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The pathophysiology and treatment of drowning and near-drowning
REvIRws
173
character and duration of the dying process and the duration of clinical death, but also on the treatment of the disturbed functions at a later period. A patient or animal brought round from clinical death has specific metabolic disturbances and characteristic changes in the function of the central nervous system and the viscera. The monograph offers a detailed description of this post-resuscitation period with data on the oxidative processes, the acid-base balance, the disturbances in haemodynamics, changes in the clotting and fibrinolytic activity of the blood, functional disturbances of respiration, and hepatic and renal insufficiency. All this warrants his description of the ‘post-resuscitation disease’, which can be treated specifically. The therapy of a number of pathological states such as cardiac arrhythmias, atonic uterine haemorrhage, cerebral trauma, poisoning etc. during the postresuscitation period is discussed. A special chapter looks at the mechanism of sudden death. The monograph devotes much attention to the concept of ‘cerebral death’, which plays an important role in resuscitation. In this connection, the recovery of the electrocardiogram, the neurological state, the pattern of respiration and the detoxifying function of the liver, all determine the prognosis. The extensive clinical material is well documented. Detailed analysis of specific disturbances in the different systems should help in the future to eliminate haemodynamic disorders, hypoxic hypoxia and afibrinogenic haemorrhage. The monograph emphasizes the importance of general prophylactic measures in preventing terminal states, and the necessity of treating simultaneously the specific pathology leading to death. A chapter deals with the organization of specialized Intensive Care Units in large hospitals, and their work in close contact with specialized first-aid teams and mobile resuscitation units. Negovsky’s book is of high standard, and well printed and illustrated. It will undoubtedly be of interest to research workers and clinicians in the field of reanimatology. MARIAS. GAEVSKAYA THE
PATHOPHYSIOLOGY
AND
TREATMENT
OF DROWNING
AND
NEAR-DROWNING
Jerome H. Modell. pp. xv+ I 15, with 17 figures. Charles C. Thomas, Springfield, Illinois, 1971. Professor Model1 of the University of Florida College of Medicine has written a short book summarizing g years of his experience, and the literature on this subject. It is important, because-as he points out-every year about 5500 people in the United States, I 100 in the U.K. and 500 each in Australia and Norway, lose their lives by drowning, and many more nearly do so. He has synthesized knowledge from experiments on dogs, sheep, rabbits and rats, with that derived from clinical examination of patients. Chapters deal with blood gases, pulmonary changes, blood volume and electrolytes, cardiovascular changes, neurological effects, renal effects, autopsy findings, tests for drowning, first aid and hospital therapy. Although chapters vary from only two pages to thirteen pages in length, each has its own stmunary. One might have assumed intuitively that hypoxaemia is the real physiological problem of drowning. There is a good analysis of effects on the lungs, with discussion
174
REVIEWS
of the role of aspirated water on the surfactant properties, the intrapulmonary shunt, atelectasis and more delayed effects, which help to clarify one’s thinking on this aspect. The clinical distinction, known for a long time, between fresh-water and sea-water drowning is illustrated by citation of pathological and biochemical findings. The autopsies of drowned patients show a remarkable pathological variability with the brain and the lungs being the chief sufferers. The aim of treatment is well summarized: ‘to restore normal arterial blood and acid-base levels by effective ventilation, circulation, oxygenation, and by the judicious use of buffers’. These are the main conclusions I derived from a useful summary in a short monograph about a relatively under-explored field. Perhaps in the nature of the syndrome, there is not much new experimentation, or revolutionary treatment, that could have been presented. One may hope that this book will stimulate investigators to turn their attention to a fascinating exercise in anaesthetics, physiology, biochemistry, medicine, intensive care, pathology and forensic science. There is probably still much room for important new advances in the treatment of drowning and neardrowning.
173
character and duration of the dying process and the duration of clinical death, but also on the treatment of the disturbed functions at a later period. A patient or animal brought round from clinical death has specific metabolic disturbances and characteristic changes in the function of the central nervous system and the viscera. The monograph offers a detailed description of this post-resuscitation period with data on the oxidative processes, the acid-base balance, the disturbances in haemodynamics, changes in the clotting and fibrinolytic activity of the blood, functional disturbances of respiration, and hepatic and renal insufficiency. All this warrants his description of the ‘post-resuscitation disease’, which can be treated specifically. The therapy of a number of pathological states such as cardiac arrhythmias, atonic uterine haemorrhage, cerebral trauma, poisoning etc. during the postresuscitation period is discussed. A special chapter looks at the mechanism of sudden death. The monograph devotes much attention to the concept of ‘cerebral death’, which plays an important role in resuscitation. In this connection, the recovery of the electrocardiogram, the neurological state, the pattern of respiration and the detoxifying function of the liver, all determine the prognosis. The extensive clinical material is well documented. Detailed analysis of specific disturbances in the different systems should help in the future to eliminate haemodynamic disorders, hypoxic hypoxia and afibrinogenic haemorrhage. The monograph emphasizes the importance of general prophylactic measures in preventing terminal states, and the necessity of treating simultaneously the specific pathology leading to death. A chapter deals with the organization of specialized Intensive Care Units in large hospitals, and their work in close contact with specialized first-aid teams and mobile resuscitation units. Negovsky’s book is of high standard, and well printed and illustrated. It will undoubtedly be of interest to research workers and clinicians in the field of reanimatology. MARIAS. GAEVSKAYA THE
PATHOPHYSIOLOGY
AND
TREATMENT
OF DROWNING
AND
NEAR-DROWNING
Jerome H. Modell. pp. xv+ I 15, with 17 figures. Charles C. Thomas, Springfield, Illinois, 1971. Professor Model1 of the University of Florida College of Medicine has written a short book summarizing g years of his experience, and the literature on this subject. It is important, because-as he points out-every year about 5500 people in the United States, I 100 in the U.K. and 500 each in Australia and Norway, lose their lives by drowning, and many more nearly do so. He has synthesized knowledge from experiments on dogs, sheep, rabbits and rats, with that derived from clinical examination of patients. Chapters deal with blood gases, pulmonary changes, blood volume and electrolytes, cardiovascular changes, neurological effects, renal effects, autopsy findings, tests for drowning, first aid and hospital therapy. Although chapters vary from only two pages to thirteen pages in length, each has its own stmunary. One might have assumed intuitively that hypoxaemia is the real physiological problem of drowning. There is a good analysis of effects on the lungs, with discussion
174
REVIEWS
of the role of aspirated water on the surfactant properties, the intrapulmonary shunt, atelectasis and more delayed effects, which help to clarify one’s thinking on this aspect. The clinical distinction, known for a long time, between fresh-water and sea-water drowning is illustrated by citation of pathological and biochemical findings. The autopsies of drowned patients show a remarkable pathological variability with the brain and the lungs being the chief sufferers. The aim of treatment is well summarized: ‘to restore normal arterial blood and acid-base levels by effective ventilation, circulation, oxygenation, and by the judicious use of buffers’. These are the main conclusions I derived from a useful summary in a short monograph about a relatively under-explored field. Perhaps in the nature of the syndrome, there is not much new experimentation, or revolutionary treatment, that could have been presented. One may hope that this book will stimulate investigators to turn their attention to a fascinating exercise in anaesthetics, physiology, biochemistry, medicine, intensive care, pathology and forensic science. There is probably still much room for important new advances in the treatment of drowning and neardrowning.