Drowning is caused by fluid inhalation into the lungs during submersion. There are four types of drowning. Fresh water drowning causes fluid absorption into the lungs and blood dilution, while salt water drowning causes fluid movement into the lungs and blood concentration. Death can occur from asphyxia, cardiac issues, or secondary complications. Autopsies of drowning victims show fluid in the lungs and signs of asphyxia. Diatoms found in the bones or organs can also indicate drowning.
Drowning is caused by fluid inhalation into the lungs during submersion. There are four types of drowning. Fresh water drowning causes fluid absorption into the lungs and blood dilution, while salt water drowning causes fluid movement into the lungs and blood concentration. Death can occur from asphyxia, cardiac issues, or secondary complications. Autopsies of drowning victims show fluid in the lungs and signs of asphyxia. Diatoms found in the bones or organs can also indicate drowning.
Drowning is caused by fluid inhalation into the lungs during submersion. There are four types of drowning. Fresh water drowning causes fluid absorption into the lungs and blood dilution, while salt water drowning causes fluid movement into the lungs and blood concentration. Death can occur from asphyxia, cardiac issues, or secondary complications. Autopsies of drowning victims show fluid in the lungs and signs of asphyxia. Diatoms found in the bones or organs can also indicate drowning.
aspiration of fluid into respiratory passage, caused by submersion in water or other fluid. Types: Drowning is four types 1. Wet Drowning or primary Drowning 2. Dry Drowning 3. Secondary Drowning (post immersion syndrome or near Drowning ) 4. Immersion syndrome Pathophysiology of drowning Drowning in fresh water(.6%NaCl) water in the lung alveoli (with lower electrolyte concentration) absorbed by osmotic exchange into pulmonary capillaries in interalveolar septa haemodilution with coincident haemolysis (RBC’s are lysed) Sodium reduced potassium rises, K-Na ratio greatly increased ventricular fibrillation death from cerebral anoxia Drowning in Salt water(3%NaCl)water in pulmonary capillaries lying in interalveolar septa (with lower electrolyte concentration) absorbed by osmotic exchange into lung alveoli containing salt water (with higher electrolyte concentration) haemoconcentration(RBC’s crenated) and massive pulmonary oedema relative increase in electrolytes, plasma sodium rises and magnesium increase death from myocardial anoxia in 8-12 minutes. Causes of death 1. Asphyxia 2. Ventricular fibrillation 3. Laryngeal spasm 4. Vagal inhibition 5. Exhaustion 6. Injuries Fatal period: 1.instantaneous syncope from sudden cardiac arrest 2. Rapid Asphyxia 3. Delayed secondary cause 4-8 minutes in cases of complete submersion Post mortem findings These may be considered under following heading I Signs suggestive of drowning a. Presence of mud, sand and weeds in the firmly cleanced hands as well as under the finger nails. b. Presence of abrasion on the hand c. Wet clothing's, sand and mud on the body. d. A fine white tenacious lathery froth or foam is seen in the mouth and nostrils. This is the characteristic feature. II. General sign of asphyxia 1. The face may or may not be cyanotic 2. The conjunctiva are usually congested and a few sub-conjunctival eccymosis may be present 3. Pupils are dilated 4. The tongue is swollen and may be protruded. 5. Post mortem staining is usually found on the face. Upper part of chest, hands, arms feet and calves. 6. Petecheal haemorrages are rarely seen in the skin. 7. Rigor mortis appears early. III. Special sign of drowning A. Special external signs: 1. Cutis anserina or goose skin in which sin has granular and puckered appearance may be seen (surest sign of drowning). 2. The skin of hand and feet shows a bleched and sodden appearance. These is called washer woman’s hand. It is seen only when the body has remained in water for more than 10-12 hours. 3. Penis and scrotum are retracted and contracted particularly in winter. B. Specia internal signs: 1. lungs- affored in most cases the most evidence of drowning. i. Ballooning of the lungs voluminous, overlap the heart and bulge out of chest when the sternum is removed. ii. Heaviness, oedematous, tough to the feel and pit on pressure with finger. Lungs are often indented by the ribs. iii. Blood stained frothy fluid comes out from the cut surface of the lungs on section. iv. The alveolar walls may ruptured due to increase pressure during forced expiration v. Small intra-alveolar haemorrhage may be seen. b. Larynx ,Trachea and bronchial tube- 1. Usually contain fine lathery white froth. 2. May contain some foreign matter such as sand, mud, or fragment of aquatic plants. 3. Mucous membrane is usually red and congested. c. Stomach 1. Composition of water present in the stomach often gives idea of the water in which the victim drowned 2. Water is also not found in the stomach if the person died from syncope or shock and in putrefaction d. Middle ear-haemorrhage are found in middle ear in about half of the cases of drowning. e. Alteration of blood- 1. Water in the blood becomes usually fluid. 2. Chloride content of blood; higher Chloride content of blood occurs in salt water drowning. f. Findings of Diatoms Difference in lungs between fresh & salt water drowning Traits Fresh water Salt water drowning drowning Size weight Ballooned but light Ballooned and heavy; weight up to 2 kg Color Pale pink Purplish or bluish Consistency Emphysematous Soft & jelly-like Shape after Retained; do not Not retained; tend removal from collapse to flatten out the body Sectioning Crepitus is hard. No crepitus. Little froth & no Copious fluid & fluid froth. Diatoms They are microscopic unicellular or colonial alge. They have a complex structure of their cell walls which are usually strongly impregnated with silica and contain chromophyll and diatomin, a brown pigment. They resist heat and acid. There are 25000 species. They very considerably in size from 2 micron to 1 mm. Their shape may be circular, triangular, oval, rectangular etc. During drowning in the water, diatoms present in the water pass from wall of ruptured alveoli into the lymph channel and pulmonary veins and thereby taken to the left side of heart. From left side of heart by flow of circulation diatoms are taken to brain, bone marrow, skeletal muscle, liver and other organs. Thus diatoms can be detected from mentioned sites of the body in a case of antemortem drowning only. The bone marrow is highly suitable and reliable. a Diatoms may be demonstrated in human organs by 1. Direct digestion of the material with nitric acid & sulphuric acid. 2. Incineration in electric oven and then dissolving the ashes with nitric acid. 3. Direct microscopic examination of the lungs. Water is squeezed out and centrifuged and sediment examined 4. Microscopic examination of tissue section whereby optically empty sections are produced. Technique: The bone marrow is highly suitable and reliable. A piece of rectangular bone is removed with a sharp and clean knife and the bone marrow is curetted out from the gutter. Kidney, lungs, liver or brain is also washed and 1x1cm. Pieces cut from the deeper tissue. 5gms of bone marrow or tissue is put in a separate test tube and covered with 5 times the volume of conc. Nitric acid and left at room temperature for 1 to 2 days to allow digestion/they can be heated overnight in a water bath. The tube is centrifuged, the supernatant acid poured off and replaced with distilled water. This process is repeated 2 to 3 times to dilute the acid. The deposit is examined under phase-contrast or dark- illumination