Drowning

Contents

- Examples of reasons for death in body recovered from water- Definition of drowning- Types of drowning- Epidemiology- Pathophysiology - Causes of death- Signs of drowning (P.M picture)- Time passed since drowning death- Was drowning accidental , suicidal or homicidal- Role of Alcohol in drowning - Drowning resuscitation

Examples of reasons for death in a body recovered from water

- Died of natural causes before entering / while in water (e.g. M.I)

- Hypothermia particularly in thin , old and young people

- Injuries & unnatural causes before entering water (e.g. assault) or after being in water (e.g. hit by boat )

- True drowning (due to aspiration of water into lungs)

Definition

Process of experiencing respiratory impairment due to submersion or immersion in a liquid .

Three possible outcomes : No injury , Injury or Death .

Types of drowning

1-Wet drowning

Water inhaled into lungs & Sever chest pain & if resuscitated : no pleasant recollections

2-Dry drowning

Water not enter lungs & death occurs by immediate sustained laryngeal spasm & if resuscitated : panoramic views of past life

3-Secondary drowning (near drowning)

Death occurs ( from 1/2 h to several days) by cerebral anoxia & irreversible brain damage

4- Immersion Syndrome

Death occurs by cardiac arrest caused by vagal inhibition (cold water stimulating nerve endings & water striking epigastrium & Alcohol induce such effect)

Epidemiology

- Third leading cause of unintentional injury death worldwide

- In 2012 , 372.000 people died from drowning making drowning major public health problem

- Low & Middle income countries account for 91% of drowning deaths

- China & India account for 43% of drowning deaths

- Africa has the highest drowning mortality rate

- Males have higher drowning mortality rates than females for all ages and regions

- Children under 5 years have highest rate globally

PathophysiologySubmersion: airway drops below surface of water

Struggle: victim attempts to resurface

Breath hold: voluntary attempt to protect airway

Gasp: involuntary attempt to inhale oxygen

Reflexive swallowing of water

Respiratory failure: due to airway obstruction & alveolar damage

Hypoxia: lack of oxygen & reduced systemic oxygen

Causes of death

Asphyxia: due to airway obstruction

Ventricular fibrillation: due to anoxia & disturbed sodium-potassium ratio

Laryngeal spasm

Vagal inhibition: in icy water due to high emotion & unexpected immersion

Exhaustion

Signs of drowning (P.M picture)

1-

Washer-woman hands:

Hands are wrinkled and bleached due to loss of skin tone (after submersion in water for 12-18 hours)

2-The epidermis of hand and feet get separated in form of gloves and stocking after 2 weeks

3-External foam (froth) ,fine white and odorless, reflecting mixture of air,water and mucus due to forcible respiration during drowning.

:4- Cadaveric spasmInvolving the hand (firmly grasping weeds or sands) indicating the victims was alive when immersed

:5- Emphysema aquosum and heavy lungsHyper-expanded and water-logged lungs . Ribs imprints may be present on the surface of lungs6- Sub-pleural heamorrhages (Paultauf spots) :In 5-60% of drownings reflecting intra-alveolar heamorrhages

7-Diatoms:Microscopic organisms present in sea and fresh water, and have siliceous capsule that survives acid digestion . Its presence in organs (kidneys and brain) and bone marrow taken to imply that victim found in water drowned in water where diatoms found in his body match those found in the water

8-Miscellaneous signs:

Middle ear congestion / heamorrhage

Bloody/Watery fluid in intracranial sinuses

Engorgement of solid organs

Reduced weight of spleen

Muscular heamorrhage / rupture in neck and back ( physical signs of drowning)

Was the drowning accidental , suicide or homicidal ?

Frequency: accidental drowning the most common , Suicide common and homicidal rare and difficult to prove.

Accident: evidences e.g. wearing bathing costume & history of epilepsy

Suicide: no struggle signs & suicidal note (may) & history of psychological illness or financial trouble

Homicide: commonly the victim killed first then thrown into water & signs of resistance or struggle

Time passed since drowning

Estimated through :

- Rate of body cooling

- Floating of body (occurs

after 5-8 days in summer)

- Volume of pleural fluid

accumulated

Role of alcohol in drowning

- Alcohol frequently found in blood of adult drowning victims . The strongest association between the two is “fall related” cases .. Concussive head injuries exacerbated by alcohol

- Alcohol also hasten hypothermia (due to V.D)

- If person heavily intoxicated by alcohol, ability to respond well to save himself hampered by confusion & in-coordination.

Drowning resuscitation

Thanks