Discussion Drowning vs suffocation

[marcy2022]

I'm trying to get some idea regarding how it feels when drowning and how it feels when suffocating.
While researching "drowning vs suffocation" I've found that suffocation is basically not being able to breathe air while drowning is the same and breathing in water too. This is the part where I have questions, does inhalation of water makes a huge difference when it comes to drowning and suffocation?

The body itself doesn't recognize O2 as far as I can tell, that's why methods such as "ppeh exit bag" works and considered peaceful as the body releases CO2 while breathing in something other than oxygen and slowly systems start failing, therefore its considered there's no pain involved.

Here: https://www.chegg.com/learn/biology/anatomy-physiology-in-biology/suffocation

The brain cells, when devoid of Oxygen progress towards brain cell death. If the brain doesn't get enough oxygen for 1 minute, the degeneration starts. When the same condition continues for a longer duration up until 6 minutes, the stage of irreversible damage to the brain takes place. After 10 minutes, it becomes impossible to revive the cardiopulmonary system.

If the above is correct then suffocation should take around 10minutes.

One of my preferred method is vecuronium bromide which paralyzes a person. Medically its used in surgeries where slightest movement from the patient even while under the effect of anesthesia may complicate the surgery. Not medical use includes animal euthanasia and in lethal injections.

Personal experience with little bit of breathing issues which may or may not be taken as experience of suffocation. I've failed with thiopental oral solution (ppeh suggest dosage is 10g but I took almost double the dosage with 48 hour fasting, anti-emetic regime and still failed). My lungs were badly damaged. I couldn't talk for a long time. Even after being released from the hospital I was on inhalers for months. Sometimes it would get so bad that I couldn't breathe or even when breathing it felt as if I wasn't getting enough air or something. But nothing painful or horrible, could be panic idk. I wonder if vecuronium would feel the same but then the mechanism maybe a little bit different as it paralyzes the diaphragm which may lead to CO2 buildup as being paralyzed may result in unable to breathe out.

Idk how CO2 buildup works with drowning as one still gets to let go some of the CO2 in their systems while drowning but probably there's more to it. The difference with vecuronium and drowning is the paralysis part which maybe double edged in terms of the effects. Being paralyzed may help countering SI and at the same time not being able to breathe out may result in CO2 buildup may result in panic or maybe even some pain (don't know about pain but feeling of panic is likely I think).

https://www.ccjm.org/content/ccjom/13/3/177.full.pdf

Relaxation follows an intravenous injection of curare in two to four minutes. The first muscles affected are those supplied by the cranial nerves, as evidenced in the un-anesthetized subject by strabismus, diplopia, nystagmus, and weakness of the eyelids, accompanied by relaxation of the muscles of mastication and those of the lower jaw and
pharynx, and by impairment of the functions of swallowing and coughing. The muscles of facial expression are relaxed, and speech becomes slow and difficult. The muscles of the trunk and extremities are next involved, and this results in weakness and inability to move the body. The diaphragm is the last skeletal muscle to be affected.
An effective blood level cannot be attained by the oral administration of curare, as it is destroyed and eliminated as fast as it is absorbed

This trial was done with curare without anesthesia (The bromide salt form of vecuronium, a synthetic steroid derivative of the naturally occurring alkaloids of curare with a muscle relaxant property). If I understood that correctly first the other parts of the body is effected and diaphragm is the last. One should be able to breath before complete paralysis but I could be wrong.

https://www.ccjm.org/content/ccjom/13/3/177.full.pdf

It is serving to supplement an increasing number of pentothal anesthesias given for laryngoscopy, laryngeal intubation, bronchoscopy, and esophagoscopy. In this type of procedure the curare (usually 60 units) is given as soon as the venipuncture is made, the needle then being flushed by the withdrawal and reinjection of 1 or 2 cc. of blood before attaching the pentothal syringe or tubing. This precaution is taken in order to avoid injecting the precipitate which results from mixing pentothal and the curare extract in the concentrations generally employed. The pentothal anesthesia is then begun immediately, the patient going to sleep before the discomfort of the curare effect appears.

In the same article it is also said that curare can be given first followed by thiopental/pentothal. It doesn't mention any waiting period in between the induction of either of them. The question here is can one inject a large dosage of vecuronium and still be able to inject thiopental before getting paralyzed?

https://physoc.onlinelibrary.wiley.com/doi/full/10.1113/expphysiol.2005.031625

A test of Paralysis of the diaphragm (maybe similar to vecuronium diaphragm paralysis)

Between 1967 and 1969 Campbell paralysed voluntary musculature with d-tubocurarine in two atropinized subjects (one had an oral airway inserted) and mechanically ventilated them with 63% O2​ via a facepiece (Campbell et al. 1966, 1967, 1969). Voluntary control of one arm was retained (using an arterial occlusion cuff to restrict the entry of curare) to enable the subject to signal when they wanted to 'breathe'. The ventilator was then switched off and the conscious subjects were asked to signal when they wanted ventilation restarted. Their mean 'breath-hold' durations (Fig. 1d) were prolonged at least threefold (Campbell et al. 1967), and after ∼4 min the experimenters intervened. P

levels at 'breakpoint' of up to 72 mmHg were reported (Campbell et al. 1969). When they could again talk, subjects reported no distressing symptoms of suffocation or of discomfort.

Even after 4mins of no breathing it was said to have no suffocation or discomfort, specially after the ventilation device was inactive.

https://physoc.onlinelibrary.wiley.com/doi/10.1113/jphysiol.1993.sp019849

This article is mentioned on the Paralysis of the diaphragm article above. Lots of medical stuff which I don't understand but from what I've understood is that this trial too was done using curare. Some patients in the trial were able to continue breathing without need for ventilation at a dosage of 0.2 mg/kg over a 40-min period of time.
This article totally contradicts almost all other articles I've found online about vecuronium guidelines for medical useage suggests to use ventilation at such dosage or even at a dosage of 0.1mg/kg which is half the dosage used in that trial.

Curare - an overview | ScienceDirect Topics

www.sciencedirect.com

This article mentions the following:

As a potent muscle relaxant, curare can cause death quickly by inducing asphyxia due to rapid relaxation of diaphragmatic muscles. According to one source, death from respiratory arrest can take place within a few minutes in birds and small prey, and up to 20 min in larger mammals. Curare is considered to be highly toxic.

I mean it can take down a large mammal. Ofcourse people are different but what I'm trying to say is it works. The link above also has LD50 values for some animals.

https://journals.sagepub.com/doi/pdf/10.1177/00258172211053127

The breath-hold time (BHT).
If submerged directly into cold water, BHT is likely to be significantly shorter than that which can be achieved in air. This is due to the respiratory drive evoked by sudden skin cooling and the resulting cold shock response

One thing to note here is that longer breath holding time meaning it takes more time overall for one to die.

https://journals.sagepub.com/doi/pdf/10.1177/00258172211053127

At the end of breath-holding, and before water is aspirated into the lung, an undetermined percentage of drowning victims (but perhaps up to 89%) swallow water. 4 Entry of water into the pharynx can cause reflex swallowing, often accentuated by the cough reflex. Transient laryngospasm or bronchospasm may occur as a result of stimulation of the innervated
mucosa of the oropharynx and larynx by water. However, it seems unlikely that this situation persists to death (what was previously known as 'Dry Drowning' 26). Swallowing of water may explain the high incidence of vomiting in drowning victims.27 During and after swallowing, water enters the lung and hypoxia-induced relaxation of the larynx will eventually permit water to be aspirated.

Confusion exists about the volume of water aspirated in drowning. 4 Aspiration of 2.5 mL . kg1 body weight of sea water causes the pulmonary shunt fraction to increase from about 10% to 75%.28 Aspiration of 2.2 mL . kg1 of sea water reduces PaO 2 from 13 kPa (100 mmHg) to 8 kPa (60 mmHg) within 3 min. The lethal dose of water in the lung has been estimated to
be 22 mL . kg1 for salt water, 44 mL . kg1 for fresh water. 29,30 Salt water may be more 'lethal' because more of it remains unabsorbed in the lung, increasing pulmonary pressure and thereby causing earlier right ventricular failure. Often smaller volumes of water (1 to 11 mL . kg1 ) than those presented above are aspirated in drowning cases. 31–33 It is worth noting that much of what is known about drowning comes from early work with animals.

Some additional information about drowning and dry drowning. Lethal dose of water in lungs is also mentioned above for both salt water and fresh water.

The initial sift left 34 cases, in 19 of which it was probable that water had entered the lung (aspiration group, AG), and in the other 15 of which aspiration could not be confirmed (non-aspiration group, NAG).

A summary of the subjective comments of those experiencing drowning is presented in Table 1. In both groups, many individuals mention struggling to hold their breath on initial immersion (see previous section). All but two of the AG group (who may have been semi-conscious on submersion) found at least part of the experience 'painful', 'awful', a 'strug-
gle' or 'shocking'. In all such cases, this was associated with the aspiration of water, irrespective of whether this water was fresh, chlorinated or salt water. A 'burning sensation' on aspirating water was specifically mentioned by eight of these individuals. Again, this sensation was not associated with any particular type of water. In contrast, only three individuals in the NAG mentioned their experience being painful; it is possible that these particular individuals aspirated water, but the evidence was not sufficient to place them in the AG. Nine of the NAG (60%) specifically mentioned not feeling any pain.

Other than 2+3 people most found it to be not peaceful in both groups.

Dr Justin Sempsrott from Lifeguard Without Borders, personal communication) who estimate that there is 30–60 s of panic during the surface struggle, then 30–60 s underwater of panic or neutral feelings before loss of consciousness.

Unconsciousness is generally thought to occur when the oxygen saturation of the blood falls from near 100% to 50 to 60% (P50 on the oxygen dissociation curve i.e. 50% saturation of haemoglobin) or an arterial partial pressure of oxygen (PaO 2) below 3.6 kPa (27 mmHg) and/or arterial partial pressure of carbon dioxide (PaCO 2) of 12 to 16 kPa (90–120 mmHg). The critical acute alveolar partial pressure of oxygen (PAO 2) for hypoxic loss of consciousness in healthy people ventilating normally is between 4.00 kPa (30 mmHg) and 5.07 kPa (38 mmHg). 39 The time spent at a given PAO 2 is critical, and this is recognised by including a time factor in the calculation of the 'dose' of hypoxia received. Thus, a dose of 20 kPa.s1 (150 mmHg.s1 ) of hypoxia is thought to be required to induce loss of consciousness, 40–42 and an acute PAO 2 of 4 kPa (30 mmHg) would therefore be predicted to result in loss of consciousness in about 5 s.

The above mentions time to lose consciousness.

For a drowning individual, the time taken to become unconscious will depend on the available oxygen stores of the body and the rate of oxygen consumption ( _VO 2). The _VO 2 will, in turn, be determined by factors such as water temperature (increasing _VO 2 with falling water temperature), clothing protection worn (decreasing _VO 2 with increasing clothing protection) and exercise undertaken (increasing _VO 2 with increasing exercise).

More information regarding drowning and unconsciousness.

The reservoirs of oxygen within the body that are available for metabolism are: dissolved in body fluids; bound to haemoglobin and myoglobin, and in the gas cavities, particularly the lungs. The amount of oxygen available in these stores is usually calculated for a 70 kg human at a lung capacity of 5.5 L in normal atmospheric air (PAO 2 of 120 mmHg), and ranges between 1546 mL and 2000 mL with an average of 1724 mL. In the drowning scenario, this is likely to represent a maximum value as, on average, 40% of the available oxygen is in the air within the lung, and some of this will be replaced by water with drowning.

Body reserve oxygen calculation example.

Using the rates of reduction of oxygen concentration presented in this study, the average time to a PAO 2 of 5.07 kPa (38 mmHg) was approximately 75 s. This duration would be extended if a larger breath were taken initially. However, as noted, in a drowning situation, air in the lung will be replaced by water with a break of breath-holding, reducing oxygen availability and therefore time to unconsciousness.

It suggests that average time to be unconscious while drowning would be somewhere around 75 seconds.

Szpilman et al. 6 concluded that the risk of death or severe neurological impairment after hospital discharge is 'nearly 100%' when the duration of submersion exceeds 25 min.

https://journals.sagepub.com/doi/pdf/10.1177/00258172211053127

In this article they are tring toestimate the duration, and pain and suffering associated with drowning in different scenarios

into the following sequence: (i) struggle to keep the airway clear of the water, (ii) initial submersion and breath-holding, (iii) aspiration of water, (iv) unconsciousness, (v) cardio-respiratory arrest and (vi) death - inability to revive.

My understanding is that drowning stages may not apply when it comes to suffocation while paralyzed. Stage 1 may activate in ones brain but the body won't respond to it. Stage 2 submersion part is only applicable when drowning, breath holding response from brain may activate in ones brain but without the diaphram functioning idk how that works as already in a breathe holding (sort of) stage cuz the diaphragm isn't working. Stage 3 where one inhales water, idk how this would work while paralyzed (can water still get into the lungs without the diaphragm is paralyzed?). Stages 4 and 5 are self explanatory.

How Long Does It Take to Drown? Facts, Safety, and Precautions

Drowning remains a leading cause of preventable death in the United States. Proactive steps, like taking swimming lessons and keeping safety equipment handy, can decrease your risk for drowning.

www.healthline.com

1. For the first several seconds after water is inhaled, the drowning person is in a state of fight-or-flight as they struggle to breathe.
2. As the airway begins to close to prevent more water from getting into the lungs, the person will start to hold their breath involuntarily. This takes place for up to 2 minutes, until they lose consciousness.
3. The person becomes unconscious. During this stage, they can still be revived through resuscitation and have a chance at a good outcome. Breathing stops and the heart slows. This can last for several minutes.
4. The body enters a state called hypoxic convulsion. This can look like a seizure. Without oxygen, the person's body appears to turn blue and may jerk around erratically.
5. The brain, heart, and lungs reach a state beyond where they can be revived. This final stage of drowning is called cerebral hypoxia, followed by clinical death.

Stage 4 hypoxic convulsion, can this happen while paralyzed? Can a medically paralyzed person (with vecuronium bromide) move during a seizure?
Note: when vecuronium bromide is used for surgeries or for lethal injection, they are almost always accompanied by anesthetics such as thiopental, propofol which is given before vecuronium. Thiopental has properties which helps control seizures while vecuronium paralyzes the muscles. For me it'll probably be vecuronium only without anesthetics or maybe after the vecuronium injection if I'm not paralyzed yet but I doubt it. so I'm thinking vecuronium only (for now).

Effects of atracurium, vecuronium or pancuronium pretreatment on lignocaine seizure thresholds in cats - PubMed

Among the non-depolarizing neuromuscular blocking drugs, atracurium appears to be unique in its ability to produce cerebral stimulation in lightly anaesthetized animals. This effect is attributed to the atracurium metabolite, laudanosine. The following studies were performed to determine if...

pubmed.ncbi.nlm.nih.gov

This is one study regarding seizure measurement. While the study itself is about something else, one thing caught my eyes is that

Since all study subjects were paralysed, it was necessary to define seizure onset using EEG criteria.

EEG was necessary as there was no visible physical movements due to paralysis. Does it mean while paralyzed with vecuronium even though seizures may happen and detectable in brain signals but they'll be no physical movements?
However it should be noted that anesthetic agents were used before vecuronium. Could it be that the anti-seizure properties of certain anesthetics may have suppressed any visible seizure movements or I could be wrong?

[Effects of anesthetic agents on seizure duration and hemodynamics in electroconvulsive therapy] - PubMed

Rocuronium, which will be used for ECT in future, is needed to be studied in suxamethonium-controlled design.

pubmed.ncbi.nlm.nih.gov

Seizure duration was measured by EEG engineer

Another test where they used EEG to measure seizure. Anesthetic and vecuronium was used in the test. I'm guessing due to paralysis EEG was used to measure seizure as there was no visible physical movements.

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2006.00870.x

Recommendation 14 : Neuromuscular blocking agents are indicated in the treatment of convulsive SE in ICU. They should be used only in association with EEG monitoring to allow assessment of cerebral seizure activity

Medical guidelines with recommendations for seizure treatment options. Neuromuscular blocking agent is recommended after benzo, Phenytoin, thioepental. Idk but If I'm not mistaken this is suggested as a last measure.

FTO

chemport-n.cas.org

Paralysis induced by neuromuscular blocking agents facilitates ventilation of seriously ill patients but may preclude clinical recognition of seizures.

Does it mean neuromuscular blocking agent or in my case vecuronium will prevent physical signs of seizures?


From the above my understanding is that water does make some difference but not that much. However it should be noted that typical suffocation such as hanging may not be peaceful due to different reason. While night night method can be peaceful but its a difficult one. So If I'm correct suffocation just like drowning can be peaceful (ofcourse depends on the individual). Does it mean suffocation by neuromuscular blocking agent or vecuronium could actually be peaceful?

 

[jodes2]

Wow, lots of well researched information there. But I still think drowning / suffocating / being paralysed is a horrible way to go

 

[GasMonkey]

I have had water in my lungs which I accidentally "inhaled" while using a front snorkel and it was the most horrible shit ever, no fucking way drowning is peaceful.

I think you are losing your time researching all those theoretical chemical combos, none of that research is gonna generate a method better than a proper N₂ setup.

 

[marcy2022]

I have had water in my lungs which I accidentally "inhaled" while using a front snorkel and it was the most horrible shit ever, no fucking way drowning is peaceful.

I think you are losing your time researching all those theoretical chemical combos, none of that research is gonna generate a method better than a proper N₂ setup.

I know you're probably right. I wish I could do the exit bag method but circumstances and lack of access isn't helping.

 

[marcy2022]

Wow, lots of well researched information there. But I still think drowning / suffocating / being paralysed is a horrible way to go

Yup even though it suggests that drowning with or without water in lungs maybe considered peaceful based on statistics from limited documents and researches which are publicly available, it could still be a bad experience.

Question remains, what is horrible or what makes it so? I have yet to find a proper documentation identifying whats the underlying causes behind the "horrible" feeling. Is it the pain from something, is it panic from SI, or a combination of both or other maybe protective mechanisms built into the body which makes one "want to survive" regardless of voluntary or involuntary drowning? Proper measurement of pain is complicated to say thee least. However the methods used in certain researches using adrenaline, brain waves and other. With drowning, even the experiences described by people are subjective and It's unknown should different people were put in the same situation, if their experiences would differ or not.
Without proper controlled trials its difficult to conclude on something. I couldn't find any controlled drowning or asphyxiation trial documents, that may have offered better insights and more accurate data.

As for paralysis, only reason I'm considering this is based on actual scientific evidence found using online research that this maybe the key to shut down SI. Maybe even a better choice than some anesthetics. While I understand its not a popular topic due to unavailability of such medications in certain countries, lack of access as its a medication used for surgical purposes and not easy to acquire. Also the idea of being unable to move while one is awake and the brain is trying to fight it may feel horrible. It would be nice to be able to use anesthetic and paralytic agents at the same time however its really complicated to do that by oneself without proper medical training/expertise and equipment. However I'm finding lots of evidence suggesting the paralysis part is reliable. It may involve some pain or panic or in another words "horrible" feeling but timeframe to ctb is something that can be said with certainty that its fast and it works.