DROWNING DEATH

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1. DROWNING CASES……. Presented by… RAKESH KUMAR MISHRA , , (M.Sc.1 st year SHIATS,ALLAHABAD )

2. 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 . Introduction…..

3. Classification … Typical Atypical Typical drowning Obstruction of air passages and lungs by inhalation of fluid and is known as “Wet drowning”. Typical signs are found at autopsy.

4. Atypical drowning…. Conditions in which there is very little or no inhalation of water or fluid in the air passages. Dry drowning. Immersion syndrome(vagal inhibition). Submersion of the unconscious. Secondary drowning syndrome/near-drowning.

5. Typical drowning…. Fresh water drowning. Salt water drowning . Fresh water drowning Water cross the alveolar membrane into the circulation. Produces marked hypervolemia. Red cells swell or burst-hemolysis-liberation of potassium. Circulation will suffer 50% dilution within 2-3 min .

6. The heart is submitted to the insult of anoxia,hypervolaemia,potassium excess and sodium deficit. Ventricular fibrillation due to anoxia and potassium excess within 4-5 min . Salt water drowning Marked hypertonicity of the inhaled water cause loss of fluid from circulation into the lungs-fulminating pulmonary edema and progressive hypovolemia. Circulatory shock and cardiac arrest .

7. Atypical drowning Dry drowning Intense laryngeal spasm due to entry of water into nasopharynx and larynx. Very little water enters into lungs. Best case for resuscitation. Immersion syndrome Due to sudden impact with very cold water and causes death from cardiac arrest. Victims are young people with excess of alcohol.

8. It also result from falling or diving with feet or duck diving by the inexperienced swimmers. Loss of consciousness instantaneous and death occurs in few minutes. Autopsy disclose non of the usual signs of drowning. Submersion of the unconscious Commonly seen if the victim is suffering from disease like epilepsy,heart diseases and is drunk or head injury during fall.

9. Ballooning of the lungs may be absent. Formation of the foam my be negligible. Complete picture of death by drowning is not found . Secondary drowning/near-drowning Its mainly due to infection from inhalation of contaminated water. Lung complications, oxygen lack, tired heart muscle and cerebral edema . A victim look alert and breathing, may respond to initial resuscitation. Late stage-respiratory distress, hypotension and cardiac arrhythmia may cause death.

10. Vicious cycle of drowning

11. Medico legal aspects…. Whether the death was due to drowning or other cause? Length of time the body was in water. Whether it was accidental/suicidal/homicide?

12. Postmortem findings….. External findings Fine froth at the nose and mouth. Its whit or rarely blood stained, leather- like, abundant and increases in amount with compression of the chest. Rarely the presence of weeds, mud etc. in the tightly clinched hand.

13. Cutis anserine(Goose skin )… Due to spasm of the erector pilae muscles and due to exposure to cold water at the time of death. Rarely seen in India. Skin appears granular and puckered, with hair standing on the end. Extremities are mainly affected. The skin of the finger, palms and later the soles of the feet may be wrinkled, bleached and sodden. Due to osmotic action of water, on thickened epidermis. This immersion changes known as Hands and Feet of a Washer-Woman.

14. Internal findings…. Lungs & respiratory tract:- Airways filled with froth,sand,weeds etc found in the water. Lungs are voluminous,edematous,doughy to feel with rib markings. Paltauf’ hemorrhages seen. C/s:- Oozing out of blood stained frothy fluid and ballooning of the lungs is known as “Emphysema Aquosum”. Wt upto 2 kgs . Watery fluid transudates into pleural cavities during putrefaction. Hydrostatic lung:- 2meters depth-20min. Hemorrhages in the middle ear & mastoid air cells. Water in the stomach & intestine.

15. Biochemical changes…. “ Getlers test” Chloride content in chambers of the heart normally 600mg/100ml. Chloride decreases by 50% in fresh water & increases of 40% in salt water. Test is of doubtful value in -Septal defects -Putrefaction -Death due to vagal inhibition -Chloride in water

16. Diatoms …. Microscopic unicellular algae present in water. Silicaceous cell wall which resists acid digestion, heat and putrefaction. Size 10-80 microns. Only a live body with a circulation can transport diatoms from lungs to the brain or bone marrow. Isolation- acid digestion of tissue commonly bone marrow,lung,blood and kidney-centrifugation and washing. Residue is examined under phase contrast microscopy .

17. Cause of death…. Asphyxia Ventricular fibrillation Laryngeal spasm. Vagal inhibition. Exhaustion. Injuries. Fatal period 4-8min.

18. Diagnosis of drowning…. Froth Weeds & gravel/soil in hand. Voluminous lungs. Diatoms in tissues .