Drowning

Drowning is a form of asphyxia due to

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