Many sides of Drowning concerning pathological and forensic sides .

1. Drowning

2. Contents
- Examples of reasons for death in body recovered from water
- Definition of drowning
- Types of drowning
- Epidemiology
- Pathophysiology
- Causes of death
- Signs of drowning (P.M picture)
- Time passed since drowning death
- Was drowning accidental , suicidal or homicidal
- Role of Alcohol in drowning
- Drowning resuscitation

3. Examples of reasons for death in a
body recovered from water
- Died of natural causes before entering / while in water
(e.g. M.I)
- Hypothermia particularly in thin , old and young
people
- Injuries & unnatural causes before entering water (e.g.
assault) or after being in water (e.g. hit by boat )
- True drowning (due to aspiration of water into lungs)

4. Definition
Process of experiencing respiratory impairment
due to submersion or immersion in a liquid .
Three possible outcomes : No injury , Injury or
Death .

5. Types of drowning
1-Wet drowning
Water inhaled into lungs & Sever chest pain & if
resuscitated : no pleasant recollections
2-Dry drowning
Water not enter lungs & death occurs by
immediate sustained laryngeal spasm & if
resuscitated : panoramic views of past life

6. 3-Secondary drowning (near drowning)
Death occurs ( from 1/2 h to several days) by
cerebral anoxia & irreversible brain damage
4- Immersion Syndrome
Death occurs by cardiac arrest caused by vagal
inhibition (cold water stimulating nerve
endings & water striking epigastrium &
Alcohol induce such effect)

7. Epidemiology
- Third leading cause of unintentional injury death
worldwide
- In 2012 , 372.000 people died from drowning making
drowning major public health problem
- Low & Middle income countries account for 91% of
drowning deaths
- China & India account for 43% of drowning deaths

8. - Africa has the
highest drowning
mortality rate
- Males have higher
drowning mortality
rates than females
for all ages and
regions
- Children under 5
years have highest
rate globally

9. Pathophysiology
Submersion: airway drops below surface of water
Struggle: victim attempts to resurface
Breath hold: voluntary attempt to protect airway
Gasp: involuntary attempt to inhale oxygen
Reflexive swallowing of water
Respiratory failure: due to airway obstruction & alveolar damage
Hypoxia: lack of oxygen & reduced systemic oxygen

11. Causes of death
Asphyxia: due to airway obstruction
Ventricular fibrillation: due to anoxia &
disturbed sodium-potassium ratio
Laryngeal spasm
Vagal inhibition: in icy water due to high
emotion & unexpected immersion
Exhaustion

12. Signs of drowning
(P.M picture)
1-
Washer-woman
hands:
Hands are wrinkled
and bleached due to
loss of skin tone
(after submersion in
water for 12-18
hours)

13. 2-
The epidermis of hand and feet get separated
in form of gloves and stocking after 2 weeks

14. 3-
External foam (froth) ,fine white and odorless,
reflecting mixture of air,water and mucus due to
forcible respiration during drowning.

15. :4- Cadaveric spasm
Involving the hand (firmly grasping weeds or sands)
indicating the victims was alive when immersed

16. :5- Emphysema aquosum and heavy lungs
Hyper-expanded and water-logged lungs . Ribs imprints may be
present on the surface of lungs
6- Sub-pleural heamorrhages (Paultauf spots) :
In 5-60% of drownings reflecting intra-alveolar heamorrhages

17. 7-Diatoms:
Microscopic organisms present in sea and fresh water, and have
siliceous capsule that survives acid digestion . Its presence in
organs (kidneys and brain) and bone marrow taken to imply
that victim found in water drowned in water where diatoms
found in his body match those found in the water

18. 8-Miscellaneous signs:
Middle ear congestion / heamorrhage
Bloody/Watery fluid in intracranial sinuses
Engorgement of solid organs
Reduced weight of spleen
Muscular heamorrhage / rupture in neck and back (
physical signs of drowning)

19. Was the drowning accidental , suicide or
homicidal ?
Frequency: accidental drowning the most common ,
Suicide common and homicidal rare and difficult to
prove.
Accident: evidences e.g. wearing bathing costume &
history of epilepsy
Suicide: no struggle signs & suicidal note (may) & history
of psychological illness or financial trouble
Homicide: commonly the victim killed first then thrown
into water & signs of resistance or struggle

20. Time passed since drowning
Estimated through :
- Rate of body cooling
- Floating of body (occurs
after 5-8 days in summer)
- Volume of pleural fluid
accumulated

21. Role of alcohol in drowning

22. - Alcohol frequently found in blood of adult
drowning victims . The strongest association
between the two is “fall related” cases ..
Concussive head injuries exacerbated by
alcohol
- Alcohol also hasten hypothermia (due to V.D)
- If person heavily intoxicated by alcohol, ability
to respond well to save himself hampered by
confusion & in-coordination.

23. Drowning resuscitation

24. Thanks