Drowning

Drowning


Drowning: 
  • Is a form of asphyxia due to aspiration of fluid into the air passage, due to submersion in fluid or water.
  • Complete submersion is not necessary, that of mouth and nose alone for a sufficient period can cause death from drowning.
Types of Drowning

1. Typical drowning

  • Wet drowning
  •  Fresh water
  • Salt water

2. Atypical drowning

  • Dry drowning
  • Immersion syndrome
  • Submersion of the unconscious
  • Near drowning /secondary drowning
Typical Drowning/Wet Drowning
  • Obstruction of air passages and lungs by inhalation of water or other fluid.
  • Findings of fluid and froth are present in PM examination.

1.Fresh water drowning:

  • Large quantities of water cross the alveolar membrane into circulation
  • Causing hypervolemia and hemodilution
  • RBCs imbibe water and burst (hemolysis) with liberation of potossium
  • Heart is exposed to volume overload, potassium excess, sodium deficit.(hyponatremia), and anoxia.
  • Anoxia and hyperkalemia cause ventricular fibrillation and death in 4-5 minutes.

2. Salt water drowning :

  • Seawater is hypertonic (3% NaCl)
  • Water is withdrawn by osmosis from the plasma into alveolar spaces in the lungs.
  • Giving rise to fulminating pulmonary edema
  • With progressive hypovolaemia, circulatary shock, and eventually cardiac standstill(asystole)
  • HB increases
  • Death in 8-12 minutes.
Atypical drowning

  • Even after submersion of body in water, little or no water enters respiratory passages and lungs. .

1. Dry drowning:

  • On contact with water, especially cold water, there results intense laryngospasm
  • So that water does not enter the lungs.
  • Death is due to asphyxia because of laryngospasm

2. Immersion syndrome (hydrocution/submersion inhibition/vagal inhibition) :

  • Due to vagal inhibition sudden death
  1. Sudden impact with cold water
  2. Duck diving (falling in water with feet first)
  3. Horizontal entry in water with impact on epigastrium
3.Submersion of the unconscious :

  • Person is unconscious since before submersion in water, Little or no water enters respiratory passages.
  • May occur in MI, cerebrovascular accident, hypertension, epilepsy, cerebral aneurysm and in drunk state.

4. Near drowning (secondary drowning syndrome/post-immersion syndrome) :

  • Death occurs at a later stage after removal from water.
  • Hyperventilation before drowning can cause secondary drowning.
  • Either the person himself comes out of water or he is recovered alive
  • Due to complications of submersion, he dies at a later stage.
  • Due to hypoxic encephalopathy and fibrosing alveolitis.

The death occurs due to combined effect of :

  • Cerebral hypoxia
  • Pulmonary edema
  • Aspiration pneumonitis
  • Electrolyte disturbances 
  • Metabolic acidosis
Cases of Drowning in India 
  • Most of the cases of drowning (2/3) in India are accidental. 
  • Rest 1/3 being suicidal
  • Homicidal drowning is less common in india.

Suicidal drowning is indicated by:

  • Absence of signs of struggle or assault (e.g. torn clothes, injury marks). 
  • A determined suicide may tie his hands and legs together or attach weights to his body or take poison or cut throat before immersion.

In homicidal drowning,

  • Signs of struggle and violence (assault) (e.g. head injury, signs of strangulation, or throttling). 
  • Head and feet may be tied, heavy weight may be attached to body or body may be tied up inside a gunny bag.
  • Homicidal drowning is very rare except in infants and children.
  • Accidental drowning is quite common and usually seen in children, non-swimmers, during floods or due to fall in well etc.
Causes of death in drowning
  • Asphyxia.
  • Myocardial anoxia.
  • Ventricular fibrillation.
  • Vagal inhibition.
  • Laryngeal spasm.
  • Exhaustion.
  • Secondary injuries.( for eg., head injuries)

Exam Important

Typical Drowning/Wet Drowning
1.Fresh water drowning:

  • Large quantities of water cross the alveolar membrane into circulation
  • Causing hypervolemia and hemodilution
  • RBCs imbibe water and burst (hemolysis) with liberation of potossium
  • Heart is exposed to volume overload, potassium excess, sodium deficit.(hyponatremia), and anoxia.
  • Anoxia and hyperkalemia cause ventricular fibrillation and death in 4-5 minutes.

2. Salt water drowning :

  • Seawater is hypertonic (3% NaCl)
  • Water is withdrawn by osmosis from the plasma into alveolar spaces in the lungs.
  • Giving rise to fulminating pulmonary edema
  • With progressive hypovolaemia, circulatary shock, and eventually cardiac standstill(asystole)
  • HB increases
  • Death in 8-12 minutes.
Atypical drowning

1. Dry drowning:

  • On contact with water, especially cold water, there results intense laryngospasm
  • So that water does not enter the lungs.
  • Death is due to asphyxia because of laryngospasm

2. Immersion syndrome (hydrocution/submersion inhibition/vagal inhibition) :

  • Due to vagal inhibition sudden death
  1. Sudden impact with cold water
3. Near drowning (secondary drowning syndrome/post-immersion syndrome) :

  • Hyperventilation before drowning can cause secondary drowning.
Cases of Drowning in India 
  • Most of the cases of drowning (2/3) in India are accidental. 
  • Rest 1/3 being suicidal
  • Homicidal drowning is less common in India.

Suicidal drowning is indicated by:

  • Absence of signs of struggle or assault (e.g. torn clothes, injury marks). 
  • A determined suicide may tie his hands and legs together or attach weights to his body or take poison or cut throat before immersion.

In homicidal drowning,

  • Signs of struggle and violence (assault) (e.g. head injury, signs of strangulation, or throttling). 
  • Head and feet may be tied, heavy weight may be attached to body or body may be tied up inside a gunny bag.
Causes of death in drowning
  • Asphyxia.
  • Myocardial anoxia.
  • Ventricular fibrillation.
  • Vagal inhibition.
  • Laryngeal spasm.
  • Exhaustion.
  • Secondary injuries.( for eg., head injuries)
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