Drowning

Introduction to drowning Drowning is the submersion of water in the water, the water filled the respiratory tract and alveoli, causing suffocation caused by ventilation disorders. It can also cause suffocation due to reflex throat, trachea, bronchospasm and water sludge and weeds blocking the respiratory tract. If it falls into the pit, cesspool and chemical storage tank, it can cause skin and mucous membrane damage and systemic poisoning. basic knowledge The proportion of illness: 0.015% Susceptible people: no special people Mode of infection: non-infectious Complications: adult respiratory distress syndrome arrhythmia pulmonary edema heart failure hemolytic anemia acute renal failure disseminated intravascular coagulation

Drowning cause

(1) Causes of the disease

Those who are incapable of self-rescue water, or those who are unfamiliar with the rivers and ponds of water flow and terrain, are mistakenly entering the danger zone, and suicide or accidents can cause drowning. Reflective breath holding, laryngeal bronchospasm and muddy grass blockage occur in the initial stage of water fall. The nose and mouth make the asphyxia worse, so about 20% of the drowning people do not have water inhaled into the lungs or only a small amount of water to the throat, which can last 3 to 5 minutes of respiratory occlusive phlegm, and then the throat is delayed to enter the respiratory tract. And alveolar, alveolar surfactant active damage and lack of function, leading to lung ventilation and ventilation dysfunction, resulting in hypoxia and carbon dioxide retention, hypoxia dysfunction in various organs.

(two) pathogenesis

People drown in the water, instinctively cause reactive breath holding, avoid water entering the respiratory tract, due to lack of oxygen, can not hold the breath and be forced to take a deep breath, so that a large amount of water into the respiratory tract and alveoli, block gas exchange, causing systemic hypoxia and carbon dioxide retention The water in the respiratory tract is quickly absorbed into the blood circulation through the alveoli, and the lesions caused by the submerged water are different.

Freshwater and seawater drowning caused by different pathophysiology, fresh water due to hypotonic and alveolar into the blood circulation caused by increased blood volume can cause pulmonary edema, V / Q decreased and heart failure, accompanied by hypotonicemia, causing red blood cell destruction, Hemolysis, hyperkalemia, and organ cell edema of organs, insufficiency, in addition, hyperkalemia can cause arrhythmia, ventricular fibrillation, and hemoglobin caused by hemolysis in renal tubular embolism caused by acute renal failure, at the same time, water damage And the alveolar epithelial cells cause alveolar surfactants to decrease, the formation of alveolar atelectasis further aggravates the V/Q, resulting in severe hypoxia, and the acute pulmonary edema caused by the infiltration of water from the blood vessels into the alveoli after inhalation of seawater due to hypertonic (35 % salt). And blood moisture is reduced, and blood is concentrated, hyperosmolaremia leads to insufficient blood volume, poor tissue perfusion, and seawater often has calcium salts. Hypercalcemia caused by magnesium salts has bradycardia, conduction block, and even Cardiac arrest, hypermagnesemia on the central nervous system to inhibit and dilate blood vessels, lower blood pressure and other effects.

Drowning prevention

1. When drowning occurs, you can take self-help method when you are unfamiliar with water: in addition to calling for help, take the supine position, the head is backward, so that the nose can breathe out of the water surface, exhale lightly, and inhale deeply.

2, do not panic, do not raise the arm on the flutter, and make the body sink faster, swimmers, if the calf cramps, to keep calm, take the backstroke position, hand to the back of the cramped leg toe The side bends, allowing the cockroaches to loosen and then slowly swim to the shore.

3, rescue drowning, should quickly swim to the vicinity of the drowning, observe the location, rescue from the rear, or put wood, lifebuoy, long pole, etc., so that the drowning people climbed ashore.

4. After the drowning person rescues the shore, first clean the sludge in the nose and mouth, smash, remove the dentures, and then carry out the water control treatment. The ambulance personnel bend their knees on one leg, and the drowning person lies prone on the thigh of the rescuer. The water in the drowning body is drained from the tracheal mouth.

5. If the drowning person's breathing heartbeat has stopped, perform mouth-to-mouth resuscitation immediately and perform a chest external heart massage.

6, for breathing, pulse normal drowning, after pouring water, go back to the house after gargle, drink some ginger soup or hot tea, and keep warm, let the child sleep quietly; pay attention to cough, fever should go Hospital treatment.

7. Strengthen publicity on swimming safety knowledge, prepare activities before swimming to avoid gastrocnemius tendon, accompany water activities, and strengthen the safety and first aid knowledge education of marine workers.

Drowning complications Complications Adult respiratory distress syndrome arrhythmia pulmonary edema heart failure hemolytic anemia acute renal failure disseminated intravascular coagulation

Various arrhythmias, even ventricular fibrillation, heart failure and pulmonary edema, cerebral edema, acute adult respiratory distress syndrome, hemolytic anemia, acute renal failure or disseminated intravascular coagulation after 24 to 48 hours which performed.

Drowning symptoms Common symptoms Coughing ambiguous dyspnea skin cold and pale sticky nose and mouth blood secretions conjunctival congestion irritability restlessness respiratory failure coma coma

Due to the length of drowning, the severity of the illness is different. The short time is rescued in the early stage of the throat (within 1 to 2 minutes of drowning). It is mainly the hypoxic performance of transient asphyxia. After being rescued, the mind is more awake, coughing, breathing. The frequency is increased, the blood pressure is increased, the chest is swelled and discomfort, and the limbs are sore and weak. In the late stage of the throat (within 3 to 4 minutes of drowning), the suffocation and hypoxia are longer, and there may be confusion, irritability or unclearness, and severe coughing. Asthma, difficulty breathing, slow heart rate, lower blood pressure, cold skin, blemishes, etc., after the throat period, water enters the respiratory tract. The clinical manifestations of the digestive tract are disturbance of consciousness, edema of the face, congestion of the eyes, and foaming of the nose and nose. The skin is cold and white, cyanosis, difficulty in breathing, blisters in both lungs, and swelling in the upper abdomen. When the drowning time is more than 5 minutes, the performance is dizzy, the nose and nose bloody secretions, the hair is heavy, the breathing is asthmatic or weak, and the whole is not complete. Unsatisfactory heart sounds, respiratory failure, heart failure, and even dilated pupils, respiratory heartbeats, in addition, long-lived rescuers have lung infections due to sewage into the lungs, and even concurrent with ARDS, Brain edema, acute renal insufficiency, hemolysis or anemia, DIC and other conditions.

Drowning inspection

1. Arterial blood gas analysis and pH measurement show hypoxemia and acidosis, fresh water drowning, blood sodium, potassium, chloride can be slightly reduced, blood potassium is often increased when hemolysis, free hemoglobin appears in the urine, seawater flooding Hemorrhoids, blood calcium and blood magnesium increased, calcium and magnesium ions re-enter the tissue after resuscitation, electrolyte imbalance can return to normal.

2. X-ray findings of the lungs have enlarged and deepened hilar shadows, deepened interstitial texture, flocculation exudation or inflammatory changes of different sizes in the lung field, or diffuse pulmonary edema in both lungs.

3. Drowning people often have mildly elevated white blood cells, elevated blood potassium, and free hemoglobin in blood and urine.

Drowning diagnosis

The disease can be diagnosed based on clinical symptoms and medical history without identification.

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