DROWNING

Dr K.B.Suryakumar
Prof & HOD
Dept of Forensic Medicine
KVG Medical College
SULLIA_- KARNATAKA
Drowning
 -Death caused by suffocation when
liquid interrupts body's absorption of
oxygen from air leading to asphyxia .

 ..The primary cause of death is

hypoxia and acidosis leading to
cardiac arrest
Near drowning
 -survival of a drowning
-unconsciousness /water inhalation
--can lead to serious complications,
including death, after the event.

 Secondary drowning --death due

to chemical / biological changes in
the lungs after a near drowning
incident
 Types
 Most drowning occur in water,
 90% in freshwater (rivers, lakes
and pools)
 10% in sea water ,
 drowning in other fluids are rare
and often industrial accidents.
 Types
 Dry drowning- type1
 Wet –type2
 Shallow water [alco. ,epileptics ,infants,
unconcious
 Immersion syndrome –vagal
 Secondary –near drowning –infection
,edema ,acidosis
 Believe it or not
 People have drowned in as little as 30
ml of water lying face down, in one
case in a wheel rut.
 Children have drowned in baths,
buckets and toilets;
 inebriates or those under the
influence of drugs have died in
puddles
The pathophysiology of
drowning
 The body's reaction to submersion
 Submerging the face in water colder than
about 21 °C (70 °F) triggers the
mammalian diving reflex found in all
mammals and especially in marine
mammals such as whales and seals
 This reflex protects the body by putting it
into energy saving mode to maximize the
time it can stay under water.
 The strength of this reflex is greater in
colder water and has three principal effects
 symptoms
 Bradycardia --,- slowing of the heart rate
of up to 50% in humans.
 Peripheral vasoconstriction , -to extremities
to increase the blood and oxygen supply to
the vital organs, especially the brain
 Blood Shift, the shifting of blood to the
thoracic cavity to avoid the collapse of the
lungs under higher pressure during deeper
dives.
The reaction to oxygen deprivation

 try to access air, resulting in panic

--rapid body movement.
 uses up more oxygen in blood stream
-reduces time to unconsciousness –
 victim can voluntarily hold breath for
some time, but breathing reflex will
increase until victim will try to
breathe, even when submerged.
The breathing reflex
 related to amount of oxygen in blood, to the
amount of carbon di oxide.
 During apnea, the oxygen in the body is
used by the cells, excreted as carbon dioxide.
 Thus, the level of oxygen in the blood
decreases, level of carbon dioxide increases.
 Leading to stronger breathing reflex, up to
the breath-hold breakpoint, when victim no
longer voluntarily hold breath. typically
occurs at arterial partial pressure of carbon
dioxide of 55 mm Hg,
 Reaction to water inhalation

 If water enters airways of conscious victim

--will try to cough up water or swallow ,thus
inhaling more water involuntarily.
 Upon water entering airways, both conscious
and unconscious victims experience
laryngospasm, prevents water from entering
lungs ..
 So, water enters stomach in initial phase of
drowning and very little water enters lungs.
Reaction to water inhalation
 Laryngospasm relaxes some time
after unconsciousness and water can
enter the lungs causing a "wet
drowning".
 However, about 10-15% of victims
maintain this seal until cardiac arrest,
this is called “ dry drowning " as no
water enters the lungs.
 autopsy
 In forensic medicine water in the
lungs indicates that the victim was
still alive at the point of submersion;
 the absence of water in the lungs
may be either a dry drowning or
indicates a death before submersion.
 P.M findings
 External-fresh- cloths wet ,sand ,mud on
body
 Cutis anserina [goose skin ]-erector pilae
contraction
 Washer woman hand –sodden, wrinkle
 Cadaver spasm
 Fine lathery froth –churning of air in alveoli
 Congested conjunctiva
 P M staining –variable
 Aquatic animal bite marks
 Ante mortem injuries
Internal
 Mud in mouth ,esophagus
 Fine froth in larynx ,trachea .bronchus ,
 Lung—voluminous ,edematous ,balloon
like ,rib indentation ,pit on pressure---- c/
s-frothy fluid
 Paltauf’s hemorrhage— violent resp.
effort>rupture alveoli>blood+air
[emphysematous aquosum ]
 Dry drowning
 Stomach –water, mud ,sand
Lab findings
 Diatoms –most dependable findings –in
remote organs –brain ,bone marrow
 Gettler’s test —chloride in all chambers of
heart is equal---in fresh water –
haemodilution in Rt early >50%
 Salt water drowning-heamoconcentration in
left>increase to 30-40 %
 R B C –decreased in fresh water-dilution
 Salt water – increased magnesium
 Unconsciousness

 A continued lack of oxygen to brain,

(hypoxia ,) renders a victim unconscious
at blood partial pressure of oxygen of
25-30mmHg.
 An unconscious victim rescued with an
airway still sealed from laryngospasm
stands a good chance of a full recovery.
 Artificial respiration

 --more effective without water in the

lungs.
 victim stands good chance of
recovery if attended to within
minutes.
 In most victims the laryngospasm
relaxes some time after
unconsciousness and water fills the
lungs resulting in a wet drowning.
Cardiac arrest and death

 The brain cannot survive long without oxygen

and continued lack of oxygen in the blood
combined with cardiac arrest will lead to
deterioration of brain cells
 This causes brain damage and eventually
brain death from which recovery is generally
considered impossible.
 lack of oxygen

 chemical changes in the lungs -cause

heart to stop beating;
 cardiac arrest stops the flow of blood and
stops the transport of oxygen to the brain.
Cardiac arrest used to be the traditional
point of death but at this point there is still
a chance of recovery.
 The brain will die after approximately six
minutes without oxygen but special
conditions may prolong this
 Exchange

 . Freshwater contains less salt than blood

and will therefore be absorbed into the
blood stream by osmosis
 .Sea water is much saltier than blood.
Through osmosis water will leave the blood
stream and enter the lungs thickening the
blood...
 After death rigor mortis will set in and
remains for about two days, depending on
many factors including water temperature
 Secondary drowning

 Water,, will damage the inside surface of the

lung, collapse the alveoli and cause
pulmonary edema-
 -reduced ability to exchange air.
 This may cause death up to 72 hours after a
near drowning incident. called secondary
drowning.
 Freshwater can be more dangerous than
saltwater in secondary drowning.
 Hemolysis

 When fresh water enters the lungs it is

pulled into the pulmonary circulation via
the alveoli because of the low capillary
hydrostatic pressure and high colloid
osmotic pressure.
 Consequently, the plasma is diluted and the
hypotonic environment causes red blood
cells to burst (hemolysis).
 The resulting elevation of plasma K+ level
and depression of Na+ level, due to the
hemolysis, alter the electrical activity of
the heart.
 Ventricular fibrillation

 Ventricular fibrillation often occurs as a

result of electrolyte changes.
 Additionally, if drowning occurs in very
cold water ( <10* C), the uptake of cold
water into the vascular system can stop the
heart.
 In open heart surgery, the technique of
pouring cold saline solution over the heart
is used to prevent heart action.
 If the victim is resuscitated death can occur
hours later due to renal failure.
 Hemolysis

 During hemolysis, hemoglobin is also

released into the plasma which can
accumulate in the kidneys leading to acute
renal failure.
 In contrast, salt-water drowning does not
lead to uptake of inspired water into the
vascular system because it is isotonic to
blood. Therefore, no red cell hemolysis
occurs.