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- Water is withdrawn by osmosis from the plasma into alveolar spaces in the lungs.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
- Sudden impact with cold water
- Duck diving (falling in water with feet first)
- 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
- 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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