Drowning is a special type of mechanical asphyxia that occurs when the body is completely or partially immersed in a liquid medium (usually water) and proceeds differently depending on the conditions of the incident and the characteristics of the victim's body.

The medium of drowning is most often water, and the scene of the incident is natural water bodies (rivers, lakes, seas), in which the human body is completely immersed. There is drowning in small shallow water bodies (ditches, streams, puddles), when the liquid covers only the head or even only the face of the deceased, often in a state of extreme intoxication. Drowning can occur in limited containers (baths, barrels, cisterns) filled with water or other liquid (gasoline, oil, milk, beer, etc.).

Types of drowning

Drowning is divided into aspiration (true, wet), asphyxial (spastic, dry) and syncope (reflex).

True (aspiration drowning) is characterized by the obligatory penetration of water into the lungs, followed by its entry into the blood, occurs in 65-70% of cases.

With spastic (asphyxic) type drowning due to irritation of water receptors respiratory tract a reflex spasm of the larynx occurs and water does not enter the lungs, this type of drowning often occurs when it enters contaminated water containing chemical impurities, sand and other suspended particles; occurs in 10-20% of cases.

Reflex (syncope) drowning It is characterized by a primary stop of cardiac activity and respiration almost immediately after a person enters the water. It occurs in people who are emotionally excitable and may be the result of reflex influences: cold shock, allergic reaction on water-containing substances, reflexes from the eyes, nasal mucosa, middle ear, facial skin, etc. It is more correct to consider it one of the types of death in water, and not drowning, it occurs in 10-15% of cases.

Signs of drowning

With true drowning during an external examination of a corpse, the following are characteristic signs:

• white, persistent fine-bubble foam at the openings of the nose and mouth, formed as a result of mixing air with water and mucus of the respiratory tract, the foam lasts 2-3 days, when dried, a thin fine-meshed film remains on the skin;
• an increase in the volume of the chest.

During the internal examination of the corpse, the following signs :

• acute swelling of the lungs (in 90% of cases) - the lungs completely fill the chest cavity, covering the heart, prints of the ribs are almost always visible on the posterolateral surfaces of the lungs;
• grayish-pink, finely bubbling foam in the lumen of the respiratory tract (larynx, trachea, bronchi);
• under the pleura (outer membrane) of the lungs, red-pink hemorrhages with fuzzy contours (Rasskazov-Lukomsky-Paltauf spots);
• liquid (drowning medium) in the sinus of the main bone of the skull (Sveshnikov's sign);
• liquid (drowning medium) in the stomach and in the initial section of the small intestine;

In the spastic type of drowning, common signs are found that are characteristic of mechanical asphyxia during external and internal examination of the corpse, the presence of fluid (drowning medium) in the sinus of the main bone.

There are no specific signs in reflex (syncope) drowning, there are general asphyxia signs.

death in the water

Drowning is usually an accident while swimming, playing water sports, or accidentally falling into the water.

There are many factors that contribute to drowning in water: overheating, hypothermia, loss of consciousness (fainting), convulsive contraction of the calf muscles in water, alcohol intoxication, etc.

Drowning is rarely suicidal. Sometimes there are combined suicides, when a person, before falling into the water, takes poison or inflicts gunshot wounds, cut wounds or other injuries on himself.

Murder by drowning occurs relatively rarely by pushing into the water from a bridge, boats, throwing newborns into cesspools, etc. or forcible immersion in water.

Murder-drowning in the bath is possible with a sharp rise in the legs of a person in the bath.

Death in water can also occur from other causes. In people suffering from diseases of cardio-vascular system, death can occur from acute cardiovascular failure.

When jumping into the water in a relatively shallow place, the diver hits his head on the ground, as a result of which fractures of the cervical spine with damage may occur. spinal cord, death can occur from this injury and there will be no signs of drowning. If the injury is not fatal, then the unconscious person can drown in the water.

Damage on corpses recovered from the water

If injuries are found on the body, it is necessary to resolve the issue of the nature of their origin and lifetime. Damage is sometimes caused to a corpse by parts of water transport (propellers), when removing a corpse from water (hooks, poles), when moving with a fast current and hitting various objects (stones, trees, etc.), as well as animals living in water (water rats, crustaceans, marine animals, etc.).

Corpses can end up in the water when the corpse is deliberately thrown into the water to hide the traces of the crime.

Signs of a corpse in the water, regardless of the cause of death:

• wet clothes;
• the presence of sand or silt on clothing and body, especially at the roots of the hair;
• maceration of the skin in the form of swelling and wrinkling, gradual detachment of the epidermis (cuticle) on the palmar surfaces of the hands and soles. After 1-3 days, the skin of the entire palm is wrinkled (“washerwoman’s hands”), and after 5-6 days, the skin of the feet (“gloves of death”), by the end of 3 weeks, the loosened and wrinkled epidermis can be removed in the form of a glove (“glove of death” );
• hair loss, due to loosening of the skin, hair loss begins in two weeks, and at the end of the month, complete baldness may occur;
• signs of decay;
• the presence of signs of adiposity.

. Laboratory research methods for drowning

Research on diatom plankton. Plankton are the smallest animals and plant organisms that live in the water of natural reservoirs. Of all plankton, diatoms, a type of phytoplankton (plant plankton), have the greatest forensic significance, since they have a shell of inorganic silicon compounds. Together with water, plankton enters the bloodstream and spreads throughout the body, lingering in parenchymal organs (liver, kidneys, etc.) and bone marrow.

The detection of diatom shells in the kidney, liver, bone marrow, long tubular bones is a reliable sign of drowning in water, which coincides in composition with the plankton of the reservoir from which the corpse was recovered. For a comparative study of the features of the plankton found in the corpse, it is necessary to simultaneously examine the water from which the corpse was taken.

Histological examination. Histological examination of the internal organs of corpses removed from the water is mandatory. In the lungs on microscopic examination: the predominance of emphysema (bloating) over small foci of atelectasis (fall), which are located mainly in the central parts of the lungs.

Oil sample. The test is based on the ability of oil and petroleum products to give bright fluorescence in ultraviolet rays: from greenish-blue, blue to yellow-brown. Fluorescence is detected in the contents and on the mucous membrane of the stomach and duodenum. A reliable sign of drowning is a positive oil test when drowning in navigable rivers.

Other physical and technical research methods. Determination of the concentration of blood electrolytes, measurement of electrical conductivity, viscosity, blood density. Determination of the freezing point of blood in the left half of the blood is diluted with water, so the freezing point of the blood will be different, which is determined by cryoscopy.

Forensic chemical research. Taking blood and urine for the quantitative determination of ethyl alcohol by gas chromatography.

All of these methods help to establish the fact of death from drowning with greater objectivity.

Issues to be resolved by forensic medical examination during quenching

1. Was the death from drowning or from another cause?

2. In what liquid (environment) did drowning occur?

3. Are there any reasons that could contribute to drowning?

4. How long was the corpse in the water?

5. If there are injuries on the corpse, what is their nature, localization, mechanism, did they occur during life or after death?

6. What diseases were found during the examination of the corpse? Were they the cause of death in the water?

7. Did the deceased drink alcohol shortly before death?

Content

Resting by a pond is not always pleasant. Incorrect behavior in water or emergency situations can lead to drowning. Young children are especially susceptible to this risk, but even adults who can swim well can become victims of strong currents, cramps, whirlpools. The sooner the victim is removed from the water, and he will be given first aid for drowning (removal of fluid from the respiratory tract), the higher the chance to save a person's life.

What is drowning

The World Health Organization (WHO) defines drowning as a respiratory disorder caused by immersion or prolonged exposure to water. As a result, respiratory failure, asphyxia may occur. If first aid to a drowning person was not provided on time, death occurs. How long can a person go without air? The brain is able to function for only 5-6 minutes during hypoxia, so you need to act very quickly, without waiting for the ambulance.

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

• injuries from diving in shallow water, in unexplored places;
• alcohol intoxication;
• emergencies (convulsions, heart attack, diabetic or hypoglycemic coma, stroke);
• inability to swim;
• neglect of the child (when children drown);
• falling into whirlpools, storm.

Signs of drowning

The symptoms of drowning are easy to spot. The victim begins to flounder, or swallows air like a fish. Often a person spends all his energy to keep his head above water and breathe, so he cannot scream for help. Spasm of the vocal cords may also occur. A drowning man is seized by panic, he is lost, which reduces his chances of self-rescue. When the victim has already been pulled out of the water, the fact that he was drowning can be determined by the following symptoms:

• bloating;
• chest pain;
• blue or bluish tint of the skin;
• cough;
• shortness of breath or shortness of breath;
• vomiting.

Types of drowning

There are several types of drowning, each of which is characterized by its own characteristics. These include:

1. "Dry" (asphyxic) drowning. A person dives under water and loses orientation. Often there is a spasm of the larynx, water fills the stomach. The upper airways are blocked, and the drowning person begins to suffocate. Asphyxia sets in.
2. "Wet" (true). Plunging into the water, a person does not lose the respiratory instinct. The lungs and bronchi are filled with fluid, foam may be released from the mouth, cyanosis of the skin is manifested.
3. Fainting (syncope). Another name is pale drowning. The skin acquires a characteristic white, white-gray, bluish color. Death occurs as a result of a reflex cessation of the work of the lungs and heart. Often this happens due to a temperature difference (when a drowning person plunges into ice water), hitting the surface. There is a faint, loss of consciousness, arrhythmia, epilepsy, heart attack, clinical death.

Rescue of a drowning man

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 to call the rescuer for help. The specialist knows exactly what to do. If he is not around, you can try to pull the person out yourself, but you need to remember the danger. The drowning person is in a stressful state, his coordination is impaired, so he can involuntarily cling to the rescuer, not allowing him to grab himself. There is a high probability of drowning together (with improper behavior in the water).

First aid for drowning

When an accident occurs, you need to act quickly. If there was no professional rescuer or medical worker nearby, then first aid for drowning should be provided by others. The following steps should be followed:

1. Wrap your finger soft cloth, clean them oral cavity saved.
2. If there is fluid in the lungs, you need to put a person on his knee with his stomach down, lower his head, make several blows between the shoulder blades.
3. If necessary, make artificial respiration, heart massage. It is very important not to press too hard on the chest, so as not to break the ribs.
4. When a person wakes up, you should free him from wet clothes, wrap him in a towel, let him warm up.

The difference between sea and fresh water when drowning

An accident can occur in various water sources (sea, river, pool), but drowning in fresh water is different from immersion in a salty environment. What is the difference? Inhalation of sea fluid is not as dangerous and has a more favorable prognosis. The high concentration of salt prevents water from entering the lung tissue. However, the blood thickens, putting pressure on the circulatory system. Within 8-10 minutes, a complete cardiac arrest occurs, but during this time it is possible to resuscitate a drowning person.

As for drowning in fresh water, the process is more complicated. When fluid enters the lung cells, they swell and some of the cells burst. Fresh water can be absorbed into the blood, making it more liquid. Capillaries rupture, which disrupts cardiac activity. There is ventricular fibrillation, cardiac arrest. This whole process takes a few minutes, so death in fresh water occurs much faster.

First aid on the water

A specially trained person should be involved in rescuing a drowning person. However, it is not always nearby, or several people can drown in the water. Any vacationer who knows how to swim well can provide first aid. To save someone's life, you should use the following algorithm:

1. It is necessary to gradually approach the victim from behind, dive and cover the solar plexus, taking the drowning person by the right hand.
2. Swim to the shore on your back, row with your right hand.
3. It is important to ensure that the head of the victim is above the water and that he does not swallow the liquid.
4. On the shore, you should put a person on his stomach, provide first aid.

First aid rules

The desire to help a drowning person is not always beneficial. Misbehavior by an outsider often only exacerbates the problem. For this reason, first aid for drowning must be competent. What is the mechanism of PMP:

1. After the person has been pulled out of the water and covered with a blanket, symptoms of hypothermia (hypothermia) should be checked.
2. summon ambulance.
3. Avoid deforming the spine or neck, do not cause injury.
4. Fix cervical region with a rolled-up towel.
5. If the victim is not breathing, start artificial respiration, heart massage

With true drowning

In about 70 percent of cases, water enters directly into the lungs, resulting in true or "wet" drowning. This can happen to a child, or to a person who cannot swim. First aid for drowning includes the following steps:

• palpation of the pulse, examination of the pupils;
• warming the victim;
• maintaining blood circulation (raising legs, tilting the torso);
• ventilation of the lungs with the help of breathing apparatus;
• if the person is not breathing, artificial respiration should be given.

With asphyxia drowning

Dry drowning is somewhat atypical. The water never reaches the lungs, but instead the vocal cords spasm. Death can occur due to hypoxia. How to provide first aid to a person in this case:

• carry out immediately cardiopulmonary resuscitation;
• call an ambulance;
• when the victim came to his senses, warm him.

Artificial respiration and cardiac massage

In most cases, drowning stops a person from breathing. To bring him back to life, you should immediately begin active steps: perform a heart massage, perform artificial respiration. You need to follow a clear sequence of actions. How to do mouth-to-mouth breathing:

1. It is necessary to part the lips of the victim, remove mucus, algae with a finger wrapped in a cloth. Allow liquid to drain from the mouth.
2. Grab your cheeks so that your mouth does not close, tilt your head back, raise your chin.
3. Pinch the nose of the rescued, inhale the air directly into his mouth. The process takes a fraction of a second. Number of repetitions: 12 times per minute.
4. Check the pulse in the neck.
5. After a while, the chest will rise (the lungs will begin to function).

Mouth-to-mouth breathing is often accompanied by heart massage. This procedure must be done very carefully so as not to damage the fins. How to proceed:

1. Position the patient on a flat surface (floor, sand, earth).
2. Put one hand on the chest, cover with the other hand at an angle of about 90 degrees.
3. Rhythmically apply pressure to the body (approximately one pressure per second).
4. To start the baby's heart, press on the chest with 2 fingers (due to the baby's small height and weight).
5. If there are two rescuers, artificial respiration and cardiac massage are performed simultaneously. If there is only one rescuer, then every 30 seconds you need to alternate these two processes.

Actions after first aid

Even if a person comes to his senses, this does not mean that he does not need medical care. You should stay with the victim, call an ambulance or seek medical help. It is worth knowing that when drowning in fresh water, death can occur even after a few hours (secondary drowning), so you should keep the situation under control. With a long stay without consciousness and oxygen, the following problems may occur:

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

To avoid complications, you should take care of your health as soon as possible. The rescued from drowning should observe the following precautions:

• learn to swim;
• avoid swimming while intoxicated;
• do not go into too cold water;
• do not swim during a storm or at great depths;
• don't walk on thin ice.

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Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment, based on individual features specific patient.

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Due to the fact that swimming in pools, water parks and various water bodies has become more accessible, in recent times accidents on the water have become more frequent. This is a specific type of mechanical suffocation or death caused by fluid filling the lungs. It is very important to know the causes, signs and types of drowning: first aid directly depends on these factors.

What can cause drowning?

Many people think that the main reason for an emergency on the water is the inability to swim. But it is not so. As a rule, those who begin to unsteadily stay on the surface, fear and lose control of the situation, begin to shout loudly and wave their arms, so that they can be rescued in time. But there are cases when drowning occurs almost imperceptibly to others, and it is caused by other factors. For example:

• a person may not calculate his capabilities due to intoxication (caused by alcohol or drugs). 80% of drowning deaths are associated with this factor;
• some people are drawn into whirlpools or strong currents that they cannot fight;
• a person received a severe bruise when falling flat on the surface or when hitting the bottom and pitfalls. In this case, anything can happen: a concussion, loss of consciousness, a fracture of the spine or limbs, etc.
• when diving to a depth, the equipment malfunctioned, the oxygen in the cylinders ran out, oxygen poisoning occurred, or decompression sickness developed. It happens that due to a sharp immersion and a change in pressure, the liver, spleen or other internal organs burst;
• if the water is very cold, convulsions, circulatory arrest, epileptic seizures, cerebral hemorrhages can occur, which hinders movement and sometimes leads to fainting.

Depending on the causes, types, signs and, as a result, first aid for drowning may differ.

Types of drowning

The types of drowning can be divided mainly into three categories.

Aspiration or "wet" drowning(or otherwise true) occurs in cases where water enters the victim's airways and fills the lungs. Then it passes into the alveoli, and if capillaries begin to burst under the pressure of the fluid, it penetrates into the blood. This type of drowning is considered the most common (up to 35% of cases), and is divided into three stages:

1. Elementary. A drowning person remains conscious, makes arbitrary movements, is able to hold his breath when immersed in water. Those rescued during this period may not show signs of drowning or may be limited to bloating (because the person swallows a lot of water) and chills, even if the water was warm;
2. agonal. The victim loses consciousness, but breathing and pulse persist, becoming slower. Reflexes are sluggish but present;
3. clinical death. At this stage, the heartbeat stops and the pupils do not react to light, remaining dilated.

The second type is called "dry" or false / asphyxic drowning. It happens when there is a spasm of the glottis, which prevents fluid from entering the lungs. Often this condition is caused by intoxication, a sharp fright, a blow to the stomach or head on the water surface. A drowning person in most cases loses consciousness, and if asphyxia under water continues for a long time, it flows into clinical death, in which water is gradually poured into the respiratory tract, which is much more dangerous.

Syncope drowning less common, in 10% of cases. As a rule, women and children are more likely to become its victims, who begin to panic sharply, losing control of the situation, or simply freeze very much in cold water. With such drowning, the heart and breathing stop reflexively. However, experienced swimmers, who may develop unstable cardiodynamics, are not immune from it either. motor activity at the same time, it is absent, rare convulsive sighs can only be observed. At an average water temperature, clinical death lasts within 6 minutes, and in ice water this period increases significantly. There were times when cold water managed to save people who had been at the bottom for 30-40 minutes!

Signs of drowning by their types

You can recognize that a person is starting to drown by the following signs:

• The person tries to roll onto their back or tilts their head back to take a breath;
• Even breathing is replaced by convulsive sharp breaths;
• Before diving, the head is held low to the water, the mouth is already submerged;
• The person is in a vertical position, but does not move his legs, trying to help himself with sharp swings of his arms;
• A person does not try to straighten his hair if it gets in the way and hangs over his eyes;
• The look becomes empty, "glassy".

With true drowning, a person has a lot of foamy discharge near the mouth and nose, chills and weakness. If he was pulled out during the first stage, then he has intermittent breathing, which is accompanied by bouts of coughing, the heartbeat may change from fast to slow. The upper part of the abdomen is swollen due to the ingestion of a large amount of water, vomiting is possible. After drowning, the patient may remain dizzy for a long period, headache and cough.

At the second stage of true drowning, the victim's skin acquires a bluish tint, and the foam at the mouth becomes pinkish. The jaws are tightly compressed, and there is practically no movement. There is an arrhythmia of the heartbeat, and the pulsation can be felt only on the femoral and carotid arteries. Sometimes they show signs of increased pressure in the veins - their swelling on the neck and forearms.

With asphyxic drowning, water entering the mouth and larynx causes laryngospasm, which closes the airways. Foam also accumulates at the mouth, the skin turns blue. The pulsation of the arteries is almost absent, it can be distinguished only on the carotid and femoral arteries. This type of drowning is quite difficult to distinguish from the first if the victim has no injuries. However, in this case, artificial respiration is much more difficult due to laryngospasm of the larynx.

In contrast to the two types mentioned above, syncopal drowning the skin, on the contrary, turns pale due to spasm of peripheral vessels. Fluid does not leave the lungs, and breathing may be completely absent. Foamy discharge near the mouth and nose is not observed.

First aid rules

The sooner a drowning person is provided with first-aid medical care, the higher his chances of recovery!

Before proceeding with resuscitation measures, the person must be pulled out of the water. To do this, the rescuer swims up to him from behind, grabs him under his arms and brings him to a horizontal position, after which he swims to the shore. Many victims of drowning begin to reflexively grab the person who is saving them with their hands, which is why they pull him to the bottom. In order for a person to open his hands, you need to take a deep breath and go under the water, then the grip will loosen.

Depending on the type of drowning, you need to choose different tactics for providing first aid. With "wet" drowning, the algorithm is as follows:

1. Remove water from the airways. To do this, lay the person with their stomach down on the thigh, due to which the body will bend. Press down on your lower chest and upper abdomen, patting it on the back. This will help fluid out of the abdomen and lungs;
2. Remove wet clothes, wrap the victim in a blanket. If he is conscious and not very sick, give him a hot drink. Even in warm water, drowning people are very cold;
3. Call an ambulance, make sure that the heartbeat is not intermittent, and breathing is restored.

With false and syncopal drowning, water from the lungs does not need to be removed if the person has not yet passed into the stage of clinical death. The following is done:

1. Water can be removed from the stomach and lungs by the method described above;
2. It is necessary to do artificial respiration. To do this, a finger, previously wrapped in a rag or bandage, is inserted into the mouth to clean it from all that is superfluous. If a spasm occurs and the jaws do not open, you need to insert a mouth expander or any other metal object. Then the patient is placed on the ground, his head is thrown back, one hand is placed on his forehead, the other on his neck. After that, the rescuer tightly presses his mouth to the mouth or nose of the victim, and begins intense inhalations and exhalations. It is worth continuing artificial ventilation of the lungs until the person fully comes to his senses and begins to breathe on his own;
3. This measure can be combined with chest compressions. To do it, the rescuer puts his hands perpendicular to the sternum of the drowned man, and makes 60-70 sharp shocks per minute. If everything is done correctly, then the blood will begin to flow from the ventricles into the vessels.

If the drowned man is saved by one person, then he can alternate the second and third stages. For example, do one blow and 4-5 shocks per heart.

As a rule, if first aid was provided within 4-6 minutes after drowning, the victim has every chance of a full recovery.

After providing first aid, you need to call a doctor, because even if the victim feels well, he may have secondary drowning. In addition, within 7-10 days after the incident, there is a risk of colds, pneumonia, circulatory disorders and pulmonary edema.

Signs of drowning:

Pronounced goose bumps over the entire surface of the body due to contraction of the muscles that raise the hair under the influence of cold water.

Persistent white finely bubbling foam, resembling cotton, at the openings of the mouth and nose, as well as in the respiratory tract (sign of Krushevsky S.V.).

Detection of foam at the openings of the nose, mouth and airways is a valuable sign indicating active respiratory movements during drowning.

Acute swelling of the lungs - water presses on the air in the alveoli and bronchi, preventing the collapse of the lungs.

Spots of Rasskazov - Lukomsky (A. Paltauf) - hemorrhages of light red color, up to 0.5 cm in diameter under the pulmonary pleura (in sea ​​water are not formed).

The presence of a drowning fluid in the sinus of the sphenoid bone (Sign of Sveshnikov V.A.)

Lifogeniya - reflux of red blood cells into the lymphatic thoracic duct.

Large volumes of fluid in the abdominal and chest cavities (Moro's sign).

The presence of a significant amount of drowning fluid mixed with sand, silt, algae in the stomach and small intestine(sign of Fegeerlund).

Hemorrhage into the eardrums, mastoid cells, mastoid caves, into the cavity of the middle ear. Hemorrhages look like free accumulations of blood or abundantly impregnate the mucous membrane, which in this case is edematous, full-blooded, dark red, hemorrhagic (Sign of K. Ulrich).

The presence of plankton in the blood and internal organs. Laboratory research plankton is primarily produced from rotten corpses.

Plankton (or diatoms) from the lungs of a living person are carried throughout the body with blood flow. A positive result will be if diatoms are found in bone tissue. it must be remembered that the dishes are washed with distilled water before taking water and water is taken from the reservoir for mandatory control.

When examining a corpse removed from water, the question often arises of the duration of its stay in the water.

Usually, the expert gives an answer to this question based on the degree of maceration (softening due to soaking with water) of the skin and the severity of the decay processes.

In this case, the temperature of the water and other conditions of the presence of the corpse in the reservoir must be taken into account. Maceration develops faster in warm water than in cold water. Hair on the head, starting from 10-20 days, is easily pulled out, and at a later date falls out on its own.

While the corpse is under water putrefaction is slow, but as soon as the corpse floats to the surface of the water, putrefaction develops much faster. If this happens in the summer, then a few hours after surfacing, the corpse turns into a giant one, due to the rapid formation of putrefactive gases. According to the signs of the presence of the corpse in the water, one can presumably judge the time of death.

Signs of a corpse in the water:

Maceration of the fingertips - 2-3 hours;

Maceration of the palms and soles - 1-2 days;

Maceration of the back surface - a week;

Departure of the skin (gloves of death) - a week;

Algae on the body - a week;

Baldness - a month;

The beginning of the formation of a fat wax - 3-4 months;

The transition of the corpse into a fat wax - 1 year;

Pink coloration of cadaveric spots (due to loosening of the epidermis and improved oxygen access to cadaveric spots)

Features of the external examination of the corpse in cases of death from closing the respiratory tract with liquid (drowning)

The protocol notes where the corpse is located, in what liquid, at what depth, which parts of it are above the surface of the liquid, whether the corpse floats freely or is held by objects surrounding it, indicate which parts of the body come into contact with these objects and how the body is held.

This scheme should be followed if the examination of a corpse immersed in a liquid is performed.

Removal of the corpse from the liquid must be carried out with great care, without causing additional damage.

In the event that they could not be avoided (when pulling the body with hooks, cats), the method of extracting the corpse should be specified in the protocol and the cause of the damage should be indicated, as well as a thorough description should be made.

When examining the clothes of a corpse, the expert notes the degree of its humidity, its correspondence to the season (it helps to establish the time when drowning occurred), pollution, the presence of any heavy objects (stones, sand) in the pockets that contribute to the rapid immersion of the body.

On examination, they describe the presence or absence of white foam around the openings of the mouth and nose (indicate that the body has been ingested into the liquid during life, usually persists for 3 days), note the condition of the skin (their pallor, the presence of “goose bumps”) when describing cadaveric spots, pay attention to their color. produce a description of the phenomena of maceration, which are important for establishing the length of stay of the corpse in the water. In cases of overgrowth of the body with algae, the degree of their spread on the surface of the body is described (which parts of the corpse are covered) and general form(length, thickness, skin bond strength, etc.).

The description of the algae at the scene is important, along with signs of maceration.

When describing the damage, it is necessary to pay attention to the identification of signs indicating the possibility of causing these damages by aquatic inhabitants. If other damage is found, it should be borne in mind that they can be caused posthumously by propellers of steamers, oars. The question of their intravital or posthumous origin is finally resolved during a forensic medical examination of the corpse.

Issues resolved by a forensic medical examination during drowning:

Was death really caused by drowning?

2. In what liquid did drowning occur

What circumstances contributed to drowning

How long was the corpse in the liquid?

When did death occur - during the stay in the water or before entering the water?

If injuries were found on the corpse, did they occur before falling into the water, or could they have occurred while the corpse was in the water, and how?

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How to rescue a drowning person? How effective are pre-hospital resuscitation actions? What should be done after providing first aid before the arrival of doctors? You will read about this and much more in our article.

Almost always, the correct provision of first aid to a drowning person saves the life of the victim, since a professional medical team will not have time to arrive at the scene on time, even if it was called 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 rescue of a drowning person, if he has not yet had time to dive under water for a long period of time, is his correct pulling out, which provides not only the possibility of resuscitation of the victim, but also the safety of the helper.

The basic scheme for rescuing a drowning person:

First aid for a drowning person

After the victim was brought ashore, it is necessary to proceed with the necessary resuscitation actions.

Algorithm of first aid for drowning (briefly by points):

• from liquid or foreign matter. The victim's mouth opens, dentures, vomit, mud, and liquid are removed from it. When drowning directly in the water, the rescuer lays the person on his stomach on his knee, face down, to allow the liquid to flow freely. Two fingers are placed in the victim's mouth and pressure is applied to the root of the tongue to induce vomiting, which helps to free the airways and stomach from water that has not had time to be absorbed;
• Active pre-resuscitation actions. As part of the implementation of first aid, it is necessary to continue inducing vomiting in the victim in the initial position from 1 point until a cough appears. If the effect this process does not give, then in the vast majority of cases there is no free fluid in the respiratory tract and stomach, since it has managed to be absorbed;
• immediate resuscitation. The victim is turned over on his back and placed in a horizontal position, after which the rescuer proceeds to massage the heart and artificial respiration.

How to provide first aid for drowning, see the video:

With true (wet) drowning

How to provide first aid to a drowning person? As part of the provision of first aid when rescuing a drowning person, when the incident occurred directly within the reservoir and a large amount of water got into the human body, the above-described measures are taken.

Their average duration takes from 2 to 3 minutes for the primary two stages. At the same time, artificial respiration and indirect heart massage are effective for an average of 6-8 minutes. After 10 minutes and the absence of any signs of heartbeat and breathing, with a high degree of probability it is impossible to save a person.

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An important factor in true drowning is also the circumstances of the incident. So in salt water, a person's chances of surviving in the absence of breathing and heartbeat are higher, since irreversible processes occur later than in the case of flooding with fresh water - it is possible to restore vital processes within 10-15 minutes.

In addition, the temperature of the water also makes a certain contribution. When drowning in a cold or icy liquid, irreversible destruction processes slow down significantly. In some cases, resuscitation practice recorded situations when a person was brought back to life by performing an indirect heart massage and artificial respiration 20, and sometimes 30 minutes after drowning.

With asphyxial (dry) drowning

Asphyxia or dry drowning is a pathological circumstance that is formed as a result of a spasm of the glottis and suffocation, when water does not penetrate into the respiratory tract.

In general, this type of incident is considered more favorable in the context of the potential for human resuscitation.

What to do with dry drowning? First aid for dry drowning generally coincides with first aid, as for classical drowning, however, the second stage (attempts to induce vomiting and free the airways with the stomach from the accumulated fluid) is skipped and direct resuscitation actions are immediately applied to the victim.

Resuscitation actions

As part of the resuscitation efforts to provide emergency care when drowning is of a manual nature, two main procedures are performed - this is an indirect heart massage and artificial respiration. The basic rules for helping a drowning person are presented below.

Artificial respiration

The victim is laid on his back, the airway opens as wide as possible, any foreign objects that make it difficult to breathe are removed from the oral cavity. If there is an air duct of a medical design, it must be used as part of the first aid for a drowning person.

The lifeguard takes a deep breath and exhales air into the victim's mouth, covering the wings of his nose with his fingers and supporting his chin, pressing his lips tightly to the victim's mouth. As part of forced ventilation, a person's chest should rise.

The average blowing time is about 2 seconds, followed by a 4 second pause for a slow reflex lowering of the drowned chest. Artificial respiration during drowning is repeated regularly until stable signs of breathing appear or the ambulance arrives.

Indirect cardiac massage

Measures to start cardiac activity can be combined with the implementation of artificial respiration as part of their alternate shift. To begin with, you must first strike with a fist in the area of ​​\u200b\u200bthe projection of the heart- it should be of medium strength, but sharp and fast enough. In some cases, this helps to instantly start the functioning of the heart.

If there is no effect, you need to count two fingers down from the sternum to the center of the chest, straighten your arms, putting one palm on the other, orient yourself to the connection of the lower ribs with the sternum, and then apply pressure strictly perpendicular to the heart with both hands. The heart itself is compressed between the sternum and the spine. The main efforts are carried out with the whole torso, and not just with the hands.

The average depth of indentation should not exceed 5 cm, while the approximate frequency of pressure is about 100 manipulations per minute, in cycles of 30 times with a combination of ventilation of the lungs.

The general cycle, therefore, is as follows: 2 seconds of inhalation of air into the victim, 4 seconds for his spontaneous exit, 30 massage manipulations in the region of the heart and a repetition of the cyclic double procedure.

First aid for children

It is worth noting that the chances of resuscitating a child during drowning are significantly less than an adult, since irreversible processes leading to death develop much faster in him.

On average, there are about 5 minutes to try and rescue a drowned toddler.

Algorithm of actions for providing first aid for drowning a child:

• Pulling the victim to the shore. It is carried out as quickly as possible, while observing the general precautions described earlier;
• Release of the upper airways from foreign substances. You should open the child's mouth, try to free him from any kind of foreign matter, including water, then put your knee and put the baby on his stomach, simultaneously causing the latter to have a gag reflex by pressing on the root of the tongue. The event is repeated until the child has an active cough, and water, along with vomit, stops actively flowing out;
• resuscitation activities. In the absence of the effect of the procedure from the previous paragraph, or if there are signs of a “dry” type of drowning, the child is turned over on his back, placed in a horizontal position, and he is given an indirect heart massage, as well as artificial respiration.

Further rescue actions

If the victim managed to start the breathing of the heartbeat, then he is laid on his side, while continuing to remain in a horizontal position. A person is covered with a blanket or towel for warming, while his condition is constantly monitored and in the event of a repeated stoppage of breathing or heartbeat, manual resuscitation is resumed.

It should be understood that regardless of the circumstances, even if the person is in a satisfactory condition, it is necessary to wait for the arrival of the ambulance team, which will provide the first medical care when drowning. Specialists will competently assess the potential risks for the victim and decide on the need or absence of such hospitalization.

In some cases, the ingress of a significant amount of water into the lungs, secondary cerebral edema and other symptoms appear after a certain period of time, there are no medium-term health effects only when more than 5 days have occurred after drowning, while no pathological symptoms have appeared in a person.

Types of drowning

In general modern medicine distinguishes three types of drowning:

• True drowning. The main sign of such an incident is the ingress of a large amount of water into the lungs and stomach, against which there is swelling of the corresponding tissues and irreversible destruction of their structure. Occurs in every one of the 5 reported cases;
• Asphyxial drowning. It can also occur on water, but the liquid itself does not penetrate into the lungs of the stomach, because before this process a pronounced spasm of the vocal cords is formed with a complete stop of respiratory activity. All basic pathological processes associated with direct suffocation and shock. Occurs in 40 percent of cases;
• Syncopal drowning. It is characterized by a reflex cardiac arrest, in the vast majority it causes an almost instantaneous death. Occurs in 10 percent of cases;
• Mixed drowning. It has signs of both classic "wet" and asphyxic drowning. Diagnosed in an average of 15 percent of the victims.

The difference between sea and fresh water

Classical medicine distinguishes between drowning in fresh and sea water according to a number of characteristic features:

• Fresh water. There is a stretching of the alveoli and the penetration of the corresponding fluid into the bloodstream by direct diffusion through the violation of the integrity of the alveolar-capillary membrane. Hypotonic hyperhydration develops sharply, the functioning of the blood flow is disrupted.

  Due to the absorption of hypotonic waters into the vascular bed, pulmonary edema, hypervolemia, hyperosmolarity, blood thinning with an increase in its volume are formed.

  Ventricular fibrillation occurs, unable to cope with a large amount of "diluted" biological fluid. In general, irreversible damage occurs quickly;

• Salty water. The fluid enters the alveoli, which leads to hypertensive dehydration, an increase in the amount of sodium, potassium, magnesium and calcium, as well as chlorine in the blood plasma. In fact, it is not liquefaction that occurs, but, on the contrary, blood thickening, while irreversible damage to the body occurs more slowly compared to fresh water (up to 25 percent).

The processes described above are often separated into separate categories of descriptive characteristics of the medical literature of the 20th century.

Current large-scale studies show that the pathogenesis of drowning in fresh and salt water does not differ significantly in the context of clinical hazard.

Accordingly, the difference in potential resuscitation is actually negligible and amounts to only a few minutes. As real practice shows, the chances of restoring brain function and vital signs are significantly increased in cases of drowning at very low temperatures, especially in children with low body weight.

Individual doctors recorded cases of complete resumption of life 30 minutes after drowning, while all the time the victim had no breathing and heartbeat.