This document discusses drowning cases and presents information on: 1. Classification of drowning cases into typical and atypical categories based on the presence or absence of fluid inhalation. 2. The pathophysiology and findings associated with different types of drowning including fresh water, salt water, dry drowning, and secondary drowning. 3. Important postmortem findings that can aid the diagnosis and medico-legal investigation of drowning cases, including the presence of froth, water in the lungs, diatoms in tissues, and cutis anserine skin changes.

1. DROWNING CASES…….
Presented by… RAKESH KUMAR
MISHRA , ,(M.Sc.1st year
SHIATS,ALLAHABAD)

2. Contents….
• Introduction
• Classification
• Vicious cycle of drowning
• Medico legal aspects….
• Postmortem findings…..
• Biochemical changes….
• Diatoms ….
• Cause of death….
• Diagnosis of drowning

3. Drowning:
 Is a form of asphyxia due to aspiration
of fluid into the air passage, due to
submersion in fluid or water.
 Complete submersion is not necessary,
that of mouth and nose alone for a
sufficient period can cause death from
drowning.
Introduction…..

6. Classification …
• Typical
• Atypical
Typical drowning
Obstruction of air passages and
lungs by inhalation of fluid and is
known as “Wet drowning”.
Typical signs are found at autopsy.

7. Atypical drowning….
Conditions in which there is very little or
no inhalation of water or fluid in the air
passages.
 Dry drowning.
 Immersion syndrome(vagal inhibition).
 Submersion of the unconscious.
 Secondary drowning syndrome/near-
drowning.

8. Typical drowning….
 Fresh water drowning.
 Salt water drowning.
Fresh water drowning
 Water cross the alveolar membrane into the
circulation.
 Produces marked hypervolemia.
 Red cells swell or burst-hemolysis-liberation
of potassium.
 Circulation will suffer 50% dilution within 2-3
min.

9.  The heart is submitted to the insult of
anoxia,hypervolaemia,potassium excess
and sodium deficit.
 Ventricular fibrillation due to anoxia
and potassium excess within 4-5 min.
Salt water drowning
 Marked hypertonicity of the inhaled
water cause loss of fluid from
circulation into the lungs-fulminating
pulmonary edema and progressive
hypovolemia.
 Circulatory shock and cardiac arrest.

10. Atypical drowning
Dry drowning
 Intense laryngeal spasm due to entry of
water into nasopharynx and larynx.
 Very little water enters into lungs.
 Best case for resuscitation.
Immersion syndrome
 Due to sudden impact with very cold
water and causes death from cardiac
arrest.
 Victims are young people with excess of
alcohol.

11.  It also result from falling or diving with
feet or duck diving by the inexperienced
swimmers.
 Loss of consciousness instantaneous and
death occurs in few minutes.
 Autopsy disclose non of the usual signs
of drowning.
Submersion of the unconscious
 Commonly seen if the victim is suffering
from disease like epilepsy,heart diseases
and is drunk or head injury during fall.

12. Ballooning of the lungs may be absent.
Formation of the foam my be negligible.
Complete picture of death by drowning is not
found.
Secondary drowning/near-drowning
Its mainly due to infection from inhalation of
contaminated water.
 Lung complications, oxygen lack, tired heart
muscle and cerebral edema.
 A victim look alert and breathing, may
respond to initial resuscitation.
 Late stage-respiratory distress, hypotension
and cardiac arrhythmia may cause death.

13. Deep
inspiration
Water enters
resp.passage
Cough
reflex
Air driven
out of lungs
Need for air
Vicious cycle of drowning

14. Medico legal aspects….
 Whether the death was due to drowning
or other cause?
 Length of time the body was in water.
Whether it was
accidental/suicidal/homicide?

15. Postmortem findings…..
External findings
 Fine froth at the nose and mouth. Its
whit or rarely blood stained, leather-
like, abundant and increases in amount
with compression of the chest.
 Rarely the presence of weeds, mud etc. in
the tightly clinched hand.

16. Cutis anserine(Goose skin)…
 Due to spasm of the erector pilae muscles and due
to exposure to cold water at the time of death.
 Rarely seen in India.
 Skin appears granular and puckered, with hair
standing on the end.
 Extremities are mainly affected.
 The skin of the finger, palms and later the soles of
the feet may be wrinkled, bleached and sodden.
 Due to osmotic action of water, on thickened
epidermis.
 This immersion changes known as Hands and
Feet of a Washer-Woman.

17. Internal findings….
Lungs & respiratory tract:-
 Airways filled with froth,sand,weeds etc found in the water.
Lungs are voluminous,edematous,doughy to feel with rib
markings.
 Paltauf’ hemorrhages seen.
 C/s:- Oozing out of blood stained frothy fluid and ballooning
of the lungs is known as “Emphysema Aquosum”.
 Wt upto 2 kgs.
 Watery fluid transudates into pleural cavities during
putrefaction.
 Hydrostatic lung:- 2meters depth-20min.
 Hemorrhages in the middle ear & mastoid air cells.
 Water in the stomach & intestine.

18. Biochemical changes….
“Getlers test”
 Chloride content in chambers of the heart
normally 600mg/100ml.
 Chloride decreases by 50% in fresh water &
increases of 40% in salt water.
 Test is of doubtful value in
-Septal defects
-Putrefaction
-Death due to vagal inhibition
-Chloride in water

19. Diatoms ….
 Microscopic unicellular algae present in water.
 Silicaceous cell wall which resists acid
digestion, heat and putrefaction.
 Size 10-80 microns.
 Only a live body with a circulation can
transport diatoms from lungs to the brain or
bone marrow.
Isolation- acid digestion of tissue commonly
bone marrow,lung,blood and kidney-
centrifugation and washing. Residue is examined
under phase contrast microscopy.

20. Cause of death….
 Asphyxia
 Ventricular fibrillation
 Laryngeal spasm.
 Vagal inhibition.
 Exhaustion.
 Injuries.
 Fatal period 4-8min.

21. Diagnosis of drowning….
 Froth
 Weeds & gravel/soil in hand.
 Voluminous lungs.
 Diatoms in tissues.