drowning

Dr Frank Kakuba. MD, Mmed Path(Mak)

• Drowning is defined as death from asphyxia within 24
hours of submersion in water.

• Drowning occurs when a person submerged in water

attempts to breathe and instead aspirates water, leading
to decreased oxygenation, hypoxemia, and hypoxic
brain injury and death .

• Drowning is the frequent cause of death in bodies that

are recovered from water.
• When a body is discovered in water, one must question why the
person was in the water initially and why the person was unable to
get out of the water.

• Inability to swim, hazardous environment, trauma, seizure disorder,

heart disease, exhaustion, alcohol and drug use, hypothermia, and
other causes should be sought to answer the question of why
this person drowned.
Signs of drowning

• The effects of water on the skin

Maceration or softening of the skin begins within
minutes after immersion in water .
• If a body is removed from water (lake, ocean, bathtub),
examination of the skin for blunt injuries should be
delayed until the body is dry.
• Abrasions are not easily seen until drying occurs.
• When the body is allowed to dry, the abrasion becomes brown and is
easily seen.
• Water and the aerodigestive systems
One of the signs of drowning is the appearance of foam
issuing from the nose and mouth.
This foam is a mixture of proteinaceous liquid derived from the lungs and air
whipped up by terminal respiratory movement.
The lungs from a drowned person are often hyperinflated and meet at the
midline, partially obscuring the
pericardial cavity when the thorax is first opened at
autopsy .
The lungs fill the pleural cavities, and impressions created by the ribs may be
seen on the pleural surfaces of the lungs.

This pulmonary hyperinflation resembles that seen in obstructive lung disease

and is called emphysema aquosum .

Although water is inhaled into the lungs, it may also

enter the respiratory sinuses including the ethmoid and
sphenoid sinuses.
Water, as well as silt, sand, and aquatic vegetation, may also be
swallowed during drowning and fill the stomach.

 Middle ear and mastoid air cell hemorrhage has been

used as a sign of drowning.
Near drowning

• Drowning is death within 24 hours of immersion in water.

• Near drowning is survival beyond 24 hours after
the patient is removed from the aqueous environment.
• Near drowning patients may survive or die later.
• Central nervous system (CNS) injury is the major determinant of
subsequent survival and long-term morbidity in near
drowning.
• Near-drowning patients frequently develop pneumonia, either
infectious or chemical.
Other artifacts of water immersion

• Animal scavenging
• Injuries – always try to determine if the injury is antemortem or
postmortem.