Drowning is also called drowning. It means that a person is submerged in water, the water fills the respiratory tract and alveoli, which can also cause reflex spasm of the larynx and bronchi, closure of the vocal cords and blockage of the respiratory tract by sludge and weeds in the water, thus leading to ventilation and ventilation dysfunction of the lungs and asphyxiation. After drowning, the body’s respiration, circulation, blood, nerves, material metabolism and other serious disorders occur, if not rescued in time, will quickly endanger life. In recent years, the incidence of pediatric accidental death in various countries has increased significantly due to the strengthening of the control of infectious and nutritional diseases. In western industrialized countries such as the United States, drowning accidents rank second only to car accidents. In China, according to Jiang Jingxiong et al? reported that pediatric accidental injuries in the south are dominated by drowning, asphyxiation, and car accidents, and in the north less water, drowning is the second. Car accidents are the first in urban areas, and drowning is the first in rural areas. Drowning became the main cause of death and neurological damage factor in children. The pathophysiology of drowning is mainly asphyxia, cold-induced cardiopulmonary respiratory dysfunction or even cardiopulmonary respiratory arrest, resulting in imbalance of the body’s internal environment, such as hypoxia, ischemia, acidosis, so that the body’s important organs, such as the heart, lungs and brain, are damaged to varying degrees. The duration and degree of hypoxia directly affects the success rate of cardiopulmonary resuscitation and the effect of cerebral resuscitation. The brain cells mainly carry out a series of brain function activities through the aerobic metabolism of sugar, and the oxygen and sugar reserves are very small, and the oxygen consumption at rest accounts for 20% of the whole body. Loss of consciousness can occur in 10 s of complete cerebral hypoxia, glucose depletion in the brain in 4 min, and the anaerobic metabolism of sugar stops; ATP depletion in the brain in 5 min; irreversible pathological changes of brain neurons occur in 4-6 rains of hypoxia, and the survival rate is almost zero in 12 min. The modern concept of first aid includes a series of medical rescue processes from early detection to pre-hospital emergency, in-hospital treatment and rehabilitation medical treatment. The key to drowning rescue is to interrupt the damage of hypoxia in time, establish an effective oxygenated blood supply, correct the disturbance of the internal environment, block further damage to the cells of important organs of the body, and create conditions for the recovery of damaged cells. After drowning asphyxia, the most vulnerable cells are brain cells. The success of brain resuscitation has become the main indicator to assess the effect of CPR. First aid precautions: 1. On-site first aid for drowning is the key, do not just wait for the arrival of medical personnel, or just transfer the patient to the hospital, thus losing the great opportunity for resuscitation. 2, on-site first aid is particularly important, to the emergency room should also be actively resuscitated, do not easily give up CPR. 3, general drowning after the water in the lungs has been absorbed, not much remains, so do not pour water for too long, so as not to delay the resuscitation time. 4, do not give up easily because of a short period of ineffective resuscitation. In addition, the adoption of standardized cardiopulmonary resuscitation methods is also an important condition to ensure the success of resuscitation, cardiopulmonary resuscitation will consume considerable physical effort, and should seek the strong assistance of other bystanders. 5, the resuscitation process will be a variety of arrhythmias, and even ventricular fibrillation, heart failure, do not arbitrarily ask the termination, pressure active symptomatic treatment. 6, for swimming in shallow water or diving improperly (head down) the drowned should pay attention to the presence of cervical spine damage. 7, all drowning people should check the arterial blood gas, especially those who have no abnormal chest X-ray and physiological examination, the interval of 4-6h two blood gas are normal before going home. 8, pay attention to the “second drowning”, that is, 24-48h after the emergence of cerebral edema, pneumonia, hemolytic anemia, acute renal failure or DIC, etc.. Special instructions to patients going home, the corresponding discomfort should be immediately after the follow-up. Drowning resuscitation concept update 1, can remove the check pulse procedure For many years, pulse check has been the gold standard for assessing whether the heart is beating, but studies have shown that: its overall accuracy rate is only 65% and error rate 35%. In view of this, the 2010 International CPR Guidelines stipulate that for non-emergency professionals, checking the carotid pulsation is no longer required as a diagnostic step before performing CPR, and that it is not necessary to determine the need for chest compressions based on the results of the pulse check; instead, the evaluation of circulatory signs should be completed within 1O seconds based on the patient’s presence or absence of breathing, coughing and response to stimulation, and if it is not certain that circulation is present, then immediate Start chest compressions. Removing the pulse check procedure is particularly appropriate for drowning. When the patient is drowning, especially when combined with hypothermia pulse is difficult to find, such as the emphasis on checking the pulse, is bound to delay the time, so that the drowning is not timely treatment in the most effective time, the loss of cardiopulmonary resuscitation time, so that as soon as the drowning is removed from the water, that is, chest compressions and other cardiopulmonary resuscitation first aid should be performed as soon as possible. 2, do not have to remove water from the airway most drowning people have only a small amount of misabsorption, and water is quickly absorbed into the circulation, some patients drowning because of laryngeal spasm or breath-holding did not misabsorb any water, so the removal of water from the airway by any method other than suction is unnecessary and dangerous. For example, abdominal compressions lead to regurgitation of gastric contents and secondary aspiration, which can bring about other injury complications. People commonly used traditional back pat pouring method, also can not completely remove water, but also make water deeper, and therefore delay the early ventilation and respiratory rescue and chest compressions and other cardiopulmonary resuscitation measures, unfavorable to the rescue of drowning patients. For drowning patients to remove the water in the airway, first responders should not be used as a routine, otherwise, the loss of this. The consequences are endless. 3, moving when careful to prevent spinal cord injury drowning patients spinal cord injury may have a special relationship with diving, related recreational facilities and underwater obstacles, so when there are no witnesses, the drowning should be treated as suspected spinal cord injury, the first response teaching staff should be hand-fixed patient’s neck in a neutral position, so that the patient floats supine on the horizontal back support device before lifting the water surface. When the patient must be turned after rescue from the water, the head, neck, chest and torso should be kept in a straight line along the long axis and carefully rolled to a horizontal supine position. All drowning patients should be considered as potential spinal cord injury to rescue – fixed cervical and thoracic spine to ensure prevention of spinal cord injury, otherwise the patient is saved but may be paraplegic due to improper resuscitation methods. 4, resuscitation time frame should be extended clinically, usually the patient cardiopulmonary resuscitation immediately after cardiac arrest 2O-3O minutes, no recovery of autonomic circulation, assessment of brain function has irreversible loss, that is, the termination of cardiopulmonary resuscitation. In comparison, the duration of CPR for drowning patients should be greater than 3O minutes is appropriate. Studies have shown that drowning victims have the possibility of full recovery after prolonged submersion in water, analyzed because the “dive” reflex plays an important role, which slows down the heart rate and constricts the small peripheral arteries, driving blood from the intestines and extremities to the brain and heart, with this protective mechanism, even for drowning victims with known circulatory arrest beyond the time limit for resuscitation. and by performing extra-long cardiopulmonary resuscitation, may still survive. Therefore, no obvious medical evidence of death (such as decomposition, necropsy, rigor mortis), rescuers should start early resuscitation at the scene, and appropriately extend the time limit for termination of CPR. 5, the child rescued from the ice water, such as the need for brain resuscitation, may not need to rush insulation.