Drowning symptoms. Drowning

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 respiratory tract(a 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?

I would like to review the basics first aid for drowning, especially if you are engaged in water tourism, fishing from a boat, or just surviving near a river or sea).

Causes of death by drowning are usually fluid inhalation, hypoxia, pulmonary edema, cardiac arrest cold water, spasm of the glottis.

There are several types of drowning:

  • True, or wet, blue (primary)
  • Asphyxic, pale (dry)
  • Syncope drowning
  • secondary drowning

First aid for true drowning

The cause of true drowning is the ingress of fluid into the lungs, which happens in more than 70% of drowning cases, due to a long struggle for life with periodic immersion in water and swallowing of water. Often this happens in people who cannot swim.

The initial period of true drowning is characterized by the fact that the drowning person is conscious, while the majority behave inappropriately, which poses a great danger to the rescuer, since drowning people in this state are able to drown the rescuer, especially if he is not a professional rescuer. The face and neck of a drowning person have a characteristic blue color, which is why this type of drowning is also called blue. A pinkish foam, which is the liquid part of the blood (plasma), can be released from the nose and mouth, which enters the glottis and foams, stopping gas exchange in the lungs, which causes pulmonary edema. Rapid breathing is accompanied severe coughs and vomiting. After some time, the symptoms of true drowning of the initial period quickly disappear.

First aid for the initial period of true drowning: put the victim to rest, warm, and prevent choking when vomiting.

The aginal period of drowning is characterized by the absence of consciousness, but by the presence of a weak pulse and weak breathing. The pulse can only be felt on the carotid arteries. Pinkish foam may come out of the mouth and nose.

First aid for the agonal period of initial drowning:
Ensure airway patency as soon as possible.
Artificial respiration mouth to mouth, if necessary even in water.
Maintain proper circulation by elevating the legs or reclining.
With a loss of pulse, do a closed heart massage.

With aginal drowning, it is necessary to begin ventilation of the lungs with breathing apparatus as soon as possible to increase the concentration of oxygen in the body. It is also necessary to remove fluid from the stomach, for which the victim must be tilted over the knee of the bent leg, pat on the back between the shoulder blades and release the contents of the stomach.

The clinical period is similar to the aginal period, except for the absence of pulse and respiration. The patient's pupils are dilated and do not respond to light.

First aid for the clinical period of true drowning:
Early start cardiopulmonary resuscitation
Exhalations into the nose can be done immediately, as soon as the face of the drowning person is removed from the water.
Breathing from mouth to nose
Closed heart massage
Mandatory hospitalization.

In general, as soon as you have removed the victim from the water, without losing valuable seconds to feel the pulse and examine the pupils, put the victim so that the head is lower than the pelvis and insert two fingers into the mouth and try to remove the contents of the mouth, then press on the root of the tongue to eliciting a gag reflex. If this is followed by vomiting movements, then it is necessary to remove the liquid from the lungs and stomach as soon as possible, for which, for 5-10 minutes, press on the root of the tongue, and pat on the back with the palm of your hand between the shoulder blades. You can intensively press on the chest from the sides a couple of times during exhalation, for better water discharge. After removing water from the body, drown the victim on his side

If, after pressing on the root of the tongue, vomiting and coughing movements do not occur, then it is necessary to immediately shift the victim onto his back and begin cardiopulmonary resuscitation by performing artificial ventilation 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 on his stomach to partially remove water from the respiratory tract.

This assistance should be carried out within 30-40 minutes, even if there are no signs of effectiveness.

After revival, the appearance of a pulse and breathing, a number of first aid measures for drowning will have to be carried out. The first step is to turn the victim on his stomach again. Further measures should be provided by physicians.

The main causes of death in true drowning are pulmonary edema, cerebral hypoxia, cardiac arrest and kidney failure, which manifests itself during the following days.

Pulmonary edema is characterized by bubbling breathing, as if water is gurgling and boiling inside the victim, coughing with pinkish foam. Pulmonary edema is very dangerous and should be treated by doctors, but to help the victim in this case, it is necessary to seat the victim or raise his head, put tourniquets on his hips to drive blood to lower limbs and the pelvis, and to establish the inhalation of oxygen from the oxygen bag through alcohol vapor. To do this, it is enough to put a piece of cotton soaked in alcohol in the mask at the level of the lower lip, which will prevent foaming in the lungs, which occurs with pulmonary edema. Only these manipulations can make a significant contribution to saving the victim with pulmonary edema. The tourniquets must be applied for no more than 40 minutes, removed alternately every 15-20 minutes.

If there is a chance for salvation and it is possible to call an ambulance or rescue service, then it is better to do this than to try to transport the victim on random transport, because, on the way, worsening of the condition, cardiac arrest or something like that can happen again. Only in the case when this is not possible, it is necessary to decide on independent transportation, preferably on a large vehicle, so that the victim can be laid on the floor.

First aid for asphyxic drowning


Asphyctic drowning occurs in 10-30% of cases when the victim cannot resist drowning, for example, intoxicated, with a strong blow to the water. Due to the irritating effect of, for example, ice water, a spasm of the glottis occurs, and water does not enter the lungs and stomach. Death occurs due to the same spasm of the glottis, i.e. due to hypoxia. Therefore, asphyxic drowning is called dry.

First aid for asphyxic drowning. Since water has not entered the respiratory tract, cardiopulmonary resuscitation should be started immediately. Some experts believe that with asphyxial drowning in ice water with the onset of clinical death, there are more chances of salvation than with drowning in warm water. This fact is explained by the fact that in the lake water, the body is in a state of severe hypothermia, including the brain, as a result of which metabolism (metabolism) almost stops, due to which the time reserve for rescue increases, with, of course, timely and correctly rendered assistance on the shore.

That is, with asphyxic drowning, in the absence of a pulse and respiration, in ice water, one cannot hesitate for a second, but immediately proceed with resuscitation of the pulse and respiration. Also, with successful resuscitation of the victim, further complications are usually less. After resuscitation, it is necessary to move or, if possible, warm the victim.

First aid for syncopal drowning

Syncopal drowning is characterized by primary cardiac and respiratory arrest, and the onset of clinical death, as a result of, for example, a sharp temperature drop caused by an unexpected dive. The period of clinical death with such drowning is somewhat higher than with other types of drowning, especially in ice water due to deep hypothermia. The main external difference of syncopal drowning is the external pale appearance and the absence of fluid from the respiratory tract.

Conclusion: it is necessary to understand the causes of death in various types of drowning, not to panic, and to provide resuscitation, even if there is no improvement, for at least 40 minutes.


Signs of true drowning:

- cyanosis facial skin,

- swelling of the vessels of the neck,

Turn on the stomach, clean the mouth and press on the root of the tongue.

If there is a gag reflex, continue removing water from the stomach (up to 2-3 minutes).

If there is no gag reflex, make sure that there is no pulse on the carotid artery and proceed to resuscitation.

If there is a pulse on the carotid artery, but there is no consciousness for more than 4 minutes, turn on the stomach and apply cold to the head.

In cases of shortness of breath, bubbling breathing - seat the victim, apply heat to the feet, apply tourniquets on the thigh for 20-30 minutes.

Attention! In the case of true drowning, death can occur in the next few hours from repeated cardiac arrest, pulmonary edema, and cerebral edema. Therefore, in each case of drowning, rescue services are necessarily called, and the rescued person must be delivered to the hospital. .

Actions in case pale drowning

Signs of pale drowning:

- lack of consciousness

- lack of pulse on the carotid artery,

- pallor of the skin,

- sometimes "dry" foam from the mouth,

- more common after falling into icy water.

Move the victim to a safe distance from the hole.

Check for a pulse on the carotid artery.

If there is no pulse on the carotid artery, start resuscitation.

If there are signs of life, transfer the rescued to a warm room, change into dry clothes, give a warm drink.

Attention! In the case of pale drowning, it is unacceptable to waste time removing water from the stomach.

Actions in case of the first stage of hypothermia

Signs of the first stage of hypothermia:

- blue lips and tip of the nose,

- chills, muscle tremors, goosebumps,

- Profuse frothy discharge from the mouth and nose.

If possible, wear additional warm clothing. Force to move.

Give 50-100 ml of wine or other sweet alcohol, provided that within 30 minutes the victim will be taken to a warm room and his mouth did not smell of alcohol .

Attention! The first stage of hypothermia is protective and not life-threatening. It is enough to use additional warm clothes, make them move and take warm food or sweets in order to prevent the onset of a more dangerous stage of hypothermia.

If, after removing from the hole, there is no supply of dry clothes and the ability to make a fire, if possible, lay any paper between the body and wet clothes and continue moving towards the settlement. After 5-7 minutes, the paper will begin to dry out and become a good heat insulator.

Actions in case of the second and third stages of hypothermia

Signs of the second and third stages hypothermia (as they appear):

skin blanching,

Loss of feeling cold and feeling comfortable in the cold,

Complacency and euphoria or unmotivated aggression,

Loss of self-control and adequate attitude to danger,

The appearance of auditory, and more often visual hallucinations,

Lethargy, lethargy, apathy,

Oppression of consciousness and death.

Offer warm sweet drink, warm food, sweets.

Take to a warm place as soon as possible.

If there are no signs of frostbite on the extremities, remove clothing and place in a bath of warm water or cover with plenty of heating pads.

Attention! Before immersing the victim in water, be sure to check its temperature with your elbow.

After the warming bath, put on dry clothes, cover with a warm blanket and continue to give warm sweet drinks until the arrival of the medical staff.

Attention! It is unacceptable to offer alcohol to the victim lying in the water.


Related information:

  1. A) This is what determines, stimulates, induces a person to perform any action included in the activity
Table of contents of the topic "Acute Respiratory Failure (ARF) with Obstruction of the Airways. Foreign Bodies of the Upper Respiratory Tracts. Thromboembolism pulmonary artery(TELA).":
1. Acute respiratory failure (ARF) with airway obstruction. Laryngospasm. Causes (etiology), pathogenesis of laryngospasm. Emergency care for laryngospasm.
2. Bronchiospasm (bronchial asthma). Causes (etiology), pathogenesis of bronchiolospasm. Emergency care for bronchiolospasm (bronchial asthma).
3. Asthmatic condition. Asthmatic status. Causes (etiology), pathogenesis of status asthmaticus. Stages of status asthmaticus.
4. Principles of treatment of status asthmaticus. Treatment of status asthmaticus stage 1.
5. Treatment of asthmatic status 3 (third) stage. Signs of relief of status asthmaticus. hospitalization issues.
6. Foreign body. Foreign bodies in the upper respiratory tract. Emergency care for foreign bodies.
7. Drowning. True (wet) drowning. Asphyxic (dry) drowning. Syncope type of drowning (death in water). Emergency aid for drowning.
8. Thromboembolism of the pulmonary artery (TELA). Etiology (causes) of thromboembolism. Pathogenesis of pulmonary embolism (PE).
9. Anatomical variants of pulmonary embolism (PE) by localization. Clinical forms of PE. Clinic of pulmonary embolism (TELA).
10. ECG (ecg, electrocardiogram) of pulmonary embolism (PE). X-ray data of TELA. Principles of intensive care for pulmonary embolism (PE). Urgent care.

Drowning. True (wet) drowning. Asphyxic (dry) drowning. Syncope type of drowning (death in water). Emergency aid for drowning.

Drowning- acute pathological condition, which develops during accidental or deliberate immersion in a liquid, with the subsequent development of signs of ARF and AHF, the cause of which is the ingress of liquid into the respiratory tract.

Distinguish 3 types of drowning in water:
1. True (wet).
2. Asphyxia (dry).
3. Death in water (syncope type of drowning).

Etiology. True drowning. It is based on the ingress of water into the alveoli. Depending on the water in which drowning occurred (fresh or sea), there will be a different pathogenesis. Fresh water, due to the difference in the osmotic gradient with blood, quickly leaves the alveoli and enters the vascular bed (see Fig. 10a). This leads to an increase in BCC and hemodilution, pulmonary edema, hemolysis of erythrocytes, a decrease in the concentration of sodium, chloride and calcium ions in plasma, as well as plasma proteins. When drowning in sea water, as a result of the difference in the osmotic gradient between blood and sea water, and here there is a clear predominance of the sea water gradient over blood, part of the plasma leaves the vascular bed. In this regard, the mass of circulating blood decreases (up to 45 ml / kg), the hematocrit increases (V. A. Negovsky, 1977).

Rice. ten. The pathogenesis of drowning in fresh (a) and sea (b) water.

Asphyxial drowning occurs without aspiration of water. The basis of this pathology is reflex laryngospasm. The glottis does not allow water to pass through, but it also does not allow air to pass through. Death occurs from mechanical asphyxia.

syncopal type drowning (death in water) occurs as a result of reflex cardiac arrest and respiration. The most common variant of this type of drowning occurs when the victim is suddenly immersed in cold water.

Clinic. At true drowning distinguish 3 periods: initial, agonal and clinical death. The state of consciousness depends on the period of drowning and its type. Respiratory failure is possible from noisy to atonal. There is cyanosis, chills, goose bumps. When drowning in fresh water, there is a clinic of pulmonary edema, arterial and venous hypertension, tachycardia, arrhythmia. From the upper respiratory tract, foam, sometimes with a pink tinge, may be released as a result of hemolysis of red blood cells. When drowning in sea water, arterial hypotension and bradycardia are more characteristic.

Urgent care . Regardless of the water in which drowning occurred, when breathing and cardiac activity stop, the victim must carry out a complex resuscitation. Before performing artificial respiration, the upper respiratory tract (URT) should be freed from water and foreign bodies (river sand, algae, silt, etc.). The best way to release the upper respiratory tract, especially in children, is to lift the victim by the legs. If it is impossible to perform this manual, it is recommended to lay the victim on the bent knee of the person providing resuscitation, and wait for the fluid to flow out of the upper respiratory tract (see Fig. 11). This procedure should take no more than 5-10 seconds, after which it is necessary to proceed to resuscitation.

Treatment in a hospital setting is syndromic in nature and consists of the following areas:
1. Carrying out a complex of resuscitation measures and transferring the patient to mechanical ventilation (according to indications).
2. Sanitation of the tracheobronchial tree, therapy of bronchiolospasm, pulmonary edema.
3. Cupping OSSN.
4. Correction of acid-base balance and electrolytes.
5. Prevention of pneumonia and renal failure.

First aid video for drowning patient

Drowning first aid scheme



The main features from the monograph by V.A. Sundukov are given. "Forensic medical examination of drowning" see.

Signs characteristic of drowning in water (compendium) / Chests V.A. — 1986.

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Signs characteristic of drowning

Signs revealed during the external examination of the corpse:

1. Persistent, finely bubbling foam around the openings of the nose and mouth (Krushevsky's sign) in the form of lumps resembling cotton wool ("cap of foam"), is the most valuable diagnostic sign of drowning. At first, the foam is snow-white, then it takes on a pinkish tint due to the admixture of bloody liquid. Foam is formed during drowning due to the mixing of mucus with water and air. It consists of a frame in the form of mucus, exfoliated epithelial cells and its own foam covering the frame. When the foam dries, traces of it remain around the openings of the nose and mouth. If there is no foam on the corpse removed from the water, then it is recommended to press on the chest, after which it may appear. Usually, the foam disappears after 2-3 days, and only sanious fluid is released from the openings of the nose and mouth of the corpse due to the development of imbibition and hemolysis processes.

2. Due to the increase in the volume of the lungs (with the development of hyperhydroaeria), there is an increase in the circumference of the chest, as well as smoothing of the supraclavicular and subclavian fossae and reliefs of the clavicles.

3. The color and severity of cadaveric spots may vary depending on the type of drowning. So, Bystrov S.S. (1974) with the "true" type of drowning found cadaveric spots paler, blue-purple in color with a pinkish or reddish tint, and with asphyxic type they were plentiful, dark blue, dark purple color. Due to loosening of the epidermis, oxygen penetrates into the blood of the superficial vessels of the skin, which leads to the formation of oxyhemoglobin (from reduced hemoglobin), so cadaveric spots quickly take on a pinkish color. With partial immersion of the corpse in water at the level of the boundary line, a bright red stripe with a bluish tint is observed, gradually turning into the color of the upper and lower parts of the cadaveric spots. Sometimes, during drowning, cadaveric spots appear evenly over the entire surface of the corpse (and not only in the underlying sections, as usual) due to the displacement (turning) of corpses by the flow of water.

4. The color of the skin of the face, neck and upper chest also changes depending on the type of drowning (S.S. Bystroy). With the "true" type - the skin of these areas is pale blue or pinkish-blue in color, and with asphyxia - blue or dark blue.

5. You can detect hemorrhages in the conjunctiva and sclera, as well as identify gelatinous swollen folds of the conjunctiva due to their edema.

6. Puffiness of the face is sometimes noted.

7. Less often you can see traces of defecation. Separate external signs: the nature and color of cadaveric spots, the color of the skin of the face, neck, upper chest, hemorrhages (in the conjunctiva and sclera, puffiness of the face and traces of defecation - are not signs characteristic only of drowning, they are equally encountered in other types of mechanical asphyxia.

Signs revealed during the internal examination (autopsy) of the corpse

1. In the lumen of the trachea and bronchi, a finely bubbling persistent foam is found, which, with the "true" type of drowning, has a pinkish color, sometimes with an admixture of blood and water; in the asphyxial type - this foam appears white (S. S. Bystrov).

2. When opening the chest cavity, the lungs are sharply enlarged in volume. They fully comply pleural cavities . Their front sections cover the heart shirt. Their edges are rounded, the surface has a colorful "marble" appearance: light gray areas alternate with light pink. Stripe-like imprints of the ribs may be visible on the surfaces of the lungs. When released from the chest cavity, the lungs do not collapse. Lungs don't always look the same. In some cases (with the asphyxic type of drowning), we are dealing with the so-called "dry swelling of the lungs" (hyperaeria) - this is a condition of the lungs when they are sharply swollen, but dry on the cut or a small amount of liquid flows from the surfaces. Hypereria depends on the penetration of air into the tissue under the pressure of the liquid. There is a strong degree of swelling of the alveoli. This is accompanied by stretching and rupture of the alveolar walls and elastic fibers, often by the expansion of the lumen of the small bronchi and, in some cases, the entry of air into the interstitial tissue. There is a small number of foci of tissue edema. The surface of the lungs is uneven, mottled. The fabric feels spongy. It is dominated by small limited hemorrhages. The weight of the lungs is not increased compared to the norm. In other cases (with the "true" type of drowning), there is a "wet swelling of the lungs" (hyperhydria) - this is the name of the condition of the lungs of a drowned person, when a large amount of aqueous liquid flows from the surface of the cuts, while the lungs are heavier than usual, but everywhere airy. There is an average degree of swelling of the alveoli, the presence of a large number of edema foci and large diffuse hemorrhages. The surface of the lungs is smoother, the tissue is less variegated, and has a doughy texture to the touch. The weight of the lungs exceeds the normal by 400 - 800 g. Hyperhydria is less common than hyperaeria; it is believed that it happens when a person falls under water after a deep exhalation. Depending on the state of the foci of swelling and edema, a third form of acute swelling of the lungs is distinguished - intermediate, which is also characterized by an increase in lung volume. When probing, in some places there is a crypitation, in some places the consistency of the lungs is doughy. Foci of swelling and edema alternate more evenly. The weight of the lungs increased slightly, by 200-400 g. Microscopic examination in the lungs during drowning should look for foci of acute swelling and foci of edema. Acute swelling is recognized by a sharp expansion of the lumen of the alveoli; interalveolar septa are torn, "spurs" protrude into the lumen of the alveoli. The foci of edema are determined by the presence in the lumen of the alveoli and small bronchi of a homogeneous pale pink mass, sometimes with an admixture of a certain amount of erythrocytes. Further, studying the lungs, you need to pay attention to the blood supply to the vessels. When drowning, it is expressed unevenly. According to the air areas, the capillaries of the interalveolar septa are collapsed, the tissue appears anemic, in the foci of edema, on the contrary, the capillaries are dilated and full-blooded. The microscopic picture of the lung tissue during drowning is supplemented by the presence of atelectasis foci and the presence of hemorrhages in the interstitial tissue; the latter are limited and spilled. In addition, elements of plankton and mineral particles, particles of plant fiber, etc., can be found in small bronchi and alveoli.

3. Rasskazov-Lukomsky-Paltauf spots when drowning - an important diagnostic sign - they are large blurry hemorrhages in the form of spots or stripes under the pleura of the lungs, which have a pale pink, pale red color. However, this feature is not permanent.

4. The presence in the stomach of a liquid in which drowning occurred (Fegerlund's sign), with asphyxic type - a lot of liquid, with "true" - little. Water can also be in the initial section of the intestine. Has a certain diagnostic value the presence of admixture to the gastric contents of silt, sand, algae, etc. During lifetime ingestion, up to 500 ml of liquid can be found in the stomach. The possibility of post-mortem penetration of fluid into the gastrointestinal intestinal tract is rejected by most authors (S. S. Bystrov, 1975; S. I. Didkovskaya, 1970, etc.).

5. In the sinus of the main bone, a liquid (5.0 ml or more) is found, in which drowning occurred (V. A. Sveshnikov, 1961). When laryngospasm (asphyctic type of drowning) occurs, the pressure in the nasopharyngeal cavity decreases, which leads to the flow of the drowning medium (water) into the sinus of the main bone through the pear-shaped cracks. In the left half of the heart, blood diluted with water has a cherry-red color (I. L. Kasper, 1873). Hemorrhages in the muscles of the neck, chest and back (hemorrhages in the sternocleidomastoid muscle, Paltauf; hemorrhages in the muscles of the neck and back - Reiter, Wahholz) as a result of strong muscle tension of a drowning person when trying to escape.

6. Edema of the liver, bed and wall of the gallbladder and hepatoduodenal fold F. I. Shkaravsky, 1951; A. V. Rusakov, 1949). On microscopic examination, liver edema is expressed by the expansion of the pericapillary spaces and the presence of protein masses in them. The swelling may be uneven. In those places where it is significant, intralobular capillaries and central veins are full-blooded. In the crevices and lymphatic vessels of the interlobular connective tissue with edema, a homogeneous pale pink mass is found. Gallbladder edema is often diagnosed macroscopically. In some cases, it is found during microscopic examination - this reveals a characteristic state of the connective tissue of the bladder wall in the form of expansion, loosening of collagen fibers, and the presence of a pink liquid between them.

Signs found in laboratory tests

These include signs associated with intravital penetration of the drowning medium (water) into the body and changes in the blood and internal organs caused by this medium (water):

  1. Detection of diatom plankton and pseudoplankton in blood, internal organs (except lungs) and bone marrow.
  2. Positive "oil test" by S. S. Bystrov - detection of traces of technical liquids (petroleum products).
  3. Identification of quartz-containing mineral particles (B. S. Kasatkin, I. K. Klepche).
  4. The difference between the freezing points of blood in the left and right heart (cryoscopy).
  5. Establishing the fact and degree of dilution of blood in arterial system and in the left heart (conduction study and refractometry).

Signs characteristic of drowning:

  • finely bubbling persistent foam at the openings of the mouth and nose (Krushevsky's sign);
  • an increase in the circumference of the chest;
  • smoothing of supraclavicular and subclavian fossae;
  • the presence in the lumen of the trachea and bronchi of pinkish persistent fine bubble foam;
  • "wet swelling of the lungs" (hyperhydria) with imprints of the ribs;
  • fluid in the stomach and upper small intestine with an admixture of silt, sand, algae (Fegerlund's sign);
  • in the left half of the heart, blood diluted with water is cherry-red in color (I. L. Kasper);
  • spots of Rasskazov-Lukomsosky-Paltauf;
  • fluid in the sinus of the main bone (V. A. Sveshnikov);
  • swelling of the bed and wall of the gallbladder and hepatoduodenal fold (A. V. Rusakov and P. I. Shkaravsky);
  • hemorrhages in the muscles of the neck, chest and back as a result of strong muscle tension (Paltauf, Reiter, Vahgolp);
  • visceral pleura somewhat cloudy;
  • air embolism of the left heart (V.A. Sveshnikov, Yu.S. Isaev);
  • lymphohemia (V.A. Sveshnikov, Yu.S. Isaev);
  • swelling of the liver;
  • compression fracture cervical spine;
  • ruptures of the gastric mucosa;
  • detection of diatom plankton and pseudoplankton in blood, internal organs (except lungs) and bone marrow;
  • identification of traces of technical fluids - a positive "oil test" (S. S. Bystrov);
  • identification of quartz-containing mineral particles (B. S. Kasatkin, I. K. Klepche);
  • the difference between the freezing points of blood in the left and right heart (cryoscopy);
  • statement of the fact and degree of blood dilution in the arterial system, left heart (refractometry, electrical conductivity study).

Signs characteristic of the presence of a corpse in the water:

  • "goose pimples";
  • skin is pale;
  • nipples and scrotum wrinkled;
  • hair loss;
  • maceration of the skin (wrinkling, pallor, "washerwoman's hand", "gloves of death");
  • rapid cooling of the corpse;
  • signs of decay;
  • the presence of signs of adiposity;
  • the presence of signs of peat tanning;
  • detection of traces of technical liquids (oil, fuel oil) on the clothes and skin of the corpse.

General ("similar") signs - general asphyxia and drowning:

  • hemorrhage in the conjunctiva and the white of the eyes;
  • cadaveric spots of dark blue or blue-crimson color with a purple tint;
  • the skin of the face, neck, upper chest is pale blue or dark blue with a pinkish tint;
  • puffiness of the face;
  • traces of defecation; "dry swelling of the lungs" (hyperaeria), subpleural ecchymosis (Tardier spots);
  • liquid blood in vessels and heart;
  • overflow of blood in the right half of the heart;
  • plethora of internal organs;
  • plethora of the brain and its membranes;
  • anemia of the spleen;
  • bladder emptying.

General ("similar") signs - the presence of the corpse in the water and drowning:

  • cadaveric spots are pale, blue-purple with a pinkish or reddish tint;
  • swelling and swelling of the folds of the conjunctiva;
  • swelling and maceration of the mucous membrane of the larynx and trachea;
  • fluid in the middle ear cavity with a perforated tympanic membrane;
  • the presence in the upper respiratory tract of silt, sand, algae;
  • fluid in the abdominal (Moro sign) and pleural cavities.