Drowning. True (wet) drowning

Drowning- this is the closing of the respiratory openings of the mouth and nose by immersing the face in a liquid or semi-liquid medium, causing closure respiratory tract or reflex closure (spasm) of the glottis, accompanied by disturbance or cessation of external respiration and causing death by strangulation.

Drowning can occur while swimming in fresh and salt water, in various reservoirs, rivers, lakes, sea, bath, when falling into a puddle, liquid mud, getting into various containers filled with technical or food liquids, semi-liquid masses, sewage.

Drowning is promoted by intoxication, overwork, hypothermia, increased sweating, overheating of the body, overfilling the stomach with food, a sharp change in the conditions of blood circulation in water, an increase in stress on the cardiovascular system, mental factors, diseases of the cardiovascular and nervous systems, and injuries.

Bathing in cold water or prolonged exposure to relatively warm water can lead to convulsive contraction of certain muscle groups. Such a reaction occurs during prolonged swimming in one style, a feeling of fear, panic. Occasionally, the so-called "immersion syndrome" (water, ice or cryogenic shock) occurs due to a sharp temperature drop, causing over-irritation of skin thermoreceptors, vasospasm, cerebral ischemia and reflex cardiac arrest.

Most often, drowning is caused by injuries caused by inept diving, diving in a shallow place, hitting objects on the water, in the water and at the bottom. Sometimes there are damages by details of water transport. Extremely rarely observed damage caused by sharp tools and firearms.

Sudden and rapid immersion of a person in water, depending on the low water temperature compared to the body and the surrounding air, hydrostatic pressure that changes with the depth of immersion, psycho-emotional stress, causes certain changes that determine the type of drowning and the genesis of death.

Drowning can occur in several ways. Among them are: aspiration (true, wet drowning), spastic (asphyctic, dry drowning), reflex (syncope) and mixed types.

Occasionally there is death in the water caused by diseases (myocardial infarction, non-traumatic cerebral hemorrhage), as well as injuries not related to drowning.

The pattern and duration of drowning is influenced by a number of conditions, such as water temperature, fresh or salty, speed of current, waves, cold water training, will to live.

The aspiration type is characterized by the filling of the airways and alveoli with fluid and a significant dilution of the blood by the absorbed fluid. This type of drowning proceeds in several phases, like mechanical asphyxia.

At the beginning of a true (wet) drowning, a person is conscious and fights for his life. Trying to escape, thanks to the movements of his arms and legs, he either floats to the surface, then plunges into the water again, screams, calls for help, grabs the surrounding objects.

Plunging into the water, a person instinctively holds his breath (pre-asphyctic period) for a different time, due to the state of health and fitness (about 1 minute), tries to emerge.

On the surface takes convulsive breaths, makes chaotic swimming movements. In connection with the growing lack of oxygen in the body, involuntary respiratory movements appear. The accelerated breathing rate during ascent increases the oxygen consumption of the tissues. Respiratory failure is exacerbated by aspiration of even small amounts of water, coughing in response to irritation of the trachea, and bronchospasm. Then comes a deep breath (inspiration), and water under pressure enters the mouth, nose, larynx, trachea and bronchi, causing irritation of the receptors of their mucous membranes, which is transmitted to the cerebral cortex, where the excitation process occurs. Re-irritation of the mucous membranes leads to the release of a large amount of mucus containing protein, which mixes with water and air during breathing, forming a persistent grayish-white or pinkish foam, stained in this color with an admixture of blood from ruptured blood vessels of the alveoli (inspiratory dyspnea stage).

Taking convulsive breaths while emerging, a person can swallow water. A full stomach makes it difficult for the diaphragm to move. Physical stress and fear further increase oxygen deficiency, which irritates the respiratory center. Involuntary respiratory movements are formed under water (the stage of expiratory dyspnea). Following this reflexively there is a deep exhalation, ejecting from the respiratory tract, along with water, the air contained there. At 3-4 minutes diffuse protective inhibition of the cortex sets in. By this time, consciousness is usually lost, air bubbles appear on the surface of the water and the person sinks to the bottom. In the middle or end of the second minute after immersion in water, general convulsions occur due to the spread of overexcitation processes in the cortex and the capture of the motor zones of the cortex by them, reflexes are lost. The person becomes immobile. Further, the waves of the initial motor excitation begin to descend into the underlying sections of the central nervous system and, reaching the cervical part of the spinal cord, cause a series of deep, but rare breaths with the mouth wide open (the so-called terminal respiratory movements). Water, swallowed, enters the stomach and the initial section of the small intestine. In the stage of terminal breathing, it enters the airways in a wide stream under pressure, which increases with the depth of immersion of the body, filling the bronchi and alveoli. Due to high pulmonary pressure, an expansion of the alveoli develops - alveolar emphysema. Water enters the tissue of the interalveolar septa, breaks the walls of the alveoli, penetrates the lung tissue, displaces the air in the bronchi, and mixes with the air contained in the lungs (normally up to 2.5 liters). Through the capillaries, water enters the vessels of the pulmonary circulation, significantly diluting the blood and hemolyzing it. Blood diluted with water enters the left half of the heart, and then into big circle circulation. There comes a final cessation of breathing, soon the work of the heart stops, and after 5-6 minutes death occurs from a lack of oxygen (Fig. 281).

When examining a corpse in cases of wet drowning, pallor of the skin is observed, which is formed due to spasm of the skin capillaries, goose bumps due to contraction of the muscles that raise the hair, grayish-white or pink persistent fine bubble foam around the respiratory openings of the nose and mouth, described by the Russian scientist Krushevsky in 1870 It occurs as a result of air mixing with a large amount of mucus containing protein released due to irritation of the mucous membrane of the respiratory tract with water. This foam persists for up to 2 days. after removing the corpse from the water, and then dries, forming a film. Its formation is facilitated by the leaching of a surfactant (sulfactant) from the surface of the alveolar epithelium, which ensures the expansion of the alveoli during respiration, which was noticed by the Ukrainian scientist Yu.P. Zinenko in 1970

The presence of foam indicates active respiratory movements in the process of drowning. Due to the rupture of the vessels of the alveoli, the released blood stains the foam in a pinkish color.

The spastic type is caused by persistent reflex laryngospasm, which closes the entrance to the respiratory tract due to irritation of the respiratory tract receptors by water.

This type of drowning is formed at the moment of sudden ingress of water at a temperature of about 20 ° C into the upper respiratory tract. Water irritates the mucous membranes and endings of the upper laryngeal nerve, leads to spasm of the vocal cords and reflex cardiac arrest. Spasm of the vocal cords closes the glottis, which prevents the entry of water into the lungs during immersion and the exit of air from the lungs at the time of resurfacing. The sharply increased intrapulmonary pressure causes acute, accompanied by loss of consciousness, asphyxia. Phases of deep and atonal breathing are manifested by intense movements of the chest. Sometimes a terminal pause may be missing. In connection with the fall in cardiac activity, conditions are created for the development of pulmonary edema, impaired permeability of the alveolar-capillary membranes, which causes the final units of the lungs (alveoli) of blood plasma to enter the air spaces, which, mixing with air, forms a stable fine bubble foam. Edema can also be caused by mechanical damage to the membrane due to a drop in intrapulmonary pressure due to intense false inspiration with a closed glottis.

Sometimes a small amount of fluid enters the airways, which is quickly absorbed, especially in cases of drowning in fresh water, and does not cause blood thinning. On the cut, the lungs are dry, and therefore such drowning is called asphyxial, or dry, or drowning without aspiration of water.

The likelihood of laryngospasm depends on age, body reactivity, gender, water temperature, its contamination with chemical impurities, chlorine, sand, shells and other suspended particles. Most often, laryngospasm is observed in women and children.

During the examination of the corpse, attention is paid to the blue-purple color of the skin, especially in the upper parts of the body, abundant confluent cadaveric spots, hemorrhages in the skin of the face and mucous membrane of the eyelids, dilation of the vessels of the white membrane of the eyes. Occasionally there is a white fine bubble foam around the openings of the nose and mouth.

An internal study reveals a sharp emphysema of the lungs, their fluffiness, multiple petechial hemorrhages under the organ pleura, epicardium, in the mucous membrane of the respiratory and urinary tract, gastrointestinal tract against the background of dilated vessels. Rasskazov-Lukomsky-Paltauf spots are absent. The right ventricle of the heart is filled with blood. Blood in the heart may be in the form of clots, especially in the case of alcohol intoxication. The stomach usually contains a significant amount of watery contents, the internal organs are overflowing with blood.

Sometimes drowning begins as an asphyxial type, and ends as a true drowning, when laryngospasm is resolved by water penetrating the respiratory tract and lungs. It is possible to distinguish true insulation from false by the signs given in Table. 26.

Occasionally, signs of asphyxial and true drowning are absent. Such drowning is called reflex (syncope). This type is associated with rapid reflex respiratory arrest and primary cardiac arrest as a response of the body to the aquatic environment under extreme conditions (water shock, allergic reaction to water, etc.).

It arises from the action of cold water on the body, which increases the spasm of the vessels of the skin and lungs. There comes a contraction of the respiratory muscles, which results in severe violations of breathing and cardiac activity, hypoxia of the brain, leading to a rapid onset of death even before the development of actual drowning. Syncopal type drowned contribute to: emotional shock immediately before immersion in water (shipwreck), hydroshock caused by exposure to very cold water on the skin, laryngopharyngeal shock from the action of water on the receptor fields of the upper respiratory tract, water irritation of the vestibular apparatus in people with a perforated eardrum.

death in the waterrare in practice. As a rule, it is observed in people suffering from diseases of the cardiovascular system (angina pectoris, postinfarction cardiosclerosis, acute coronary and respiratory failure), pulmonary tuberculosispneumosclerosis,diseases of the central nervous system (ecilepsy, mental disorders). The cause of death in water in divers can be lung barotrauma, nitrogen anesthesia, oxygen starvation, oxygen poisoning, subarachnoid hemorrhage in diseases of the brain vessels, allergic shock to water associated with the effect of an allergen in the water on a sensitized organism, fainting followed by a reflex caused by water irritation nasopharynx and larynx, leading to drowning, prolonged exposure to water at a temperature of +20 ° C, causing progressive heat loss leading to hypothermia, damage to the tympanic membranes followed by water irritation of the middle ear and reflex cardiac arrest or water entering the middle ear through a perforated tympanic membrane due to a previous disease; irritation of the vestibular apparatus, leading to vomiting and drowning; pathways, aspiration of vomit during the onset of unconsciousness.

An internal study in the tympanic cavities of the middle ear reveals fluid. It enters through the Eustachian tubes or a damaged eardrum. The same fluid is also detected when opening the sinuses of the frontal and basilar bones of the skull. It enters these sinuses due to laryngospasm, which causes a decrease in pressure in the nasopharynx and the flow of water into the pear-shaped cracks. The volume of water in them can reach 5 ml, which was first noticed and described by V.A. Sveshnikov (1965).

Drowning may be accompanied by an outpouring of blood into the tympanic cavities, mastoid cells and caves. It may be in the form of loose accumulations or profuse soaking of the mucous membranes. Their occurrence is associated with an increase in pressure in the nasopharynx, circulatory vascular disorders, which, in combination with pronounced hypoxia, lead to an increase in the permeability of the vascular walls and outpouring of blood.

Sand and other foreign particles from the reservoir are found in the tympanic cavity. Blood outflows into the middle ear and tympanic membrane are revealed.

When examining the corpses of drowned people, bilateral, parallel to the longitudinal fibers, blood bundles of the sternocleidomastoid and pectoralis major muscles (Paltauf), broad and scalene muscles, and neck muscles (Reuters) are found. They occur as a result of strong muscle tension during an attempt to escape from drowning. Occasionally, in the circumference of the nose and mouth and in their openings, vomit is found, indicating vomiting in the agonal period.

The mucous membrane of the entrance of the upper respiratory tract is reddened, swollen, sometimes with pinpoint hemorrhages, which is explained by the irritating effect of water.

The same foam, as in the circumference of the mouth and nose, is also detected in the respiratory tract. Sometimes foreign inclusions (sand, algae, silt, small and large stones) are found in it, indicating drowning in a shallow place.

Foreign particles can penetrate into the corpse when they stay and stay in muddy water containing them for a long time, in fast-flowing water bodies, and therefore their evidentiary value is small. Large pebbles, deeply penetrated into the trachea, indicate active aspiration in the convulsive period of drowning. In the respiratory tract, gastric contents are sometimes found, penetrating to the small bronchi. In such cases, it should be noted whether it is squeezed out of the bronchi on the cut. Its presence indicates vomiting in the agonal period. Occasionally, mucus is found in the respiratory tract. Foam in the airways can form as a result of pulmonary edema, during vigorous artificial respiration, mechanical asphyxia from squeezing the neck with a noose or hands, and as a result, prolonged agony. The mucosa of the trachea and bronchi is edematous, cloudy, the foam is usually unstable and large-bubbly.

Lungs - large, completely fill the pleural cavities and sometimes "bulge" out of them, cover the heart, emphysematously swollen, increased in volume and sometimes in weight, which is explained by the penetration of fluid during wet drowning. The edges of the lungs are rounded, go behind each other, sometimes cover the heart bag. On the surface of the lungs, you can see the imprints of the ribs, which appear traps, between which the lung tissue acts in the form of rollers - "the lung of a drowned person." Similar prints are also found on the posterolateral surfaces of the lungs. Such changes are explained by the pressure of water penetrating the respiratory tract into the lungs, on the air present there, which breaks the walls of the alveoli and passes under the pulmonary pleura, causing emphysema. Water enters the place of the displaced air. As a result, the lungs increase significantly in volume, exerting pressure from the inside on chest, as a result of which transverse grooves appear on them - traces of the pressure of the ribs.

An increase in lung volume occurs during vigorous and prolonged artificial respiration, which must be remembered when examining a corpse. The upper lobes and the lung edges adjacent to the root are usually dry and distended with air. The organ pleura is unclear, under it there are rather large spilled reddish-pink spots with indistinct blurry borders, described independently by Rasskazov (1860), Lukomsky (1869), Paltauf (1880) and received the name Rasskazov-Lukomsky-Paltauf spots in the literature. Their color and size are due to the amount of water that has entered the systemic circulation through the ruptured and gaping capillaries of the interalveolar septa, and blood hemolysis, as a result of which diluted and hemolyzed blood becomes lighter, its viscosity decreases, it liquefies, and hemorrhages blur, acquiring fuzzy contours. The lungs become "marble" due to the alternation of protruding pink and sinking red areas. drowning in sea ​​water does not cause hemolysis, and they retain their normal color.

To the touch, light doughy, reminiscent of a sponge soaked in water. In wet drowning, the lungs are huge, with alternating dry areas with watery ones, and acquire a gelatinous appearance. A foamy fluid, similar to that contained in the respiratory tract, flows from the cut surface of such lungs. The lungs are heavy, full-blooded, with hemorrhages under the pulmonary pleura.

In cases of dry drowning, the lungs are emphysematously swollen, dry, under the pulmonary pleura, mucous membrane of the gastrointestinal tract, renal pelvis, Bladder- Tardieu spots that form during inspiratory dyspnea. In the initial parts of the respiratory tract, there may be particles of silt, etc. The venous system is full of blood with a small amount of dark red clots.

From drowning in sea water, which is a hypertonic medium in relation to blood, blood plasma escapes into the alveoli, which leads to the rapid onset of pulmonary edema and pulmonary insufficiency. The blood does not liquefy, its viscosity increases, there is no hemolysis of erythrocytes, Rasskazov-Lukomsky-Paltauf spots are not observed. Areas of atelectasis are combined with foci of emphysema and uneven blood supply.

Liquefaction of the blood contained in the cavity of the left ventricle is a consequence of intravascular hemolysis and is a valuable sign that occurs only in true drowning in fresh water, which quickly permeates the endocardium of the left ventricle and aortic intima.

Examining the corpses of the drowned, F.I. Shkaravsky drew attention to the swelling of the liver, bed and walls of the gallbladder of drowned people.

As a result of congestion and an increase in the volume of fluid in the bloodstream, the volume and mass of the liver increase.

The section draws attention to a large amount of fluid in the stomach, sometimes with an admixture of silt, sand, aquatic plants that penetrate into the stomach when swallowed during drowning. The same fluid is found in duodenum, where it passes only through the in vivo open pylorus as a result of increased reflex peristalsis, which can be considered a sign of drowning.

The overflow of the stomach with swallowed water, especially sea and polluted, causes vomiting. On the gastric mucosa there are banded hemorrhages, as well as ruptures in the region of the lesser curvature, which are the result of vomiting in the agonal period or hitting the stomach with water. Occasionally, petechial hemorrhages occur under the pancreatic capsule.

The signs of a corpse being in the water, accompanying signs of drowning, include: wet clothes covered with silt, sand with the presence of shells, fish, crayfish, water bugs, algae and fungi in its folds, characteristic of this reservoir, sticky hair, sharp pallor of the skin, raised vellus hair (“goosebumps”), wrinkling of the pectoral nipples, areola of the breast and mammary glands, scrotum, glans penis, pink color of the skin at the edges of cadaveric spots, rapid cooling of the corpse, skin maceration phenomena, “bath hand”, “skin laundresses”, “glove of death”, “sleek hand”, post-mortem hair loss, rapid development of decay, fat wax, post-mortem injuries.

A sharp pallor of the skin is formed when immersed in cold - below body temperature - water, which causes contraction of the vessels of the skin and the pallor of its integument.

The pink color of the skin along the edges of cadaveric spots occurs due to swelling and loosening of the epidermis under the influence of water. This facilitates the penetration of oxygen through the skin, which oxidizes hemoglobin and converts it into oxyhemoglobin.

The pink color of the skin is also observed on the surface of the skin, free from cadaveric spots, if the body is removed from cold water, which was noticed by E. Hoffman and A.S. Ignatovsky.

"Goose skin" is formed under the influence of cold water or only cold on the skin, and in some disorders of the nervous system - due to contraction of smooth muscles.

The surface of the skin is covered with multiple tubercles, the formation of which is due to the contraction of smooth muscle fibers that connect the surface layers of the skin with the hair follicles. As a result of this, they raise them to the free surface of the skin, forming small tubercles in the places where the hairs exit.

Irritation of the skin with water leads to a contraction of the muscle fibers of the pectoral nipples, areola circles of the breast, scrotum, as a result of which their contraction occurs 1 hour after being in the water.

A significant influence on their development is the temperature of the environment, air, the depth of the reservoir, the concentration of salts in the environment (fresh or salty), the mobility of water (stagnant or flowing), the speed of the flow, the thermal conductivity of the medium, clothing, gloves and shoes.

Maceration is one of the signs of a corpse being in the water. Maceration, or softening, is formed under the action of water, as a result of which the epidermis soaks, swells, wrinkles and gradually exfoliates on the palms and soles. Maceration is well detected in places where the skin is thick, rough, callused. It starts with the hands and feet. First, whitening and fine wrinkling of the skin appears (weakly expressed maceration, "bath skin"), then - pearl-white color and large wrinkling of the skin (clearly pronounced signs maceration - "skin of the laundress". Gradually, a complete separation of the epidermis occurs along with the nails (pronounced signs of maceration). The skin is removed along with the nails (the so-called "glove of death"). After its departure, there remains a devoid of epidermis, smooth skin (“sleek hand”).

In the future, maceration extends to the entire body.

In warm running water, maceration is accelerated. Cold water, gloves and shoes hold her back. The degree of development of maceration makes it possible to roughly judge how long the corpse has been in the water. The literature presents various terms for the appearance of initial and final signs of maceration without regard to water temperature. The most complete timing of the development of skin maceration depending on the water temperature was studied by Ukrainian scientists E.L. Tunina (1950), S.P. Didkovskaya (1959), supplemented by I.A. Kontsevich (1988) and are presented in Table. 27.

Due to loosening of the skin after about 2 weeks. hair loss begins and by the end of the month, especially in warm water, complete baldness occurs. In places of fallen hair, their holes are clearly visible.

The presence of original lubrication protects the skin of newborns from maceration. The first signs of it appear by the end of 3-4 days, and the complete separation of the epidermis - by the end of the 2nd day. months summer and for 5-6 months. in winter.

A drowned person sinks to the bottom and at first, if there is no strong current, he remains in place, but rotting develops and the corpse floats up.

Putrefactive changes begin to develop from the intestines, then the corpse floats up if there are no mechanical obstacles. The lifting force of putrefactive gases is so great that a load weighing 30 kg with a total weight of 60-70 kg is not an obstacle to ascent.

D.P. Kosorotov (1914) gives an example when a ship with 30 bulls in the hold sank in the ocean off the coast of India. All efforts to raise it from the water were in vain, but a few days later the ship surfaced due to the development of putrefactive gases in the corpses of oxen.

In warm water, decay processes develop faster than in cold water. In small reservoirs with a water temperature of more than 22 ° C, the corpse may float up as early as the second day. In central Russia, corpses float up on the second or third day, depending on the water temperature. According to the Japanese researcher Furuno, from July to September, in cases of drowning at a depth of 1-2 m, the corpse emerges after 14-24 hours, at a depth of 4-5 m - after 1-2 days, at a depth of 30 m - after 3-4 days . In winter, corpses can stay in the water for up to several months. Rotting in water occurs more slowly than in air, but after extraction from water, putrefactive processes proceed extremely rapidly. Already 1-2 hours after the removal of the corpse, the skin takes on a greenish color, cadaveric emphysema develops, the corpse begins to swell, the skin acquires a dirty green color, a putrefactive venous network and blisters appear. A fetid odor emanates from the corpse. In corpses that are in the water in summer 18 hours and in winter 24-48 hours, along with whitening of the hands and feet, the light blue color of the skin turns into a brick-red color of the head and face up to the ears and the upper part of the occipital region. The head, neck and chest acquire a dirty green color interspersed with dark red in summer after 3-5 weeks, in winter - after 2-3 months After 5-6 weeks. summer and winter more than 3 months the body swells with gases, the epidermis exfoliates everywhere, the entire surface takes on a gray or dark green color with a putrid venous network. The face becomes unrecognizable, the color of the eyes is indistinguishable. Determination of the time spent by the corpse in the water becomes impossible in the summer after 7-10 weeks. and in winter after 4-6 months due to the development of putrefactive changes. If something interferes with the ascent, then the decay that has begun is suspended and the formation of a fat wax gradually occurs.

Occasionally, corpses removed from the water are covered with algae or fungi. In corpses that are in running water, fluffy algae in the form of scattered hairy areas are found on the 6th day, on the 11th day they are the size of a walnut, on the 18th day the corpse is dressed as if in a coat of algae, which after 28- 30 days fall off, after which on the 8th day a new growth follows, having the same course.

In addition to these algae, after 10-12 days, mucus-like fungi appear in the form of small red or blue circles with a diameter of 0.2-0.4 cm.

The presence of a corpse in water is judged by the presence of fluid in the tympanic cavity of the middle ear, in the sinuses of the main bone (symptom of V.A. Sveshnikov), fluid in the respiratory tract, esophagus, stomach, small intestine, pleural (Krushevsky's symptom) and abdominal (Moro's symptom) cavities, plankton in the lungs with the integrity of the skin and in other organs in the presence of damage to it.

Moro in the pleural and abdominal cavities found a blood-colored fluid in an amount of up to 200 ml, which seeped into the pleural cavities from the lungs, and into the abdominal cavity from the stomach and intestines. The age of the corpse in the water can be determined by the flow of fluid into the pleural cavities and the disappearance of signs of drowning. The presence of fluid in the pleural and abdominal cavities indicates that the corpse has been in the water for 6-9 hours.

The enlargement of the lungs during the stay of the corpse in the water gradually disappears by the end of the week. The spots of Rasskazov-Lukomsky-Paltauf disappear after a 2-week stay of the corpse in the water. Tardieu spots are determined on the surface of the lungs and heart up to a month after drowning (Table 28).

Laboratory diagnostics for drowning

Many laboratory methods have been proposed to diagnose drowning. Among them, the most widespread are microscopic research methods - the histological method of research on diatom plankton and pseudoplankton.

Plankton- the smallest organisms of plant and animal origin, located in tap water, water of various reservoirs, in the air. They are typical for this reservoir and have specific features. In the diagnosis of drowning, phytoplankton, and especially diatoms, are of the greatest importance. Their shell is made of silicon that can withstand the impact high temperatures, strong acids and alkalis. The form of diatoms is diverse and typical for each reservoir.

Plankton, along with water, enters the mouth, from there into the respiratory tract, lungs, of which through the vessels into left heart, aorta and blood vessels spread throughout the body, lingering in the parenchymal organs and bone marrow ge long tubular bones (Fig. 282). Plankton persists for a long time in the axils of the main bone and can be found in scrapings from its walls. Together with water from the lungs, grains of sand suspended in water, starch grains, the so-called pseudoplankton (Fig. 283), can also enter the bloodstream. Until recently, plankton and pseudoplankton detection methods were considered the most convincing methods for diagnosing drowning. Their subsequent check showed the possibility of post-mortem penetration of plankton elements into the lungs and other organs of the corpse with damage to the skin. Therefore, the detection of plankton and pseudoplankton has evidential value only when the skin is intact.

At present, the histological method of research is widely used. internal organs. The most characteristic changes are established in the lungs and liver. On the section of the lungs, foci of atelectasis and emphysema, multiple ruptures of the interalveolar septa with the formation of so-called spurs facing the inside of the alveoli, focal outpouring of blood into the interstitial tissue, and swelling are revealed. In the lumen of the alveoli are light pink masses with an admixture of a certain amount of erythrocytes.

In the liver, the phenomena of edema, expansion of precapillary spaces with the presence of protein masses in them. The wall of the gallbladder is edematous, the collagen fibers are loosened.

On the corpse of a person found or removed from the water, there may be a variety of injuries. A correct assessment of their morphology and localization will allow you to correctly assess what happened and avoid wasting time searching for non-existent intruders. The main questions that an expert must answer are: who, during what, what and how long ago the damage was done.

The most common damage occurs when diving. They are formed when the jump technique is incorrectly performed, hitting objects in the fall path, objects in the water, hitting the bottom, and objects on it and in it. Impacts on objects in the path of fall, located in the water, and objects at the bottom cause extremely diverse damage, reflecting the characteristics of the contact surfaces and localized in any of the areas of the body, on any of its surfaces, sides, levels (Fig. 284).

Evaluating them, it is necessary to take into account the position of the corpse in the water after death. The human body is somewhat heavier than water in terms of its specific gravity. The presence of a small amount of clothing and gases in the gastrointestinal tract allows the corpse to be at the bottom for a certain time. A significant amount of gases in the gastrointestinal tract and developed during the process of decay quickly raises the corpse from the bottom, and it begins to move under water, and then floats to the surface. Persons in warm clothes sink to the bottom faster. The dressed corpses of men usually float face down, with their heads down, the corpses of women - face up, and the legs weighed down by the dress can be lowered below the head. This situation is explained anatomical structure male and female bodies.

Hit by a stream of water at the time of entry into it sometimes forms ruptures of the eardrum. The ingress of water into the cavity of the middle ear causes a loss of orientation of movements in the water. Those who jump into the water experience ruptures of the eardrum, injuries in the lumbar region, contusions and dislocations of the spine in the lumbar region due to the bending of the body entering the water, sprains and muscles, depression spinous processes of the vertebrae, fractures of the spine from hitting the water. If you fall into the water incorrectly, there may be bruises and ruptures of internal organs, shock, fractures of tubular bones, dislocation of the shoulder joint.

Rarely, injuries found in victims are not fatal in and of themselves, but can cause a momentary loss of consciousness sufficient to cause drowning.

Hitting the water while entering it flat causes bruises, bruises and damage to internal organs, the severity of which is determined by the angle and height of the fall. A blow to the epigastric region of the abdomen or the vulva sometimes causes shock, leading to death. An incorrectly performed “soldier” jump with legs spread apart causes bruises on the heels, scrotum, testicles, followed by the development of traumatic epididymitis. A swallow jump causes damage to the hands of one or both hands, any of the surfaces of the head, the chin, at the handle of the sternum from a chin strike. Sometimes there are fractures of the base of the skull and spine, accompanied by trauma to the brain and spinal cord, causing paralysis of the limbs, due to the level of damage to the spinal cord.

Drowning in a shallow place is accompanied by the formation of abrasions on the limbs and torso from hitting the bottom and objects on it.

Parts of sea and river vessels cause a variety of damage up to the separation of the body. Rotating propeller blades inflict damage resembling chopped. The presence of several identically directed fan-shaped wounds indicates the action of propeller blades with the same direction of turns.

The significant time spent by the corpse under water in a stagnant reservoir and the developing putrefactive changes do not exclude the possibility of the corpse moving along the bottom and in various layers of water, dragging along the bottom with a blow against various objects in the water and on the surface. In reservoirs with flowing water, the listed damage can form even before the development of putrefactive changes. In mountain rivers and rivers with a fast current, corpses sometimes move a considerable distance. Depending on the topography of the bottom, objects on it and individual stones, rapids, driftwood, clothes and shoes are sometimes completely removed, and on the remaining ones there are various damages caused by friction and hooking. Damage to the corpse, caused by dragging and impact, is localized on the skin, nails and even bones of any of the surfaces of the body. To move with water, transverse ruptures of the legs in the area are typical. knee joints, wear of shoe socks for men and heels for women, abrasions on the back of the hands. Such localization and morphology of injuries is explained by the fact that the corpse of a man floats face down, and women - up. In these cases, cadaveric spots in men are primarily formed and located on the face.

Injuries by the action of sharp objects can be inflicted when dragging along the bottom, but unlike sharp tools and weapons used to take life, these injuries are single, superficial, localized in various areas of the body, including those inaccessible to one's own hand.

Corpses in the water are sometimes damaged by water rats, snakes, crayfish, fish, snails, stingrays, crabs, amphipods, birds, and leeches. Leeches inflict typical damage, forming multiple T-shaped superficial wounds. Fish that gnaw on a corpse leave funnel-shaped depressions on the skin. Cancers and crustaceans can eat all soft tissues, penetrate into cavities and eat out all internal organs.

Atonal damage occurs in the final periods of drowning during convulsions. They are manifested by abrasions, broken nails, bruises on the forearms, abrasions on the anterolateral surfaces of the body, etc.

Attempts to provide assistance are accompanied by extensive abrasions on the lateral surfaces of the chest. Their presence indicates artificial respiration and chest compressions.

Damage from rough extraction from the water by hooks, "cats", etc. are localized in any areas of the body and reflect the features of their active part.

Inspection of the scene of a drowning accident

The protocol of the inspection of the scene by the investigator must necessarily reflect the temperature of the water and air, the mobility of the water, the speed of the current, the depth of the reservoir, the position of the corpse in the water - face up or down, the method of removing the corpse from the water. The corpse is oriented in relation to the flow of the river, its turn or some other fixed landmark.

By examining the corpse, the presence or absence of objects holding the body on the surface of the water (life jacket, etc.) or contributing to its immersion (stones tied to the body, etc.)

Damage to clothes and shoes is described according to generally accepted schemes. Examining the skin, note their pallor or pinkish color, the presence or absence of "goosebumps" skin.

Cadaveric phenomena are studied with particular care at the scene of the incident, which, after removing the corpse from the water in the air, develop extremely quickly. Inspection focuses on the color of cadaveric spots that have a pinkish tint, indicating the presence of the corpse in the water, their localization on the face and head, indicating the position of the corpse in the water, the degree of development of putrefactive changes, indicating where they are most pronounced, the presence or absence of hair, the degree of their retention by pulling the hair in different areas of the head. In the absence of hair, the area and severity of their holes are indicated.

Examining the face, note the presence or absence of pinpoint hemorrhages in the connective membranes of the eyes, the expansion of their vessels, accumulations of fine bubble foam in the openings of the nose and mouth, the amount and color (white, gray-red), vomit, damage to the protruding areas of the face.

Describing the body of a corpse, they focus on the wrinkling of the areola, nipples, scrotum and penis.

Fixing signs of skin maceration, indicate: localization of areas (palmar surface, nail phalanges, plantar and dorsal surfaces of the feet, etc.), severity of maceration - whitening, loosening, swelling of the epidermis, folding (small or deep), color, degree of retention of the epidermis by sipping , the absence of the epidermis on the limbs, swelling and separation of it in other areas of the body from the underlying layers of the skin.

When examining the hands, the fingers are clenched into a fist, the presence of sand or silt in it, abrasions with traces of sliding on the back surface of the hands, the content of sand, silt under the fingernails, etc.

It is impractical to untie the tied hands and feet at the scene of the incident, since it is better to carefully examine the knots and loops during the examination of the corpse in the sectional room. At the scene, describe the material from which knots and loops are made, their location on the limbs. The load tied to the corpse is not removed at the scene of the incident, indicating only the place of fixation, and sent for examination along with the corpse.

Algae and fungi are described with indication of location, color, degree of distribution over surfaces and areas of the body, type, length, thickness, consistency, strength of connection with the skin.

Before taking a water sample, it is necessary to rinse the liter dishes twice with water from the given reservoir in which the drowning occurred. Water is taken from the surface layer at a depth of 10-15 cm at the place of drowning or the place where a corpse was found. The dishes are closed, sealed by the investigator, the label indicates the date, time and place of taking the sample, the name of the investigator who took the water, and the case number for which the water was taken.

When corpses are found in puddles, containers (including bathtubs), their dimensions, the depth of the container, how and how filled they are, and the temperature of the liquid are noted. If there is no water in the bath, then this must be reflected in the protocol.

Describing the posture of the corpse, they indicate which areas of the body are immersed in the liquid, which are above it, if the body is completely immersed in water, then at what depth and in what layer of water. If the corpse is in contact with the details of the containers, then the contact area of ​​the body and details are described. The diagnosis of drowning is based on a combination of morphological features of the results of laboratory studies and the circumstances of the case, which can be decisive in establishing the type of drowning and death in the water. Drowning - an accident is evidenced by the testimony of eyewitnesses about the circumstances of immersion in water, the use of alcohol (confirmed by the results of laboratory tests), the presence of diseases.

In favor of suicide is the failure to take measures to save, tying a load, tying limbs, the presence of non-fatal injuries that suicides inflict near the water. In these cases, death occurs not from injuries, but from drowning. Criminal deprivation of life is indicated by the presence of injuries that the victim himself could not inflict.

Information necessary for the expert to conduct the examination drowning

In the installation part of the decision, the investigator must reflect: from which body of water the corpse was taken, the place of its discovery - in the water or on the shore, full or partial immersion in water, whether the person was in the water, the temperature of the water and air, the speed of the current, the mobility of the water, the depth of the reservoir , method of extraction from the water (hooks, cats, etc.), testimony of witnesses about the circumstances of the victim’s immersion in water, about trying to stay on the surface of the water, alternating diving with appearing above the surface of the water, information about the previous fight, drinking alcohol, diving, participation in competitions on the water, shipwreck, first aid by a specialist or an outsider, diseases that the victim has at the time of drowning and suffered by him earlier.

The type of drowning (true or asphyxic) determines one or another morphological picture revealed by the study of the corpse.

The external examination of the corpse in the sectional room differs from that at the scene of the incident by the special thoroughness of the study and fixation of the identified features of knots and loops, the weighing of the load used to hold the corpse at the bottom, sketching and detailed photographing of the damage.

Internal examination uses a variety of sectional techniques and additional examination methods aimed at detecting damage, changes typical of drowning, and painful changes that contribute to the onset of death in the water.

In the soft integument of the head, hemorrhages are found, which may be the result of pulling the victim by the hair. It is obligatory to open the cavities of the middle ear, the sinus of the main bone, with a description of their contents, its nature and quantity, the condition of the eardrums, the presence or absence of holes in them, the study of the muscles of the body, the opening of the spine, the study of the spinal cord, especially in the cervical region. Examining the neck and its organs, focus on the presence of soft tissue bundles with blood, fine bubble foam in the airways, its color, quantity, foreign liquid, sand, silt, pebbles (indicating their sizes), note the presence, nature and amount of free fluid in pleural and abdominal cavities. Carefully examining the lungs, fix their size, traces of pressure from the ribs, describe their surface, shape and contours of hemorrhages, pay attention to gas bubbles under the pulmonary pleura, the consistency of the lungs, the color on the cut, the presence and amount of edematous fluid or dryness of the cut surface, reflect the blood filling of the lungs , heart and other organs, the state of the blood (liquid or with bundles). To clarify the dilution of blood with water, a simple test is used, which is made by applying a drop of blood from the left ventricle to filter paper. Diluted blood forms a lighter ring, proving hemolysis and blood thinning.

In the study of the gastrointestinal tract, the presence of foreign bodies and fluid in the stomach and duodenum, its nature and amount (free fluid, liquefaction of the contents) are noted. The stomach and duodenum are tied up before being removed from the corpse, and then, above and below the ligatures, they are cut and placed in a glass vessel to settling the liquid. Dense particles will settle to the bottom, a layer of liquid above them sometimes covered with foam. The presence of fluid in the duodenum is one of the most reliable signs of drowning, indicating increased peristalsis, but this sign is of diagnostic value only on fresh corpses. Particular attention is paid to the small curvature of the stomach, where there may be ruptures of the mucous membrane. The diagnosis of drowning is confirmed by laboratory tests for the presence of elements of diatom plankton in the internal organs. For research, an unopened kidney is taken with a ligature applied to the leg in the gate area, about 150 g of the liver, the wall of the left ventricle of the heart, brain, lung, fluid from the middle ear cavity or sinus of the main bone. In putrefactive corpses, the femur or humerus is completely removed. In addition to research on diatom plankton, it is necessary to produce and histological examination to determine changes due to drowning and diseases that contribute to death in the water.

Drowning- death or a terminal condition resulting from the penetration of water (less often - other liquids and bulk materials) into the lungs and respiratory tract.

Drowning is possible when swimming in water bodies, although sometimes it occurs in other conditions, for example, when immersed in a bath of water, in a container with some other liquid. A significant part of the drowned are children. A drowned person can be saved if first aid is provided in a timely and correct manner. In the first minute after drowning in water, more than 90% of the victims can be saved, after 6-7 minutes - only about 1-3%.

Drowning types:

1. Primary (true, or "wet"),

2. Asphyxial ("dry")

3. syncope

In addition, in case of accidents, death in water can occur, not caused by drowning (trauma, myocardial infarction, cerebrovascular accident, etc.).

Primary drowning occurs most frequently (75-95% of all accidents in the water). With it, fluid is aspirated into the respiratory tract and lungs, and then it enters the bloodstream. When drowning in fresh water, pronounced hemodilution and hypervolemia quickly occur, hemolysis develops, and a decrease in the concentration of calcium and chlorine ions in plasma. Severe arterial hypoxemia is characteristic. After removing the victim from the water and giving him first aid, pulmonary edema often develops with the release of bloody foam from the respiratory tract. When drowning in sea water, which is hypertonic in relation to blood plasma, hypovolemia, hyperchloremia develop, and blood thickens. True drowning in sea water is characterized by the rapid development of edema with the release of white, persistent, "fluffy" foam from the respiratory tract.

Asphyxial drowning occurs in 5-20% of all cases. With it, reflex laryngospasm develops and aspiration of water does not occur, but asphyxia occurs. Asphyxial drowning occurs more often in children and women, as well as when the victim enters contaminated, chlorinated water. In this case, water in large quantities enters the stomach. Pulmonary edema may develop, but not hemorrhagic.

syncope drowning develops as a result of cardiac arrest due to the victim getting into cold water("ice shock", "immersion syndrome"), a reflex reaction to water entering the respiratory tract or the middle ear cavity with a damaged eardrum. This drowning is characterized by a pronounced spasm of peripheral vessels. Pulmonary edema usually does not occur.

Drowning mechanism:

When drowning in fresh water, blood thins. This is due to the flow of water from the lungs into the bloodstream. Occurs due to the difference in osmotic pressure of fresh water and blood plasma. Due to blood thinning and a sharp increase in blood volume in the body, cardiac arrest occurs (the heart is not able to pump such a huge volume). Another consequence of blood thinning that can cause complications and death is hemolysis, which occurs due to the difference in osmotic pressures of blood plasma and erythrocyte cytoplasm, their swelling and rupture. As a result, anemia, hyperkalemia develops, and a large number of cell membranes, cell contents and hemoglobin enter the bloodstream at a time, which, being excreted through the kidneys, can lead to acute renal failure.

When drowning in salt water, the exact opposite process occurs - blood clotting (hemoconcentration).

The usual mechanism of drowning is as follows: a non-swimmer who has fallen into the water takes deep breaths while fighting for his life. As a result, a certain amount of water enters the lungs and loss of consciousness occurs. Since the human body is completely immersed in water and respiratory movements continue, the lungs are gradually completely filled with water. At this time, spasms of the muscles of the body can occur. After a while, cardiac arrest occurs. A few minutes later, irreversible changes in the cerebral cortex begin. With an active struggle for its life, the body needs more oxygen, thus, hypoxia intensifies and death occurs in a shorter time.

When drowning in cold water, especially in children with low body weight and high regenerative capacity of the body, it is sometimes possible to fully or partially restore brain functions after 20-30 minutes after drowning.

Common Causes for Drowning :

1. Gross violation of the rules of behavior on the water and failure to follow simple precautions. There are common cases of drowning in persons who are intoxicated, when swimming in a storm, near ships and other floating facilities, when diving into dubious water bodies, when staying in cold water for a long time, when overestimating their physical capabilities.

2. Violation of the rules of scuba diving, diving alone. Causes of emergency at great depths - malfunction of equipment, depletion of air in cylinders, cold shock, narcotic effect of nitrogen, oxygen poisoning, etc. As a rule, first aid for drowning at great depths is late.

3. Exacerbation of diseases directly during the bathing period - fainting, epileptic seizure, hypertensive crisis, cerebral hemorrhages, acute coronary insufficiency and other diseases in which a person loses consciousness.

4. Intentional killings - violent execution by drowning, suicide. 5. Fear and psychological shock when faced with an emergency. 6. Accidents during swimming - concussion, spinal injury, loss of consciousness when hitting a rock, the bottom of the pool, stones, etc. allergic reactions and muscle cramps that make any movement impossible.

8. Ruptures of the spleen, liver and other internal organs during a sharp dive to a depth.

9. Reflex traumatic shock during blows in the abdomen, which can develop when jumping into the water from a height.

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 are light Red, up to 0.5 cm in diameter under the pulmonary pleura (do not form in sea water).

Presence of drowning fluid in the sinus sphenoid bone(A 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, plethoric, dark red, hemorrhagic (Sign of K. Ulrich).

The presence of plankton in the blood and internal organs. Laboratory studies for plankton are primarily made 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 in vivo, 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?

Drowning refers to death or a directly life-threatening condition resulting from the penetration of liquid into the respiratory tract of a person. According to WHO estimates, death from injuries occurs in 10% of the world's population, drowning in the list of causes of traumatic deaths ranks third in adults and second in children, thus being among the most common types of injuries. At the same time, the largest number of drownings occurs in the age group from 1 to 7 years, and over 50% of cases of drowning of children occur in front of their parents.

Types of drowning

The described injuries can have different mechanisms, in connection with which the following types of drowning are distinguished:

• Wet, or true drowning - when, as a result of an attempt to breathe underwater, the airways are filled with liquid;
• Dry, or asphyxic - respiratory failure occurs due to spasm of the upper part of the trachea and vocal cords (laryngospasm), which occurs reflexively due to water entering the upper respiratory tract. In this case, water does not enter the lungs;
• Syncopal drowning - occurs as a result of a sudden cardiac arrest, which has a shock reaction mechanism in response to a sudden immersion in water;
• Death on the water This is the name of drowning, which occurred as a result of other reasons, only indirectly related to being on the water. For example, if a person had a stroke, epileptic seizure, myocardial infarction during his stay in the water, which resulted in drowning.

Determining the type of drowning is important for developing the right assistance tactics.

The most common type of drowning is asphyxial (dry), it accounts for 30-35% of all cases, the second place is occupied by wet drowning - 20-25% of cases, the last one is syncope with 10%, the remaining cases are attributed to death on the water.

There are three phases of true drowning:

• I - initial period. The person is conscious and has not lost the ability to hold his breath, going under water. After extraction from the water, an inadequate assessment of the situation (depression or hyperactivity), rapid breathing, bouts of reflex coughing, often vomiting of water mixed with gastric contents, tachycardia, followed by bradycardia, are noted. The skin is pale cyanotic;
• II - the agonal period of drowning. The man is unconscious, but the pulse is on the sleepy and femoral arteries present, as well as shallow breathing, heart sounds are muffled. Pink-colored foam is released from the nose and mouth, the skin is cyanotic;
• III - the terminal period, or the period of clinical death. The difference from the agonal period is the absence of respiratory movements and pulse even on large arteries. The pupils are dilated, there is no reaction to light.

Signs of drowning

A drowning person looks completely different from what the vast majority of people used to think. He cannot wave his arms to draw attention to himself, he cannot scream, and besides, the whole process is very fast and rarely takes more than one minute. So, the most likely signs of drowning are the following:

• In order to inhale, a person leans back strangely, throwing his head back or trying to roll over onto his back;
• Breathing is uneven, it can be superficial, when it turns out - convulsive, sharp breaths;
• The rest of the time, the head is low in the water, and the mouth is submerged;
• The look is empty, the eyes are not focused, the person seems to be looking into the distance, sometimes the eyes can be closed;
• A person is in the water vertically, cannot push off with his feet, at best he moves his feet in the water, as if climbing a ladder;
• Hair, hanging down, can close the eyes, and the person makes no attempt to remove them.

By themselves, the external signs of drowning are not characteristic of this particular condition. A person may breathe erratically if he has just surfaced, or swam at a fast pace, he may lean back, wanting to change position, and so on. But it should be taken into account that if a person really drowns, then there is practically no time for reflection, death can occur at any moment. Therefore, if you notice the behavior of a person on the water that alarms you, do not reflect on whether you see the true signs of drowning or whether it seemed to you that you need to quickly swim up to the person and call out to him. Lack of response will be a signal for emergency action.

Of course, the first thing to do in first aid for drowning is to pull the drowning person out of the water. At the same time, it is important to know that a drowning person is incapable of conscious action, he is driven by the survival instinct, and therefore he will not be able to hear and follow even the most reasonable instructions, as well as determine the location of the life-saving equipment thrown to him. For the same reason, a drowning person grabs the one who is nearby, and, going to the bottom, pulls him along with him - there is no intent in these actions, they are reflexive. At the same time, it is important for the rescuer not to get confused, not to try to tear off tightly clinging fingers from himself, but to dive, and the victim’s hands will also reflexively open themselves. To avoid this, it is advisable to swim up to the drowning man from behind, turn him on his back and evacuate him to land in this form.

Further assistance with drowning depends on the phase in which the victim is removed from the water. If you can save a drowning person in the initial period of wet drowning, you must do the following:

• To remove water from the respiratory tract, for which the person is laid on his stomach, bending over his thigh, face down, and gently pat on the back or press on the upper abdomen, facilitating the outflow of fluid;
• Warm up by wrapping, rubbing, wrapping in a dry cloth, hot drinking, since even in hot weather a person who almost drowned has a strong chill;

• Call an ambulance and transfer the person to the hands of doctors. Remember that in this state a person does not adequately assess his condition, in addition, you need to make sure that the function of the lungs and heart is not impaired. You can fully talk about the past danger no earlier than a week later.

First aid for drowning in the agony phase consists of the following actions:

• Remove water from the respiratory tract, providing oxygen to the lungs. To do this, use the method described above;
• Lay down, raising your legs, in order to increase blood flow to the heart muscle;
• Perform artificial ventilation of the lungs by mouth-to-mouth breathing;
• If the pulse does not resume after the previous actions, perform a closed heart massage;

• Call an ambulance as soon as possible in order to carry out qualified resuscitation measures (cardiac stimulation, oxygen saturation of the lungs, etc.).

Assistance with drowning during the period of clinical death should be carried out according to the same scheme as in the previous (agonal) phase. Unfortunately, resuscitation during this period of drowning has rarely been successful. It is very important to provide qualified medical resuscitation in a timely manner.