. Foam release does not occur.

In case of rescue in children, there may be no residual neurological disorders. This is due to the rapid development of hypothermia, which contributes to greater stability of the central nervous system to hypoxia, with a certain amount of air retained in the airways and lungs, thanks to which gas exchange can continue during laryngospasm with the development of reflex bradycardia and increased blood flow in the brain and heart.

[5], [6] First aid for drowning Assess the condition of the cervical spine. The neck must be linearly immobilized. Start a basic resuscitation. If resuscitation equipment is available, give oxygen through a bag / valve / mask. The risk of aspiration of gastric contents is high. Intubate as soon as possible - in this situation, medications are often not needed. If medications are available - rapid sequential induction. Introduce the probe for decompression of the stomach. Through it, the stomach can be washed. [7] Extended medical assistance for drowning If the internal temperature is less than 30 ° C, give up adrenaline and other resuscitation medications. Above 30 ° C - the lowest recommended dose with a doubling of the interval between administrations. If there is VF, first apply three shots, but from further attempts at defibrillation, you should abstain until the internal temperature rises to 30 ° C. [8], [9] Active heating First aid for drowning is unlikely to be successful if the internal temperature can not be raised above 32 ° C. Adjust rectal or (preferably) esophageal temperature monitoring. Remove all wet clothing and wipe dry. Use a warming blanket with supercharged warm air, warm all fluids before intravenous injection. If possible, heat the breathing loop of the respirator or use a circulating system with a carbon dioxide absorber and a low gas flow with warming of the inhaled gas mixture (NB, when hypothermia, CO2 production is reduced). Rinse the stomach and bladder with saline solution warmed to 40-42 ° C. Flush the abdominal cavity with a non-potassium Analyzing solution warmed to 40-42 SS, 20 ml / kg / 15 min per cycle. Extracorporeal circuit with blood warming. Complete examination for other injuries. [10], [11] Further management Supportive treatment in the ICU. Regular tracheal toilet, aspirate sowing. Course of antibiotic therapy. Physiotherapy and chest X-ray in dynamics.

What you need to know about drowning?

• Three quarters of those affected by incomplete drowning are recovered without any consequences if they receive basic assistance immediately after they are taken out of the water.
• Diving time reduces the probability of survival. Immersion for a period exceeding 8 minutes is most often fatal.
• Rapid recovery of spontaneous breathing (several minutes) after the initiation of first aid during drowning is a good predictor.
• Deep hypothermia (after immersion in cold water) can protect vital functions, but predisposes to ventricular fibrillation, which can remain refractory to treatment until the temperature is above 32 ° C.
• Myocardium does not respond to drugs at temperatures below 30 ° C, so if the temperature is less than 30 ° C, adrenaline and other drugs should be discontinued. With the introduction of drugs with standard intervals for extended resuscitation, they accumulate at the periphery, and therefore at the lowest possible recommended dose at 30 ° C with a doubling of the interval between administrations.
• First, drowning causes apnea and bradycardia due to vagus stimulation (diving reflex). Continuing apnea leads to hypoxia and reflex tachycardia. Continuing hypoxia produces severe acidosis. Eventually, breathing resumes (a turning point) and the fluid is inhaled, immediately causing laryngospasm. This spasm is weakened with the increase of hypoxia; water and what is in it, rush into the lungs. Acceleration of hypoxia and acidosis leads to bradycardia and arrhythmia, with the outcome in the arrest of the heart.