1. Self-help
(1) Keep a cool head and avoid panic.
(2) in the water can take the self-help method ① first of all do not be afraid of sinking into the water, when people fall into the water or drowning, will be on their own sinking into the water to produce a great fear, and therefore will instinctively through a variety of struggle measures (such as hands up or random paddling, etc.) to try to make their own floating, not realize that this can only be counterproductive. ② At this time the most important thing is to hold your breath, relax the whole body, remove the weight of the body, and at the same time to open your eyes and observe the surrounding situation. If the body sinks into the water, let it sink, because the water has buoyancy, and buoyancy and water depth, the deeper the liquid pressure, the greater the buoyancy, so sink to a certain extent, in most cases, there is no weight of the body will stop sinking and naturally float up. ③ Once the body to stop sinking and floating, the water should immediately take the following actions: arms palm down, from both sides of the body like a bird flying downward paddling. Pay attention to the rhythm of paddling, paddling downward to be fast, lift the upper arm to be slow; at the same time, feet like climbing stairs as hard as alternating downward stirrups, or knees back to the bend, with the back of the foot repeatedly and alternately kicking the water downward, which will accelerate their own upward floating. When the body floating should calmly take the head backward, facing upward posture, and strive for the first mouth and nose exposed to the surface of the water, once exposed, immediately breathe, while calling out for help. ④ Exhale shallow, inhale deep, as far as possible to keep their bodies floating in the water, in order to wait for others to rescue. Treading water can also be practiced to avoid sinking. ⑤ People who can't swim or tread water should not try to prevent themselves from sinking again, let alone lifting their hands up or struggling desperately, which not only consumes energy, but also makes it easier for them to sink. If you sink again, do it again as before, and so on. (6) The whole body must be relaxed, this is very important, so as to save more energy, adhere to a longer period of time. ⑦ If the water depth in the 2 ~ 3 meters of the swimming pool or in the bottom of the hard water or riverbed drowning, due to the bottom of the hard, the person who fell into the water can be in the bottom of the foot stirrups to accelerate upward, surfacing immediately call for help, again do not be afraid of sinking again. So repeatedly, insist on the arrival of rescue personnel. ⑧ with the method of treading water to prevent sinking.
(3) cramp self-help method
Swimming and underwater work suddenly occurring muscle spasmodic contraction commonly known as cramps, this situation does not seem to be very rare, the clinical manifestations of a sudden spasm of a muscle, the local muscle hardness and severe pain. Cramps can be caused by cold water, fatigue, over-breathing (respiratory alkalosis), the use of certain medications, and the lack of certain substances in the body (e.g., calcium deficiency). The more common site of cramps is the calf belly (gastrocnemius muscle spasm), and other areas such as fingers, toes, thighs, and upper arms also occur from time to time.
Sudden cramps will bring sudden pain to the patient, and can seriously affect the action of swimming, treading water, and may cause panic and choking, and even lead to the occurrence of drowning, so need to take timely countermeasures. Self-help methods and points of attention after the occurrence of cramps are as follows: ① First of all, be calm, do not panic. You should immediately call for help and tell your companions, and at the same time transfer to the shore. Cramp is a spasmodic contraction of the muscles, so massage, stretch, stretch, relax the muscles, it is possible to relieve it. ② finger cramps can massage the affected area, at the same time, the hand will make a fist, and then force open, quickly repeated several times, until the cramp stops. ③ toe cramp first deep breath and then hold your breath, do not care about the body sinking, grab the cramped toes, use your hands to stretch the toes in the opposite direction of the cramp, it can be relieved, ④ calf belly cramp first deep breath and then hold your breath, use the cramped limb on the opposite side of the hand to grip the cramped limb's toes and pull hard to the direction of the body, and at the same time, use the same side of the palm of the hand pressure on the cramped limb's knee, to help straighten out the cramped leg. Thigh cramps can be handled in the same way by stretching the cramped muscle, and then quickly paddling up to the surface to breathe. ⑤ Abdominal cramps The stomach should be drummed repeatedly, while massaging the area vigorously with the hands. ⑥repeated cramps after an episode of relief, the same part of the cramp may be again, so the same method should be used again, at the same time, the pain should be fully massaged and slowly to the shore to swim to the shore, it is best to massage and hot compresses on the affected area, can also be given to the hot drink to be taken.
(4)Self-help method of choking Choking refers to the inadvertent inhalation of water into the trachea when inhaling. When choking occurs, you should remain calm and should always know whether your mouth and nose are above the level to avoid inhaling water again when choking. At this time should restrain the coughing feeling, first in the water closed breath lying still for a moment, and then lift the head out of the water, while coughing to adjust the breathing action, to be excluded from the water in the trachea after breathing will return to normal.
(5) by the water plants and other underwater debris entangled in the self-help method by the water plants or underwater debris entangled in the most important thing is to calm down, should be a deep inhalation of breath after holding the breath into the water, and open your eyes to observe the entangled place, and at the same time, with the help of both hands to slowly untangle, don't struggle, or the more you struggle to get tightly entangled. At this time also pay special attention to the whole body relaxation, relaxation after the body oxygen demand is reduced, can extend the underwater tolerance time.
(6) encounter whirlpool self-help method whirlpool is usually faster flow of water encountered obstacles produced, usually located in the downstream of the obstacle. Small whirlpool will not lead to injury, while the whirlpool is very dangerous, the danger of the whirlpool is that first of all, it can pull the water into the bottom of the water, if people can not surface in time will cause a serious lack of oxygen, and secondly, the whirlpool can be through the huge rotational energy of the people hit the nearby obstacles, resulting in serious trauma, and even cause loss of consciousness, all of these can be fatal. In particular, once a person enters the vortex, it is very difficult to get out of it.
The way to deal with the whirlpool is: try to stay away from obstacles, because the whirlpool is mostly caused by obstacles, so approaching obstacles (such as dams, rivers suddenly narrowed, etc.) should be very careful. If you are already close to the whirlpool, you should immediately flatten your body and float on the surface of the water, along the edge of the whirlpool, and use the crawling swimming method to get rid of the whirlpool quickly. Since the edges of the whirlpool are less attractive and less likely to involve larger objects, the body must lie flat on the surface of the water, do not stand upright and tread water or dive into the water. If you have accidentally entered the whirlpool and are dragged underwater, you should immediately hold your breath, then try to curl up your body and put your hands on your head to avoid hitting your vital parts on the obstacles as much as possible. When the spin is lifted immediately open your eyes underwater and look around you, and quickly paddle to float yourself up.
(7) how to prevent drowning in the car ① calm and cool take the brunt: only calm, to be awake, only awake, to think of implementing the correct self-help methods. Do not panic, panic will be disoriented, disoriented can only miss the opportunity to bring serious consequences. ② quickly seek outside help in the first time to call the rescue phone, such as 120, 110, 119, etc., to tell their own location, so that they get help as soon as possible. The sooner you make the call, the better, especially when a large accident or natural disaster occurs, there will be a large number of calls in a short period of time, which will cause the collapse of the call system, so it is imperative to call for help quickly. ③ How to avoid being trapped inside the vehicle The reason why the door cannot be opened after falling into the water is roughly twofold: firstly, the automatic door lock will lock the door, and the vehicle into the water so that the circuit is short-circuited and cannot open the door. In this regard, when the vehicle falls into the water do not rely too much on the performance of the vehicle automation, it is best to choose manual operation, open the door locks and windows in advance, so as to avoid cocooning. The second door can not be opened is due to the pressure difference between inside and outside the vehicle. And this pressure difference is not static. As the vehicle has just fallen into the water, the car inside and outside the atmospheric pressure is almost equal, so the pressure difference is very small, the door is very easy to open, and the vehicle has just been all into the water, due to the car for the relative vacuum, so the pressure difference at this time is the largest, it is speculated that the door to bear the pressure of hundreds of kilograms, it is of course unable to open the door. With the vehicle gradually into the water, the degree of vacuum inside the car is getting lighter and lighter, inside and outside the car pressure difference will be smaller and smaller, when the vehicle is about to be filled with water, inside and outside the car pressure difference is almost the same. Therefore, the trapped person should utilize the physical characteristics of the pressure difference to escape. It is better to open the door to escape when the vehicle is just under water, so as not to miss the precious opportunity. ④ How to escape from the trapped car If the car door has been unable to open, indicating that the pressure difference between inside and outside the car is very large, at this time do not force the door, which not only does not help, but also consume physical strength. There are two ways to try: one is to try to break the glass to escape, do not use ineffective methods, such as hitting the window glass with your head. Should look for heavy objects in the car, such as toolbox hammers, jacks, etc. to be utilized to smash the windows to escape. Smash the glass to choose a larger window corners, the place is relatively weak. Do not smash the middle part of the window, then smash the kinetic energy will quickly spread around and be absorbed, resulting in localized can not form enough destructive force, so can not break the glass. In addition to repeatedly smash a place, repeatedly smash can be smashed, do not knock here and there to knock, so the effect is poor, but also a waste of energy and time. If you can not smash the window glass, you should raise the head, easy to get air, while relaxing the body, calm breathing, save energy, calmly waiting until the vehicle into the water almost up to the roof and then open the door to escape. Escape first take a deep breath, and then hold your breath, open your eyes to escape, do not close your eyes, so as not to be able to see the surrounding objects (such as broken glass, etc.) and injuries.
2. Mutual Rescue
(1) Emphasize the self-protection awareness of the rescuer All rescuers must be clear: the rescuer's own safety must come first. Only the first to protect themselves, it is possible to successfully save people. Otherwise, not only can not save people, there may be their own lives buried. Its attention to the following points: ① as far as possible to call more people to participate in the rescue of more people, at the same time can be mutual care, improve the safety of the rescue, so found that someone drowning should be as much as possible to call people to participate in the rescue. Unless absolutely necessary, should try to avoid single person rescue, especially should avoid single person alone into the water rescue, so as to avoid the occurrence of untoward when no one to help. ② do not go into the water blindly because of the different water conditions, there may be a lot of unknown factors underwater, so even if the swimmer or even swimmer should not go into the water blindly. Don't think that people who are good swimmers won't drown, so don't go into the water blindly to save people, you should use the shore rescue method as much as possible, and go into the water to save people as a last resort. ③ prohibit those who can not swim into the water to save many people know they can not swim but do not think blindly into the water to save people, do not know that this is not only can not save people, but will increase the loss, and even pay the price of life, a similar stupidity has been many times to take away the precious lives of many people. There are many ways to rescue people on the shore, for those who can't swim, they should call for help or use other methods to rescue people on the shore, and they are not allowed to go into the water blindly to save people. No matter whether children can swim or not, they are mentally and physically incapable of rescuing a drowning person, so children must be prohibited from going into the water to save a person. We must publicize this point so that all children are aware of the great dangers involved in rescuing a drowning person and must not risk their lives. ⑤ Rescue should be terminated in time if unexpected circumstances occur during rescue If the rescuer feels serious discomfort when rescuing, such as feeling extremely tired, low water temperature, choking, dizziness, chest wall suffocation, breathing difficulties, stiff limbs, etc., at this time, should immediately and decisively give up rescue, and hasten to implement the self-preservation and call for help, do not continue to reluctantly rescue people.
(2) call professional rescuers professional rescuers skills and equipment is not available to the general public, so the drowning should be called as soon as possible professional first aid personnel (medical personnel, professional lifeguards involved in the water, etc.), so that they arrive at the scene as soon as possible to participate in the first aid as well as after the shore of the medical assistance. In the following cases, it is necessary to call for professional help: ① In complicated or dangerous water conditions, such as fast flowing rivers, dangerous creatures underwater, severely cold water, drowning at night, and when there are any reasons that make it difficult for general rescue to be successful, it is necessary to call for professional rescuers with special equipment (e.g., lifeboats, scuba diving equipment, etc.). ② The drowning person is not rescued in time, and those who have been in the water for more than 5 minutes need to call professional medical emergency personnel. ③ The drowning person is a sick person, a senior citizen or a child, and these people often need medical support after being rescued. Theoretically, drowning has many subsequent comorbidities, so whenever drowning in the true sense of the word occurs, the patient needs to go to the hospital for further treatment.
(3) adequate preparation and use of rescue items Rescue items include rescue ropes, lifebuoys, life jackets and other floating objects (such as car inner tubes, wooden boards, Styrofoam, etc.), lighting equipment, rescue boats, medical equipment, etc., good rescue equipment can make the rescue work twice as much as twice as much as the work is done, you should learn to take materials from the ground, find and use these items, the effect is much better than the rescue of the bare hands. Much better. Particularly unskilled swimmers or unfamiliar with the water rescuers, it is best to carry lifebuoys, boards, ropes or boats and other self-protection tools, which not only improves the efficiency of the rescue, but also protects the rescuer's safety.
(4) before the rescue and the drowning person fully communicate with the drowning person to get the drowning person with the rescue is not only difficult to succeed, but also can increase the danger of the rescuer, so the rescuer should be the first fully with the drowning person to communicate, this is very important. The way of communication can be through the loud call, can also be carried out through the gesture, the main communication content are: tell the drowning rescue has been in progress, encourage the drowning to overcome fear, be calm, do not panic, give up the ineffective struggle, but also to tell the drowning of the method of self-help in the water, such as paddling downward, tread water method, remove the body of the weight of the body, etc., and at the same time especially have to tell the drowning of the drowning of the rescuer to listen to the command, calm down and cooperate with the rescuer, and also tell the rescuer to follow the command of the rescuer. Rescuer's command, calm down to cooperate with the rescue, this can achieve twice the result with half the effort.
(5) rescue methods and precautions Each rescue method has its own characteristics and application, the use of the correct rescue method is very important, the principle is to prioritize the use of non-contact with the water way, while trying to avoid a single person into the water rescue. The rescuer directly reaches out to the drowning person to pull the drowning person out of the water rescue method. Applicable to the rescuer and the drowning of the distance between the drowning of the hand at the same time the drowning of the drowning of the situation is still awake. There is a great risk when using this method of rescue, the rescuer is not careful, it is easy to be pulled into the water by the drowning person. Therefore, the rescuer should be as far as possible to use a wooden stick, rope (such as pants) and other things for the drowning person to grasp, as far as possible to avoid their own hands and the drowning person's hands in direct contact, and therefore in the last resort before reaching out directly to avoid accidents. Its operating methods and points of attention are: the rescuer first stand sideways on the more stable plane solid objects, and confirm that they stand firm before rescue, especially to avoid facing the drowning person, at the same time to prevent the slippery phenomenon may occur under the feet, so as not to be dragged into the water by the person who fell into the water. When firmly grasping the water after the rescuer to slowly back to drag, do not move violently, so as not to cause injury. Lift and pull the water when the rescuer must try to lower their position, the center of gravity backward and downward, preferably lying on the ground or can use the other hand to grab a solid object (such as solid stones, branches, etc.), to confirm that they are standing firm before reaching out to let them hold, and then pull them out. If the distance is a little too far to reach, use your feet to drag the drowning person out, which will increase the distance. Once you are sure that the drowning person has a firm grip on the rescuer's feet, drag him or her back to shore. Note: If the rescuer's center of gravity is too high or too far forward when dragging, the drowning person may be pulled into the water. In addition, only the rescuer's lifting and pulling is difficult to rescue the person who has fallen into the water, at this time, the person who has fallen into the water should be encouraged to calmly cooperate, so as to achieve better results. If the place where the rescuer is standing is unstable or slippery (e.g. slope, sandy ground, etc.), the rescuer should first take measures to fix himself, such as using his feet or other objects to form a small pit on the ground in order to increase the resistance, or fixing himself to a solid object (e.g., fixing himself to a big tree or a solid rock with a rope, etc.), and then reach out to rescue the rescuer. If there are several people involved in the rescue, you can hold hands and rescue people in a vertical line, so that you can avoid being dragged into the water by the person who fell into the water. Note: If it is in the wind and waves in the river or in the rapids, you can not use the method, because of the limited grip, encountered in the rapids or the impact of large waves often can not hold other people's hands, resulting in more people in the water. ② Rescue by objects The method is or with the help of certain objects (such as sticks, etc.) to pull the water out of the water method, applicable to the rescuer from the drowning distance is relatively close (within a few meters) while the drowning people are still conscious of the situation. The operation method and points of attention are: the rescuer should try to stand away from the water at the same time and be able to the drowning person's place, will extend the distance of the rescue object such as tree branches, sticks, bamboo poles and other things sent to the front of the drowning person, and asked to hold on to it. At this time, we should pay attention to avoid hard objects to the drowning person to cause injury, should be from the side of the drowning person lateral movement to the drowning person, not directly to the drowning person in front of the chest, in order to prevent it from stabbing. After confirming that the drowning person has firmly held the extension, the rescuer can pull the drowning person. The posture is the same as the reach rescue method, first take a side position, stand firm, lower the center of gravity, and at the same time ask the drowning person to cooperate and pull it out. If the rescuer suddenly loses his center of gravity during the pulling process, he should immediately release his hand to avoid being pulled into the water by the drowning person. Although the rescuer lost the extension, but to avoid falling into the water, to protect their own safety. At this time, we should find a way to rescue. ③ Throwing rescue points to the water throw rope and floating objects (such as lifebuoys, life jackets, life buoys, wooden boards, logs, car inner tubes, etc.) rescue methods, applicable to the water and rescuers are far away from the rescuer and can not get close to the water, at the same time drowning is still in the wakeful state of the situation. Its operating methods and points of attention are: throw the rope before the front of the rope to tie a heavy object, such as the front of the rope can be knotted or will be wet clothes folded into a ball bundled in the front of the rope, so as to facilitate the throwing. In addition, must be called loudly beforehand with the water fallers to communicate, so that they know and be able to catch the throwing objects. Throwing objects should be thrown to the front of the person who fell into the water, such as the river drowning, there should be a certain amount of advance, so as not to hit the person who fell into the water or fell behind the drowning person, so that you have to re-throw, a waste of time. All of the throwing objects are best to have a rope connected with the rescuer, which is conducive to the water as soon as possible to save the person. At this time, the rescuer should also pay attention to lower the body position, the center of gravity backward, stand firmly, so as not to be pulled into the water by the drowning person. ④ Boating rescue refers to the use of lifeboat support rowing to the side of the rescuer, the law applies to the drowning of the wide waters and have a boat, and it is best to have a professionally trained rescuer to participate in the rescue. It is important to note that the rescue boat must be of a certain size, such as a small sampan or a small rubber boat and other very small boats, the rescuer must be professionally trained, otherwise it is easy to cause a capsize when dragging a person who has fallen into the water, resulting in a bigger accident. If the rescue boat is too small and the water temperature is not low, you can ask the person who fell into the water do not have to get into the boat, grab the boat, and then the rescuer rowing back to shore. ⑤ Swimming rescue, also known as water rescue, this is the most dangerous, last resort rescue method, only in the above four rescue methods are not feasible, can be used this method. The operation method and points of attention are as follows: it is best for people who are familiar with and understand the water conditions (such as flow rate, water temperature, etc.) to go into the water, in addition, the rescuer should also assess his own physical strength and physical condition, if he is not able to do so, he should find another way, and should not force himself to go into the water to rescue others, otherwise it will cause double misfortune. It is best to have two or three people in the water at the same time, so that they can help each other in the water, but also to reduce the risk of rescue. The rescuer must have skillful swimming technique, and should take off clothes, pants, shoes and socks as much as possible. It is better to carry floating objects such as life jacket, life ring, thick wooden stick, etc., and give them to the drowning person to use, which can increase the safety of the rescue, and also make the rescue less difficult. The rescuer approaches the drowning person from the back as much as possible, inserts one hand from the armpit of the drowning person to hold his/her hand on the opposite side, or can hold his/her head, and drags him/her to the shore by backstroke. If the drowning person has sunk to the bottom of the water, the rescuer should dive into the water to approach, and then drag the drowning person out of the water by the back of the armpit. The key to dragging the drowning person back is to try to keep his head and face out of the water so that he can get oxygen as soon as possible. In order to survive, the drowning person will struggle desperately, see the nearby people and things, will come from the instinct to grab and hold, in order to achieve the purpose of making their own floating breathing, and once grabbed any person or thing will never let go. Therefore, the rescuer must prevent being grabbed by the drowning person. When approaching the drowning person, the blocking defense method can be used. That is, when the drowning person wants to grab and hold, the rescuer turns his body sideways, touches the drowning person's chest with one hand, and pushes him away. If the shore is close, the drowning person's wrist can be grabbed and brought back to the shore by sidestroke. Adequate conditions for follow-up support should be created at the scene, such as additional manpower, searching for life preservers, ropes, small boats and professional rescuers. It is often the case that when someone goes into the water to rescue a drowning person, a group of people on the shore are watching instead of looking for rescue supplies. As a result, when the rescuer is involved in an accident, he or she is unable to get help, and the rescuer is ultimately killed in full view of the crowd. In other cases, when the drowning person is rescued from the water to the shore only to find that there is no medical personnel, then call for help, a waste of valuable time. These situations should be avoided and professional help should be sought by calling emergency services as soon as possible.
3. Rescue after disembarkation
(1) Rapid examination of the patient If life support in the water is not available, it is imperative that the drowning victim be examined quickly after being rescued from the water to confirm the patient's condition, and then appropriate first aid measures should be taken according to the different circumstances. Therefore, do not take any resuscitation measures before identifying the patient's condition, so as not to carry out useless resuscitation or wrong resuscitation. The main checks are: ① Consciousness check By observing and calling loudly and tapping the patient's shoulder to confirm the loss of consciousness, such as the patient's lack of response can be recognized that the patient has suffered a loss of consciousness, then should be carried out as soon as possible on the spot mouth-to-mouth artificial respiration twice. In order to buy time, the patient's breathing and heartbeat should be checked after blowing oxygen to the patient. ② Breathing heartbeat check with a sweeping method to observe the patient's chest and abdomen with or without undulation, or with the method of seeing, hearing, feeling check, such as the chest does not rise and fall, it should be concluded that the patient has lost breathing, then you should immediately check the patient with or without a heartbeat. The respiratory and heartbeat examination of the drowning victim is different from the respiratory and heartbeat examination of the ordinary situation, because sometimes the drowning victim only loses breathing within a certain period of time, but there is a heartbeat, which is different from the ordinary situation that can indirectly indicate the cardiac arrest through the respiratory cessation. Therefore, if the drowning victim stops breathing in time, further heartbeat examination is still needed. If the carotid artery is not pulsating, it should be recognized that the patient has suffered cardiac arrest, and CPR should be started immediately. ③Trauma examination Patients who have lost their footing in the water, encountered whirlpools, jumped into the water (which can cause craniocerebral and spinal injuries if the head hits the ground first), and drowned in complicated water or water with a lot of debris often have traumatic injuries, and therefore need to be examined for traumatic injuries. The patient is placed in a lying position and is examined from the top down for injuries in the water through questioning, observation, and localized pressure and palpation.
(2) Rescue of conscious patients Warming measures: except for the hot summer, warming measures should be taken in other seasons when rescuing drowning patients. Remove the patient's wet clothes, dry the body surface of water, change to dry clothes, in order to reduce the body surface water evaporation to take away the heat. When possible, the body can be wrapped in blankets and other things to keep warm, but also can be fully massaged limbs, promote blood circulation, and can be given hot drinks as appropriate. Never give the patient alcohol, which will promote heat loss.
Further examination of the patient: ask the patient about the cause of drowning, the cause of falling into the water after the situation, as well as what is the feeling of discomfort, choking, drinking water, etc.. At the same time, observe the patient's lips and face color, measure blood pressure and heart rate, and check for trauma.
Send the patient to the hospital: drowning can lead to many physiological disorders, and there are many subsequent secondary problems, especially lung tissue damage, etc., so most of the patients need to get medical assistance as soon as possible, but many people do not realize the importance of this point. Therefore, the public should be sensitized to the fact that all patients who have suffered from drowning should go to the hospital for further treatment, regardless of their current condition. Especially for the elderly, young children and patients who have choked, drank a large amount of water, were injured during drowning, and have abnormal symptoms and signs (such as vomiting, pallor, abnormal blood pressure, abnormal pulse, etc.) should be sent to the hospital for further treatment in a timely manner.
(3) on-site first aid for patients with loss of consciousness but breathing and heartbeat The situation where the patient is in a state of persistent loss of consciousness with breathing and heartbeat is called coma. The common cause of drowning patient coma is hypoxia, rare cause of craniocerebral injury in the process of drowning (such as the drowning head hit, etc.). In addition to warmth, the main measure to be taken at this time is oxygenation, preferably using a ventilator to provide high-flow oxygen through a mask. For patients with weak respiration and cyanosis, respiratory support should be provided, such as mouth-to-mouth artificial respiration without ventilator and mask. For patients with normal respiration, the airway should be kept open, and the patient should be placed in the stable lateral position, which is the position that should be adopted by comatose patients, so as to prevent the occurrence of respiratory obstruction caused by vomit. Since vomiting is the most common symptom of drowning, it is important to stabilize the patient in the lateral position. The patient should also be examined in detail to exclude craniocerebral injuries, and measures to protect the spine should be taken for those who cannot be excluded. Then call an ambulance or quickly send the patient to the hospital, and closely observe the condition on the way.
(4) the heartbeat without respiratory patients on-site first aid drowning patients after a period of time occurs after severe hypoxia, first caused by the loss of cerebral cortical function, the patient occurs coma, such as failing to get oxygen, will occur respiratory arrest, if the lack of oxygen is not corrected, will occur cardiac arrest. Therefore, a heartbeat without breathing is a stage of severe drowning, and this stage indicates that the patient is on the verge of death. Generally speaking, drowning 3 to 4 minutes after being retrieved patients often need artificial respiration, drowning 5 minutes after being retrieved more have occurred cardiac arrest, need to immediately implement cardiopulmonary resuscitation.
The most important thing to do at this time is to immediately implement artificial support for the patient, the best method is endotracheal intubation, if you can successfully intubate in a timely manner and the use of air bag artificial respiration, can play an immediate effect. Other methods include mouth-to-mouth (or mouth-nose) artificial respiration, squeeze chest artificial respiration, swinging arm artificial respiration and so on. Among them, mouth-to-mouth artificial respiration has the best effect. Note: If the mouth-to-mouth artificial respiration resistance is very large, it is difficult to blow air into the patient's body when the respiratory tract is not clear, then we should take measures to clear the airway, such as removing the mouth of sediment and weeds, so that the patient to use cardiopulmonary resuscitation position, and then implement the blowing.
(5) On-site first aid for patients without a heartbeat - cardiopulmonary resuscitation.
(6) The controversy of whether or not to control water for the patient before performing CPR Water control, also known as drainage, is a measure to remove water from the patient's body before performing CPR. Is it necessary to control water before resuscitation? Until now this question has been controversial in the medical community. Traditional textbooks, some popular science materials, and the media have long promoted water control as the first measure in resuscitating a drowning patient, but this practice is increasingly being questioned in the current medical community. As the 2010 International Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care point out: there is no evidence that water in the airway is the same as any other obstruction, so don't waste time trying to clear it. So is water control needed or not? (1) How do you control the water? Make the patient's head low and buttocks high: quickly pick up the patient's waist, make his back up and head down, pour out the water in the lungs, trachea and stomach as soon as possible; you can also put his abdomen on the resuscitator's bent-knee thighs to make the head down, and then press his back with the flat of his hand to make the water in the trachea and oropharynx pour out; you can also use a small wooden stool, a big stone, an inverted iron pot, etc. as a cushion to raise the height of the objects. During this period, the rescue action must be agile, do not control the water for too long and affect other rescue measures. To be able to pour out of the mouth, throat and trachea for the degree of accumulation of water, such as the discharge of water is not much, should immediately take artificial respiration, chest compressions and other emergency measures. ②Reasons for not controlling water before CPR No water to control: For dry drowning, the patient does not inhale water due to vocal atresia, so there is no water to control. For wet drowning, from the morbidity point of view, the vast majority of drowning patients belong to hypotonic drowning (freshwater drowning), this part of the patient even through the respiratory tract inhalation of a large amount of water, these water has already entered the blood circulation, coupled with the respiratory volume of the airway according to calculations, the respiratory tract, if full of water, at best, 150 ml, and this point of water is not worth controlling. As noted in the 2005 International Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, the amount of water that enters the respiratory tract of a drowning person is usually not very large, and small amounts of water are quickly absorbed, so for drowning people who have been removed from the aquatic environment, the respiratory tract water is not a serious obstacle to respiratory tract In clinical practice, we usually control out of the water is the water in the stomach, which does not need to be discharged. Water control harms: many literature reports that water control tends to cause reflux and aspiration of gastric contents, which can instead block the airway and can also lead to lung infections. The implementation of water control measures will inevitably delay the time of cardiopulmonary resuscitation, which in turn will deprive the patient of the optimal resuscitation time.
In summary, many physicians believe that water control is not necessary when resuscitating a drowning patient. There is no need to try to apply various maneuvers (including dumping water from the airway through the body position, rapid abdominal compression, or the Heimlich maneuver) to remove water from the airway. However, the medical community has not yet reached a **** understanding of which viewpoint is more valid, and there is a lack of data from large-scale clinical trials to support it. The authors of this article believe that seawater drowning still needs to be controlled first, because the presence of a large amount of seawater in the patient's respiratory system is not only not conducive to resuscitation, but also can cause lung tissue damage, which should be discharged, while freshwater drowning does not need to be controlled, and cardiopulmonary resuscitation should be initiated in a race against time.
4. IN-HOSPITAL TREATMENT
The management after admission to the hospital includes further life support. All near-drowning individuals should be admitted to a custodial unit for 24 to 48 hours of observation to prevent the development of acute respiratory distress syndrome.
(1) General treatment ① Oxygen supply Inhaled high concentration oxygen or hyperbaric oxygen therapy. Conditions can use artificial respirator. ② rewarming and insulation If the patient's body temperature is too low, according to the situation can be used in vitro or in vivo rewarming measures. The drowning patient is prone to cardiac arrhythmia, so cardiac monitoring is indispensable. Hypoxia can cause damage to the brain, so brain protection measures are very important. Those with elevated intracranial pressure should be hyperventilated appropriately to maintain PaCO2 at 25-30mmHg, and at the same time, intravenous infusion of mannitol should be given to reduce intracranial pressure and alleviate cerebral edema. ⑤ Easy digestible diet It is better to give high nutritional semi-liquid food.
(2) the treatment of hypotonic drowning ① diuretic drainage can be 3% hypertonic saline drip, while the application of diuretics such as tachycardia injection. ② alkalinization of urine The purpose is to reduce the damage of hemolysis, to protect the kidneys, available 5% sodium bicarbonate injection IV. ③ Reduce blood potassium For patients with high blood potassium should be taken immediately to reduce blood potassium measures, such as the application of calcium, alkaline drugs, glucose and insulin.
(3) Treatment of hypertonic drowning.
(4) Treatment of post-cardiac arrest syndrome.