admin
New Delhi, February 27,2018:
Dr KK Aggarwal , Padma Shri awardee, President HCFI
1. Drowning is the third most common cause of accidental death
2. Risk factors for drowning include use of alcohol and illicit drugs, hypothermia, seizures, and developmental disorders.
3. Drowning ultimately produces tissue hypoxia, which affects virtually all tissues and organs within the body.
4. First aid: If the patient does not respond to the delivery of two rescue breaths that make the chest rise, the rescuer should immediately begin performing cardiopulmonary resuscitation (CPR).
5. The Heimlich maneuver or other postural drainage techniques to remove water from the lungs are of no proven value, and rescue breathing should not be delayed in order to perform these maneuvers.
Complete recovery of patients with hypothermia and cardiac arrest has been well documented despite prolonged resuscitation (sometimes up to several hours).
Characteristics of antemortem drowning
• Fine, white, leathery, copious froth or foam tinged with blood, seen at the mouth and nostrils (Froth is of lasting nature and large in quantity),
• Cadaveric spasm in hands
• Finding of diatoms by microscopic examination of tissues from brain, liver and bone marrow of long bones: such as femur, tibia, and humerus or sternum.
• Presence of water in stomach and intestines
• The voluminous water logged lungs
• The presence of fine froth in lungs and air passages
Causes of drowning in tub
1. The bathtub is the most common site of seizure-induced drowning, and patients with epilepsy should be told to take showers instead of baths.
2. Heart attack leading to syncope and subsequent falling in the tub. A gasping patient with ventricular arrhythmia will end up with drowning. In post-mortem the coronary arteries will show plaque and rupture of the plaque.
3. Undetected primary cardiac arrhythmia is a common cause of drowning. As an example, cold water immersion and exercise can cause fatal arrhythmias in patients with the congenital long QT syndrome type 1.
4. Mutations in the cardiac ryanodine receptor (RyR)-2 gene, which is associated with familial polymorphic VT in the absence of structural heart disease or QT prolongation, have been identified in some individuals with unexplained drowning.
5. Duration of submersion >5 minutes (most critical factor)
6. Use of alcohol and illicit drugs (more than 50 percent of adult drowning deaths are believed to be alcohol-related).
7. Hypothermia, which can lead to rapid exhaustion or cardiac arrhythmias.
8. Concomitant trauma, paralysis or heart attack
9. Sudden death in a hot bathtub occurs frequently in Japan, particularly among elderly people.
10. Am J Forensic Med Pathol. 2013 Jun;34(2):164-8: In total, 268 victims were found unconscious or dead during tub bathing. After postmortem examination, the manner of death was judged as natural cause in 191 (71.2%) and accidental drowning in 63 (23.5%) cases. Mean age (SD) was 72.1 (15.2) years with no significant difference between males and females. A seasonal difference was evident: the winter displayed the highest frequency. Drowning water inhalation, which was confirmed in 72% of victims, was absent in the others. The most common observations on postmortem examination were cardiac ischemic changes and cardiomegaly. Water inhalation signs were evident in a significantly fewer victims exhibiting these factors. In contrast, inhalational findings were observed more frequently in victims with other backgrounds such as alcohol intake, mobility disturbance, and history of epilepsy. Annual mortality in Japan from accidental drowning in persons aged older than 75 years is 33 deaths per 100,000 population. However, this number may be considerably underestimated as pathologists tend to regard lack of water inhalation as indicating a natural cause of death. Confusion in diagnosis remains consequent to the accidental and natural aspects of “dead in hot bathtub” phenomenon.
11. A series of 14 cases of suicide by drowning in the bath in the Bristol area, England between 1974 and 1996 is presented. There were six males and eight females with a mean age of 66 years. The majority were married and lived with their spouse or another relative. Most drowned at home, face down, fully clothed. Six cases had evidence of concomitant alcohol or substance use. Seven cases had a past psychiatric history and a history of previous deliberate self-harm. [Med Sci Law. 1999 Oct;39(4):349-53.]
12. Forensic Sci Int. 2015 Aug;253:64-70: A bathtub drowning is one of the leading causes of death in a bathtub. The purpose of this study was to evaluate how reliable the drowning-related signs could be for identifying a bathtub drowning in the cases of death in the bathtub. Performing a retrospective review of 92 deaths in the bathtub in Maryland, 71.7 percent were the presence of bathtub drowning and 28.3 percent were the absence of bathtub drowning. Three leading contributory causes of death were cardiovascular disease, drug/alcohol-related death, and seizure disorder in both groups. There was a statistically significant difference between the groups in relation to a history of recovery from the water (95.5% and 38.4%, p<0.001), foam in the air way (33.3% and 15.4%, p<0.05), watery fluid in the sphenoid sinuses (81.8% and 11.5%, p<0.05), hyperinflated lungs (36.4% and 3.8%, p<0.01), and watery fluid in the stomach contents (40.9% and 3.8%, p<0.01). More than triple overlapped drowning-related signs could be beneficial for the diagnosis of a bathtub drowning. A comprehensive investigation incorporating a thorough scene investigation, gathering of the victim’s medical and psychosocial history, and a meticulous full autopsy is necessary to elucidate both the cause and manner of death in these cases of death in the bathtub.
13. Arch Kriminol. 1991 Jul-Aug;188(1-2):35-46: A retrospective analysis concerning deaths in the bathtub was carried out in the Institute of Legal Medicine in Hamburg. The study includes 245 death cases between 1971 and 1988 (1% of all autopsies). 66 cases proved to be natural deaths, 76 were classified as suicides, 39 as accidents and 13 as homicides; 51 fatalities remained unclear with respect to one of these groups. Among the natural deaths sudden cardiac deaths were dominating (n = 39), among the suicides the intoxications (n = 37) and electrocutions (n = 20), and among the accidents the intoxications by carbon monoxide (n = 17) and electrocutions (n = 12). Out of 13 homicides only 2 were committed directly in the bathtub: One by drowning of a child and one by electric current via a hair dryer; in the other cases the dead body was put into the bathtub post mortem. About 50% of the victims were alcoholized. Signs of drowning were present in about 40% of all cases; the most frequent finding was emphysema aquosum.
14. Forensic Sci Int. 1995 Mar 31;72(2):147-55: Retrospective analysis of 215 deaths in the bathtub (Institute of Forensic Medicine, University of Cologne, 1980-1993) revealed 12 fatalities involving children, seven boys and five girls, aged from 9 months to 13 years. The manner and cause of death was seven accidents (five by drowning, two by scalding burns), two natural deaths (epilepsy, heart failure due to Hurler’s syndrome), one homicide (stabbing) and two undetermined cases (one probable seizure, one subdural hematoma associated with signs of maltreatment). Seven children < 4 years old died without exception from accidental drowning or scalding. Three toddlers had been left alone and unattended in the bathtub for a ‘short time’ (< or = 15 min) and two in the care of elder siblings. The immersion time and the amount of water required to cause lethal drowning are expressed in the terms of pathophysiology.
15. In conclusion, this study revealed that drowning may play a crucial role in the final process of bath-related sudden death. Although unexpected heart attack may be the most common underlying cause, the medical histories and pathological findings of cases of bath-related death vary. J Epidemiol. 2015; 25(2): 126–132.
HealthySoch
