I. The Great Physician Without a Book In a small village on the Loess Plateau in Shaanxi, drowning occurred when a child fell into the water of a yellow mud pit while playing. What were the key points in the management of this patient? Regarding the treatment of drowning, clinicians know that: 1. The main pathophysiology of freshwater drowning is that a large amount of freshwater (hypotonic), enters the body and causes a state of hypotonicity in the body; hypotonicity is the main problem, and it can be corrected by administering diuretics or hypertonic fluids and other measures. 2.The main pathophysiology of seawater drowning is that a large amount of seawater (hypertonic), enters the body, resulting in a hypertonic state of the body; hypertonicity is the main problem, and can be corrected by giving measures such as rehydration and dilution or hypertonic fluids. 3. So, what is the main pathophysiology of a drowning person who falls into a pit of yellow mud? Answer: The main pathophysiology of drowning victims in yellow mud pits is metabolic acidosis, which should be actively supplemented with sodium bicarbonate. Thus, the loess of China is acidic, and yellow mud slurry is a weak acid, which enters the body, and the metabolic acidosis of the patient will be very prominent. Of course, if the patient is drowning in an area with a karstic topography, a limestone structure that is alkaline, the patient’s metabolic alkalosis will be prominent. These elements will not be written in textbooks, but are the result of reasoning and sublimation by physicians based on specific information in the clinic, combined with basic knowledge of chemistry and so on. “The great physician has no books”, which is a kind of realm and a lifelong pursuit for medical practitioners. It is also in line with the philosophical principle of “collective analysis of specific problems” in material dialectics. Second, the understanding of drowning According to some regional statistics, drowning mortality rate of 10% of the total number of accidental deaths. Drowning is due to a large amount of water into the lungs, or cold water stimulation caused by laryngeal spasm, resulting in asphyxiation or oxygen deprivation, if the rescue is not timely, within 4-6 minutes can die. 1, the controversy of water in the lungs traditionally believed that drowning is composed of the following processes: first of all into the water, and then the sense of breathlessness, followed by swallowing water, swallowing water after the stomach is stimulated and vomited, and then inhaled into the lungs, resulting in asphyxiation and death. The most critical part is the water in the stomach and lungs, so from the 18th century onwards, people have included the pouring method as the first choice, that is to say, first of all, they have to find a way to pour out the water in the stomach or lungs. Since 1980, this treatment is controversial, removing the water in the stomach can easily cause suffocation or aspiration. And some scholars found that about 10% to 20% of drowning patients do not have water into the lungs, and even if there is inhalation, it is a very small amount (less than 20 ml per kilogram of body weight). Such a small amount of water can be quickly absorbed by the capillaries into the circulation, Ruben’s experiments confirmed that the injection of 1% saline 1-2L from the tracheal tube did not overflow. For patients with seawater drowning, because seawater is hypertonic (3.5% salt), the circulating water can be inhaled into the lungs, resulting in pulmonary edema, but the ventilation obstacle in this case is not in the airway, but due to alveolar edema, so the key to resuscitation is mouth-to-mouth and positive pressure ventilation. Therefore, most scholars believe that only when chest compressions and mouth-to-mouth respiration are basically ineffective, only then will they consider that it may be caused by excessive water in the lungs. 2, prolong the rescue time drowning in a long period of time after submerged in water still have the possibility of complete resuscitation, sometimes its submergence time than usually considered cardiac arrest patients brain survival time limit of 4 ~ 6 minutes longer than Sim recently collected a group of eight cases of drowning, had been submerged for 10 ~ 40 minutes, and after resuscitation and no neurological sequelae. The mechanisms are: (1) the role of diving reflex after drowning long-term survival may be diving reflex at work, that is, humans and some birds and mammals have a common physiological response, which can be a long time to stay underwater without breathing. Submerging a person’s face in cold water immediately triggers a reflex that slows the heart rate, constricts the small peripheral arteries, and drives blood from the intestines and limbs to the brain and heart, thus allowing people to survive for a longer period of time while submerged in cold water. (2) late cardiac arrest Cardiac arrest usually does not occur immediately due to submergence; generally only in the blood oxygen levels reduced to dangerous levels before the heart stops, which under normal circumstances take several minutes or longer. (3) Decreased body oxygen consumption The diving reflex and cold both reduce the body’s oxygen consumption. Therefore, the drowning victim should be actively resuscitated, clear history of drowning, distinguish between freshwater or seawater drowning; the drowning victim whose respiration has ceased, artificial respiration should be carried out immediately; and appropriately prolong the resuscitation time.