09.04.2019

What signs indicate clinical death of the victim. Signs of clinical death

A living organism does not die simultaneously with the cessation of breathing and cessation of cardiac activity, therefore, even after they stop, the body continues to live for some time. This time is determined by the brain’s ability to survive without oxygen supplied to it; it lasts 4–6 minutes, on average 5 minutes. This period, when all the extinct vital processes of the body are still reversible, is called clinical death. Clinical death can be caused by heavy bleeding, electrical trauma, drowning, reflex cardiac arrest, acute poisoning, etc.

Signs of clinical death:

1) absence of pulse in the carotid or femoral artery; 2) lack of breathing; 3) loss of consciousness; 4) wide pupils and their lack of reaction to light.

Therefore, first of all, it is necessary to determine the presence of blood circulation and breathing in the patient or victim.

Definition of signs clinical death:

1. Absence of pulse in the carotid artery is the main sign of circulatory arrest;

2. Lack of breathing can be checked by visible movements of the chest during inhalation and exhalation, or by placing your ear to the chest, hearing the sound of breathing, feeling (the movement of air during exhalation is felt by the cheek), and also by bringing a mirror, a piece of glass or a watch glass, or a cotton swab to your lips or thread, holding them with tweezers. But it is precisely on the determination of this characteristic that one should not waste time, since the methods are not perfect and unreliable, and most importantly, they require a lot of precious time for their determination;

3. Signs of loss of consciousness are a lack of reaction to what is happening, to sound and pain stimuli;

4. The victim’s upper eyelid is raised and the size of the pupil is determined visually, the eyelid lowers and immediately rises again. If the pupil remains wide and does not narrow after lifting the eyelid again, then we can assume that there is no reaction to light.

If one of the first two of the 4 signs of clinical death is determined, then resuscitation must be started immediately. Since only timely resuscitation (within 3–4 minutes after cardiac arrest) can bring the victim back to life. Resuscitation is not performed only in the case of biological (irreversible) death, when irreversible changes occur in the tissues of the brain and many organs.

Signs of biological death :

1) drying of the cornea; 2) the “cat’s pupil” phenomenon; 3) decrease in temperature;. 4) body cadaveric spots; 5) rigor mortis

Definition of signs biological death:

1. Signs of drying out of the cornea are the loss of the iris of its original color, the eye appears to be covered with a whitish film - a “herring shine”, and the pupil becomes cloudy.

2. Big and index fingers they squeeze the eyeball; if a person is dead, then his pupil will change shape and turn into a narrow slit - a “cat’s pupil”. This cannot be done in a living person. If these 2 signs appear, this means that the person died at least an hour ago.

3. Body temperature drops gradually, by about 1 degree Celsius every hour after death. Therefore, based on these signs, death can only be confirmed after 2–4 hours or later.

4. Cadaveric spots purple appear on the underlying parts of the corpse. If he lies on his back, then they are identified on the head behind the ears, on back surface shoulders and hips, back and buttocks.

5. Rigor mortis is a post-mortem contraction of skeletal muscles “from top to bottom,” i.e. face – neck – upper limbs – torso – lower limbs.

Full development of signs occurs within 24 hours after death. Before you begin to revive the victim, you must first establish the presence of clinical death.

! They begin resuscitation only if there is no pulse (in the carotid artery) or breathing.

! Revitalization efforts must begin without delay. The sooner resuscitation measures are started, the more likely a favorable outcome is.

Resuscitation measures directed to restore the vital functions of the body, primarily blood circulation and breathing. This is, first of all, artificial maintenance of blood circulation in the brain and forced enrichment of the blood with oxygen.

TO events cardiopulmonary resuscitation relate: precordial stroke , indirect cardiac massage And artificial ventilation (ventilation) using the mouth-to-mouth method.

Cardiopulmonary resuscitation consists of sequential stages: precordial stroke; artificial maintenance of blood circulation (external cardiac massage); restoration of airway patency; artificial pulmonary ventilation (ALV);

Preparing the victim for resuscitation

The victim must lie down on your back, on a hard surface. If it was lying on the bed or on the sofa, then it must be moved to the floor.

Expose your chest the victim, since under his clothes on the sternum there may be a pectoral cross, medallion, buttons, etc., which can become sources of additional injury, as well as unfasten the waist belt.

For ensuring airway patency it is necessary: 1) clean the oral cavity of mucus and vomit with a cloth wrapped around the index finger. 2) eliminate tongue retraction in two ways: by throwing back the head or extending the lower jaw.

throw back your head the victim needs to ensure that the back wall of the pharynx moves away from the root of the sunken tongue, and air can freely pass into the lungs. This can be done by placing a cushion of clothing either under the neck or under the shoulder blades. (Attention! ), but not to the back of the head!

Forbidden! Place hard objects under your neck or back: a backpack, a brick, a board, a stone. In this case, during chest compressions, the spine can be broken.

If there is a suspicion of a fracture of the cervical vertebrae, you can, without bending your neck, push only lower jaw . To do this, place your index fingers on the corners of the lower jaw under the left and right earlobes, push the jaw forward and secure it in this position thumb right hand. Left hand is released, so it is necessary to pinch the victim’s nose with it (thumb and forefinger). So the victim is prepared to carry out artificial ventilation lungs (ventilator).

Signs of clinical death:

1) absence of pulse in the carotid or femoral artery; 2) lack of breathing; 3) loss of consciousness; 4) wide pupils and their lack of reaction to light.

Therefore, first of all, it is necessary to determine the presence of blood circulation and breathing in the patient or victim.

Definition of signs clinical death:

1. Absence of pulse in the carotid artery is the main sign of circulatory arrest;

3. Signs of loss of consciousness are a lack of reaction to what is happening, to sound and pain stimuli;

1) drying of the cornea; 2) the “cat’s pupil” phenomenon; 3) decrease in temperature;. 4) bodies cadaveric spots; 5) rigor mortis

Definition of signs biological death:

1. Signs of drying out of the cornea are the loss of the iris of its original color, the eye appears to be covered with a whitish film - a “herring shine”, and the pupil becomes cloudy.

2. The thumb and forefinger squeeze the eyeball; if the person is dead, then his pupil will change shape and turn into a narrow slit - a “cat’s pupil.” This cannot be done in a living person. If these 2 signs appear, this means that the person died at least an hour ago.

3. Body temperature drops gradually, by about 1 degree Celsius every hour after death. Therefore, based on these signs, death can only be confirmed after 2–4 hours or later.

4. Purple cadaveric spots appear on the underlying parts of the corpse. If he lies on his back, then they are identified on the head behind the ears, on the back of the shoulders and hips, on the back and buttocks.

5. Rigor mortis is a post-mortem contraction of skeletal muscles “from top to bottom,” i.e. face – neck – upper limbs – torso – lower limbs.

Full development of signs occurs within 24 hours after death. Before you begin to revive the victim, you must first establish the presence of clinical death.

! They begin resuscitation only if there is no pulse (in the carotid artery) or breathing.

! Revitalization efforts must begin without delay. The sooner resuscitation measures are started, the more likely a favorable outcome is.

TO events cardiopulmonary resuscitation relate: precordial stroke , indirect massage hearts And artificial ventilation (ventilation) using the mouth-to-mouth method.

Preparing the victim for resuscitation

The victim must lie down on your back, on a hard surface. If it was lying on the bed or on the sofa, then it must be moved to the floor.

Forbidden! Place hard objects under your neck or back: a backpack, a brick, a board, a stone. In this case, during chest compressions, the spine can be broken.

If there is a suspicion of a fracture of the cervical vertebrae, you can, without bending your neck, extend only the lower jaw. To do this, place the index fingers on the corners of the lower jaw under the left and right earlobes, push the jaw forward and secure it in this position with the thumb of the right hand. The left hand is freed, so it is necessary to pinch the victim’s nose with it (thumb and forefinger). This way the victim is prepared for artificial pulmonary ventilation (ALV).

2. Clinical death, its causes and signs. Biological death.

When the heart stops, the supply of oxygen to all cells of the body stops. However, they do not die immediately, but continue to function for some time. For brain cells this time is 4-6 minutes. This period, when brain cells have not yet died, is called a state of clinical death. V.A. Negovsky defines it this way: “No longer life, but not yet death.” If cardiac activity and breathing are restored during this time, the victim can be revived. Otherwise, biological death occurs.

Reasons clinical death can be: blockage of the respiratory tract with vomit and soil, electrical trauma, drowning, poisoning with chemical agents, being covered with earth, myocardial infarction, severe nervous shock (fear or joy), etc.

Signs of clinical death.

The victim, who is in a state of clinical death, is motionless and has no consciousness. The skin is pale or bluish. The pupils are sharply dilated and do not react to light. There is no breathing or cardiac activity. Its absence is determined by the pulse in the large arteries (carotid and femoral) and by listening to heart sounds.

During development biological death the victim also has no pulse in the carotid artery, no breathing, no pupillary reflex, skin temperature below 20ºС. 30 minutes after cardiac arrest, cadaver spots and rigor mortis (difficult movements in the joints) appear. One of the early signs of the onset of biological death is the Beloglazov sign (cat's pupil symptom). With lateral compression of the eyeball, the pupil of a corpse takes on an oval shape, and in clinical death, the shape of the pupil does not change.

The determination of biological death is carried out by a doctor. If there are signs of biological death, the police should be called.

3. First aid for sudden stop of breathing and cardiac activity

In life, you may encounter this (or similar) situation: a person is sitting, talking and suddenly suddenly loses consciousness. Those present have a natural desire to help him, but they do not know how to do it. And, nevertheless, in cases of sudden stoppage of breathing and cardiac activity, only people who are nearby at this moment can help the victim. To do this correctly, you must be able to assess the condition of the victim and master first aid techniques.

How to assess the condition of the victim? If he turns pale, loses consciousness, but breathing continues (the chest or pit of the stomach rises) and the heart beats (pulsation in the carotid artery is detected), then the victim faints. In cases where the bluishness of his lips, fingertips, and face increases, one must think about primary respiratory arrest. Secondary respiratory arrest occurs shortly after cardiac arrest. The victim's face is pale gray.

What are the causes of sudden respiratory arrest? This is, first of all, obstruction of the respiratory tract caused by the ingress of foreign bodies, retraction of the tongue in unconscious persons; swelling and spasm of the glottis, during drowning, compression of the larynx from the outside. Sudden cessation of breathing is also possible with damage respiratory center electric shock or lightning, poisoning from sleeping pills or drugs, with sudden inhalation of highly irritating and toxic substances, etc.

After breathing stops, cardiac activity stops very soon, so you need to hurry to help the victim. If the victim’s heart is still beating, then first aid will consist of performing artificial respiration.

First aid for sudden respiratory arrest

First of all, it is necessary to examine the victim’s oral cavity and remove foreign bodies. You can do this with two fingers, wrapping them in a napkin or handkerchief. Lay the victim on a flat, hard surface on his back. Free your chest and stomach from clothing. Place a cushion under your shoulders and tilt your head back so that your chin is almost in line with your neck. Tighten your tongue if it sinks too deep. The listed techniques allow you to create better air flow into the lungs.

If you have a special s-shaped breathing tube at hand, then artificial respiration is best performed using this tube. One end is inserted into the mouth, pushing back the root of the tongue, and the other end is inflated.

In the absence of a breathing tube, artificial respiration is carried out from mouth to mouth, and in case of damage to the oral cavity - from mouth to nose. Before this, a napkin or handkerchief is placed on the face (for hygienic purposes). With one hand, support the lower jaw, push it forward and open the mouth. With the palm of the other hand they press on the forehead, and with the first and second fingers they squeeze the nose so that when blowing air does not escape through it. After this, the person providing assistance presses his lips tightly against the victim’s lips and blows vigorously. At the same time, the victim’s chest expands (inhalation). He exhales passively. In order not to interfere with exhalation, the person providing assistance should turn his head to the side after each insufflation. Artificial respiration is usually performed at a frequency of 12-14 per minute.

In children, insufflation is performed at a frequency of about 20 per minute, and the volume of air should be appropriate for the age so as not to damage the lungs. In practice, the volume of air blown in can be determined by the degree of respiratory excursions (movements) of the chest.

If the victim's head is not tilted back enough, air will enter the stomach and not the lungs. This can be noticed by the increasing size of the epigastric region. If this happens, you need to turn the victim’s head to the side and gently press with your hand on the epigastric region to remove air from the stomach. After this, examine the oral cavity, remove the stomach contents from it, tilt your head back and continue artificial respiration.

Artificial ventilation is carried out until spontaneous breathing occurs. It is restored gradually and at the beginning may be insufficient, so so-called auxiliary breathing is carried out for some time: at the height of independent inspiration, an additional amount of air is blown into the victim’s lungs.

There are, however, cases when the heart stops first, and then breathing stops. Cells of tissues and organs, deprived of oxygen and nutrients, begin to die off. Brain cells die earlier than others, as they are the most sensitive to lack of oxygen. At normal temperatures, the cells of the cerebral cortex die, as previously mentioned, 4-6 minutes after the cessation of blood circulation in the body.

If the victim is declared to be clinically dead, it is necessary to urgently carry out a set of resuscitation measures at the scene of the incident - artificial respiration and external (indirect) cardiac massage. With the help of resuscitation measures, the victim can be saved. If you yourself fail to restore cardiac activity, then these measures will allow you to artificially maintain blood circulation and breathing until the arrival of a medical worker.

Clinical death

Clinical death- a reversible stage of dying, a transition period between life and biological death. At this stage, the activity of the heart and the breathing process stop, all external signs of the body’s vital activity completely disappear. At the same time, hypoxia (oxygen starvation) does not cause irreversible changes in the organs and systems that are most sensitive to it. This period of the terminal state, with the exception of rare and casuistic cases, lasts on average no more than 3-4 minutes, maximum 5-6 minutes (with an initially reduced or normal temperature body). Survival is possible.

Signs of clinical death

Signs of clinical death include: coma, apnea, asystole. This triad concerns the early period of clinical death (when several minutes have passed since asystole), and does not apply to those cases when there are already clear signs of biological death. The shorter the period between the declaration of clinical death and the start of resuscitation measures, the greater the patient’s chances of life, therefore diagnosis and treatment are carried out in parallel.

Coma is diagnosed based on a lack of consciousness and dilated pupils that do not respond to light.

Apnea is recorded visually by the absence of respiratory movements of the chest.

Asystole is recorded by the absence of pulses in the two carotid arteries. Before determining the pulse, it is recommended to perform artificial ventilation on the victim.

Treatment

Main article: Cardiopulmonary resuscitation

In 2000, the First World Scientific Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care was held, at which for the first time unified international recommendations were developed in the field of resuscitation of the body (Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care).

From a practical point of view, cardiopulmonary resuscitation (CPR) can be divided into 2 stages:

1. Basic Life Support- basic resuscitation measures (basic CPR or primary resuscitation complex), which can carried out by non-professional rescuers (trained volunteers, firefighters, and others), as well as must carried out by medical professionals.

Basic CPR is all about maintaining the airway ( A irway), performing artificial ventilation ( B reathing) and indirect cardiac massage ( C circulation). In fact, basic CPR is the initial stage of resuscitation, when the rescuer often finds himself alone with the victim, and is forced to carry out resuscitation measures “empty-handed.”

2. Advanced Cardiovascular Life Support- specialized resuscitation measures (specialized or advanced CPR), which must be performed by someone trained and equipped with appropriate equipment and medications medical staff(emergency medical service, doctors of the intensive care unit).

Specialized CPR involves the sequential implementation of the same techniques as with basic CPR, but with the use of resuscitation equipment and medications, which makes it significantly more effective.

Pathophysiological basis of clinical death

The duration of clinical death is determined by the period during which the higher parts of the brain (subcortex and especially the cortex) are able to maintain viability under hypoxic conditions. Describing clinical death, V. A. Negovsky speaks of two terms.

First term clinical death lasts only 3-5 minutes. This is the time during which the higher parts of the brain retain their viability during anoxia (lack of oxygen supply to organs, in particular the brain) under normothermia (body temperature - 36.5 °C). All world practice shows that if this period is exceeded, people can be revived, but the result is decortication (death of the cerebral cortex) or even decerebration (death of all parts of the brain).
But maybe second term clinical death that doctors have to deal with when providing care or in special conditions. The second period of clinical death can last tens of minutes, and resuscitation measures (methods of revival) will be very effective. The second period of clinical death is observed when special conditions to slow down the processes of degeneration of the higher parts of the brain during hypoxia (decreased oxygen content in the blood) or anoxia (see above).

The duration of clinical death increases under conditions of hypothermia (artificial cooling of an organ or the entire body), with electric shock, and with drowning. In clinical practice this can be achieved by physical influences(head hypothermia, hyperbaric oxygenation - oxygen breathing at high pressure in a special chamber), the use of pharmacological substances that create a state similar to suspended animation ( a sharp decline metabolism), hemosorption (hardware purification of blood), transfusion of fresh (not canned) donor blood and some others.

If resuscitation measures were not carried out or were unsuccessful, biological or true death occurs, which is an irreversible cessation of physiological processes in cells and tissues.

Clinical death in culture

There is a point of view that during an episode of clinical death a person sees an “afterlife.” Some patients who have experienced clinical death describe experiences that are similar to each other (see Near-Death Experiences). Common to all these observations is often a feeling of flight, movement through a dark tunnel towards the light, a feeling of calm and tranquility, meetings with deceased relatives, etc. This phenomenon is called near-death experiences.

The main problem is that the brain almost completely stops working soon after the heart stops. It follows that in a state of clinical death, a person, in principle, cannot feel or experience anything.

There are two ways to explain this problem. According to the first, human consciousness can exist regardless of human brain. And near-death experiences could well serve as confirmation of the existence of an afterlife. Most scientists consider such experiences to be hallucinations caused by cerebral hypoxia. According to this point of view, near-death experiences are experienced by people not in a state of clinical death, but at earlier stages of brain death during the period of the preagonal state or agony, as well as during the coma, after the patient has been resuscitated. Contrary to this, science knows of cases where patients, recovering from a state of clinical death thanks to resuscitation actions, later said that they remember what happened in the place where they were resuscitated, including the actions of resuscitators with precision down to the smallest detail[ source not specified 434 days]. From a medical point of view, this is impossible, if only because there is practically no brain activity.

From point of view pathological physiology These sensations are quite naturally caused. As a result of hypoxia, brain function is inhibited from top to bottom from the neocortex to the archeocortex.

The cerebral cortex is depressed: tunnel vision develops, recognition of images coming from the retina ceases to function - this is what causes the vision of a spot of light ahead.

Then the brain stops receiving data from the visual analyzer, and foci of stable excitation of the cortex are formed, supporting the picture of continuous illumination, the person seems to be approaching the light, this illusion arises due to the reverberation of the signal in the visual cortex of the brain, which imitates the intensification and spread of light before the eyes sick. This also explains the phenomenon of seeing light spots in the blind; if the eyes are damaged, the visual cortex, as a rule, does not suffer, and is quite capable of generating a signal that imitates the arrival of data from the visual analyzer.[ source not specified 423 days]

The sensation of flying or falling occurs as a result of ischemia. There is a lack of oxygen for the vestibular analyzer, as a result of which the brain stops analyzing and adequately perceiving data coming from the receptors of the vestibular apparatus.

Also in some cases this state may be accompanied by specific hallucinations. For religious people, these can indeed be pictures of the afterlife, and what a person sees can vary significantly depending on his life experience and individual characteristics. These hallucinations are often very similar to similar experiences in mental illness.

/ Death

Death, cessation of the vital activity of the organism and, as a result, the death of the individual as a separate living system, accompanied by decomposition proteins and others biopolymers, which are the main material substrate life. The basis of modern dialectical-materialist ideas about psychology is the idea expressed by F. Engels: “Already now, that physiology that does not consider death as an essential moment of life is not considered scientific..., which does not understand that the negation of life is essentially contained in life itself, so that life is always thought of in relation to its necessary result, which is always contained in it in embryo - death" (Marx K. and Engels F., Works, 2nd ed., g. 20, p. 610 ).

Sometimes the concept of partial S. is distinguished, i.e. S. of a group of cells, a part or an entire organ (see. Necrosis). In unicellular organisms - protozoa- the natural S. of an individual manifests itself in the form of division, since it is associated with the cessation of the existence of a given individual and the emergence of two new ones in its place. The death of an individual is usually accompanied by the formation of a corpse. Depending on the reasons that determine the onset of S., in higher animals and humans they distinguish: Natural S. (also called physiological), which occurs as a result of a long, consistently developing extinction of the main vital functions of the body (see. Aging), and S. premature (sometimes called pathological), caused by painful conditions of the body, damage to vital important organs(brain, heart, lungs, liver, etc.). Premature S. can be sudden, that is, it can occur within a few minutes or even seconds (for example, with a heart attack). S. violent may result from an accident, suicide, or murder.

S. in warm-blooded animals and humans is associated primarily with the cessation of breathing and blood circulation. Therefore, there are 2 main stages C .; so-called clinical death and the following so-called. biological, or true. After the period of clinical S., when a full restoration of vital functions is still possible, biological S. occurs—the irreversible cessation of physiological processes in cells and tissues. All processes associated with S. are studied thanatology.

Lit.: Mechnikov I.I., Etudes of Optimism, 4th ed., M., 1917; Shmalgauzen I.I., The problem of death and immortality, M. - L., 1926; Ilyin N. A., Modern science about life and death, Kish., 1955; Lunts A.M., On the evolution of death in connection with the evolution of reproduction, "Journal of General Biology", 1961, v. 22, No. 2; Polikar A., Bessi M., Elements of cell pathology, trans. from French, M., 1970.

Clinical death

Clinical death a state of the body characterized by the absence of external signs of life (cardiac activity and breathing). During K. s. the functions of the central nervous system fade away, but metabolic processes are still preserved in the tissues. K. s. lasts 5-6 min after cardiac and respiratory arrest (dying from blood loss); at sudden cessation blood flow (for example, with ventricular fibrillation of the heart), the period of dying is extended to 8-10 min. After this time, full restoration of vital functions is no longer possible. See more details.

Biological death occurs after the clinical one and is characterized by the fact that, against the background of ischemic damage, irreversible changes in organs and systems occur. Its diagnosis is carried out on the basis of the presence of signs of clinical death, followed by the addition of early and then late signs of biological death.

TO early signs of biological death include drying and clouding of the cornea and the “cat's eye” symptom (to detect this symptom, you need to squeeze the eyeball. The symptom is considered positive if the pupil is deformed and elongated in length). By the later signs of biological death include rigor spots and rigor mortis.

Biological death(irreversible termination biological processes in the cells and tissues of the body). A distinction is made between natural (physiological) death, which occurs as a result of a long, consistently developing extinction of the body’s main vital functions, and premature (pathological) death, which is caused by painful condition body, damage to vital organs. Premature death can be sudden, i.e. occur within a few minutes or even seconds. Violent death can be the result of an accident, suicide, or murder.

The biological death of an individual after stopping breathing and cardiac activity does not occur immediately. The brain is most vulnerable to hypoxia and circulatory arrest. Irreversible brain damage develops with uncorrected severe hypoxia or with circulatory arrest for more than 3-5 minutes. Immediate application of modern methods cardiopulmonary resuscitation(revival) can prevent the onset of biological death.

Signs of biological death The fact of the occurrence of biological death can be established by the presence of reliable signs, and before their appearance - by a combination of signs.

Reliable signs of biological death:

1. Cadaveric spots - begin to form 2-4 hours after cardiac arrest. 2. Rigor mortis - manifests itself 2-4 hours after circulatory arrest, reaches a maximum at the end of the first day and goes away spontaneously within 3-4 days. A set of signs that allows one to ascertain biological death before the appearance of reliable signs:

1. Absence of cardiac activity (no pulse in the carotid arteries, heart sounds cannot be heard). 2. The time of absence of cardiac activity has been reliably established to be more than 30 minutes under normal (room) ambient temperature conditions. 3. Lack of breathing. 4. Maximum dilation of the pupils and their lack of reaction to light. 5. Absence of corneal reflex. 6. The presence of post-mortem hypostasis (dark blue spots) in sloping parts of the body. These signs are not a basis for declaring biological death when they occur under conditions of deep cooling (body temperature + 32°C) or against the background of the action of drugs that depress the central nervous system.

The biological death of a subject does not mean the immediate biological death of the tissues and organs that make up his body. The time before death of the tissues that make up the human body is mainly determined by their ability to survive under conditions of hypoxia and anoxia. This ability is different for different tissues and organs. Most a short time life under conditions of anoxia is observed in brain tissue, to be more precise, in the cerebral cortex and subcortical structures. Stem sections and spinal cord have greater resistance, or rather resistance to anoxia. Other tissues of the human body have this property to a more pronounced extent. Thus, the heart retains its viability for 1.5-2 hours after the onset of, according to modern concepts, biological death. Kidneys, liver and some other organs remain viable for up to 3-4 hours. Muscle tissue, skin and some other tissues may well be viable up to 5-6 hours after the onset of biological death. Bone tissue, being the most inert tissue of the human body, retains its vitality for up to several days. Associated with the phenomenon of survivability of organs and tissues of the human body is the possibility of transplanting them, and the earlier the organs are removed for transplantation after the onset of biological death, the more viable they are, the greater the likelihood of their successful further functioning in a new organism.

Diagnosis of death

The fear of making a mistake in diagnosing death pushed doctors to develop methods for diagnosing death, creating special vital samples, or creating special burial conditions. Thus, in Munich, for more than 100 years, there was a tomb in which the hand of the deceased was wrapped with a bell cord. The bell rang only once, and when the servants came to help the man who had woken up from lethargic sleep The patient found that rigor mortis had resolved. At the same time, from the literature and medical practice there are known cases of delivery of living people to the morgue, whom doctors mistakenly diagnosed as dead.

The biological death of a person is determined by a set of signs associated with the “vital tripod”: the activity of the heart, the preservation of breathing and the function of the central nervous system. Checking the safety of respiratory function. Currently, there are no reliable signs of respiratory safety. Depending on the environmental conditions, you can use a cold mirror, a fluff, perform auscultation (listening) of breathing or the Winslov test, which consists of placing a vessel with water on the patient’s chest and judging the presence of respiratory movements based on fluctuations in the water level. chest wall. A gust of wind or draft, increased humidity and temperature in the room, or passing traffic may affect the results of these tests, and the conclusions about the presence or absence of breathing will be incorrect.

More informative for diagnosing death are tests indicating preservation of cardiovascular function. Auscultation of the heart, palpation of the pulse in the central and peripheral vessels, palpation of the cardiac impulse - these studies cannot be fully considered reliable. Even when examining the function of cardio-vascular system in a clinical setting, very weak heart contractions may not be noticed by the doctor, or the contractions of one’s own heart will be assessed as the presence of such a function. Clinicians advise auscultation of the heart and palpation of the pulse in short intervals, lasting no more than 1 minute. The Magnus test, which consists of tightly tying the finger, is very interesting and conclusive even with minimal blood circulation. With existing blood circulation at the site of the constriction, the skin turns pale, and the peripheral skin becomes cyanotic. After removing the constriction, the color is restored. Certain information can be obtained by holding the earlobe through the light, which in the presence of blood circulation has a reddish-pink color, while in a corpse it is gray-white. In the last century, very specific tests were proposed to diagnose the integrity of the function of the cardiovascular system, for example: Vergne's test - arteriotomy (opening) of the temporal artery, or Bouchou's test - a steel needle inserted into the body, in a living person loses its luster after half an hour, the first Icarus test - intravenous administration fluorescein solution gives rapid staining of the skin of a living person in yellowish color, and the sclera - greenish and some others. These samples are currently only of historical, not practical interest. It is hardly reasonable to perform an arteriotomy on a person in a state of shock and at the scene of an accident, where it is impossible to comply with aseptic and antiseptic conditions, or to wait half an hour until the steel needle becomes dull, and even more so to inject fluorescein, which in the light of a living person causes hemolysis (destruction of red blood cells). blood with the release of hemoglobin into the environment).

The preservation of the function of the central nervous system is the most important indicator of life. It is fundamentally impossible to determine brain death at the scene of the incident. The function of the nervous system is tested by the presence or absence of consciousness, passive position body, muscle relaxation and lack of tone, lack of response to external stimuli - ammonia, mild painful effects (tingling with a needle, rubbing the earlobe, tapping the cheeks and others). Valuable signs are the absence of the corneal reflex and the reaction of the pupils to light. But both these and the previous signs may, in principle, be absent in a living person, for example, in case of poisoning with sleeping pills, drugs, collapse and other conditions. Therefore, these signs cannot be treated unequivocally; they must be assessed critically, taking into account a possible disease or pathological condition. In the last century, extremely unusual and sometimes very cruel methods have been used to test the function of the nervous system. Thus, the Joz test was proposed, for which special forceps were invented and patented. When a fold of skin was pinched in these forceps, the person experienced severe pain. Also based on the pain reaction, the Desgrange test is based on the introduction of boiling oil into the nipple, or the Raze test - blows to the heels, or cauterization of the heels and other parts of the body with a hot iron. The tests are very unique, cruel, showing the lengths to which doctors went to the difficult problem of ascertaining the function of the central nervous system.

One of the earliest and most valuable signs of death is the “cat's pupil phenomenon,” sometimes called the Beloglazov sign. The shape of the pupil in a person is determined by two parameters, namely: the tone of the muscle that constricts the pupil and intraocular pressure. Moreover, the main factor is muscle tone. In the absence of function of the nervous system, the innervation (connection of organs and tissues with the central nervous system through nerves) of the muscle that constricts the pupil ceases, and its tone is absent. When you apply pressure with your fingers in a lateral or vertical direction, which must be done carefully so as not to damage the eyeball, the pupil takes on an oval shape. The contributing factor for changing the shape of the pupil is the fall intraocular pressure, which determines the tone of the eyeball, and it, in turn, depends on blood pressure. Thus, the Beloglazov sign, or “cat pupil phenomenon,” indicates a lack of innervation of the muscle and, at the same time, a drop in intraocular pressure, which is associated with arterial pressure.

Ascertaining the death of a person The death of a person is declared when the brain or biological death of a person occurs (irreversible death of a person). Biological death is established based on the presence of cadaveric changes (early signs, late signs). Brain (social) death. Clinic (signs) of brain death.

« Brain (social) death“- this diagnosis appeared in medicine with the development of resuscitation. Sometimes in the practice of resuscitators there are cases when, during resuscitation measures, it is possible to restore the activity of the cardiovascular system in patients who were in a state of clinical death for more than 5-6 minutes, but in these patients irreversible changes have already occurred in the brain.

The diagnosis of brain death is established in health care institutions that have the necessary conditions for ascertaining brain death. The death of a person based on brain death is established in accordance with Instructions for ascertaining the death of a person based on the diagnosis of brain death, approved by order of the Ministry of Health of the Russian Federation dated December 20, 2001 No. 460 “On approval of the Instructions for ascertaining the death of a person based on the diagnosis of brain death” (order registered by the Ministry of Justice of the Russian Federation on January 17, 2002 No. 3170).

35. Signs of life and absolute signs of death.

SIGNS OF LIFE

Signs of life are:

presence of preserved breathing. It is determined by the movement of the chest and abdomen, the fogging of a mirror applied to the nose and mouth, the movement of a wad of cotton wool or bandage brought to the nostrils;

presence of cardiac activity. It is determined by palpating the pulse - jerky, periodic oscillations of the walls of peripheral vessels. The pulse can be determined on the radial artery, located under the skin between the styloid process of the radius and the tendon of the internal radial muscle. In cases where it is impossible to examine the pulse on the radial artery, it is determined either on the carotid or temporal artery, or on the legs (on the dorsal artery of the foot and the posterior tibial artery). Usually the heart rate is healthy person 60-75 beats/min, pulse rhythm is correct, uniform, filling is good (it is judged by squeezing the artery with fingers with varying strength).

presence of pupillary reaction to light. It is determined by directing a beam of light from any source onto the eye; constriction of the pupil indicates a positive reaction. In daylight, this reaction is checked as follows: close the eye with your hand for 2-3 minutes, then quickly remove your hand; if the pupils narrow, this indicates the preservation of brain functions.

The absence of all of the above is a signal for immediate resuscitation measures (artificial respiration, chest compressions) until signs of life are restored.

SIGNS OF DEATH

The onset of biological death - the irreversible cessation of the body's vital activity - is preceded by agony (a state preceding the onset of death and from the outside representing a struggle between life and death) and clinical death (a reversible state of deep oppression of all life important functions)

Agony is characterized by:

darkened consciousness

lack of pulse,

breathing disorder that becomes irregular, shallow, convulsive,

lowering blood pressure.

the skin becomes cold, with a pale or bluish tint.

After the agony, clinical death occurs.

Clinical death is a condition in which the main signs of life are absent:

heartbeat;

consciousness

but irreversible changes in the body have not yet developed.

Clinical death lasts 5-8 minutes. This period must be used to provide resuscitation measures. After this time, biological death occurs.

Signs of biological death are:

lack of breathing;

lack of heartbeat;

lack of sensitivity to painful and thermal stimuli;

decrease in body temperature;

clouding and drying of the cornea;

residual deformation of the pupil after careful compression of the eyeball with fingers (Cat's eye syndrome).

lack of gag reflex;

cadaveric spots of blue-violet or purple-red color on the skin of the face, chest, abdomen;

rigor mortis, which manifests itself 2-4 hours after death.

The final decision on the death of the victim is made in accordance with the procedure established by law.

Question 2. Clinical and biological death, brain death

Clinical death is the last stage of dying, which is a reversible condition in which there are no visible signs life (cardiac activity, breathing), the functions of the central nervous system fade away, but metabolic processes in the tissues are preserved. Lasts several minutes (up to 3-5, less often up to 7), gives way to biological death - an irreversible condition in which restoration of vital functions is impossible.

Diagnosis of clinical death is placed on the basis of basic and additional characteristics.

Basic:

Lack of consciousness - the victim does not respond to speech addressed to him or to painful stimuli;

Absence of pulse in the carotid artery;

Lack of breathing.

Additional:

Change in skin color (severe pallor or blueness)

Pupil dilation.

Irreversible cessation of the activity of the respiratory, cardiovascular and central nervous systems is biological death. Ascertainment of biological death is carried out on the basis of probabilistic and reliable signs of death.

Probable signs of death include the absence of activity of the nervous system, heartbeat and external respiration. There is no reaction to external stimulus, sensitivity, or muscle tone. The body position is passive and motionless. The activity of the heart is not determined (blood pressure, pulse, any other signs of heart contractions), and breathing is not detected.

Reliable signs of death include a complex of cadaveric changes - early (cadaveric cooling, local cadaveric desiccation, muscle rigor, cadaveric spots) or late (rotting, preservative cadaveric phenomena - fat wax, mummification, etc.). Reliable signs of death should also include the phenomenon of the “cat’s pupil” (Beloglazov’s sign), which can be observed 10–15 minutes after cardiac arrest and cessation of blood supply to the brain. The sign is that when the eyeball of a corpse is compressed in a transverse or vertical direction, the pupil respectively takes the form of a vertical or horizontal slit (the pupil of a living person remains round). The manifestation of the symptom is due to post-mortem relaxation (relaxation) of the orbicularis oculi muscle, which determines round shape the pupil of a person during life. Damage incompatible with life (for example, dismemberment of the body) also indicates that biological death has occurred.

For the human condition, the socio-legal concept of “brain death” is defined - the irreversible cessation of activity (death) of the higher parts of the central nervous system (cerebral cortex). “Brain death” is a condition when total death of the entire brain occurs, while with the help of resuscitation measures, heart function and blood circulation are artificially maintained, creating the appearance of life. In a state of brain death, a person is dead. We can say that the death of the brain is the death of the entire organism. Currently, “brain death” is understood as a pathological condition associated with total necrosis of the brain, as well as the first cervical segments of the spinal cord, while maintaining cardiac activity and gas exchange, ensured by continuous artificial ventilation. Brain death is caused by the cessation of blood circulation in the brain. The actual synonym for brain death is the concept of “exorbitant coma,” the treatment of which is pointless. A patient who has been declared brain dead is a living corpse, as they say, a “heart-lungs” drug. The introduction of the concept was dictated primarily by the tasks of transplantology (the science of tissue or organ transplantation). The concept is legal. In case of brain death, respiratory and cardiac functions can be supported artificially medical measures or sometimes be saved. Human brain death naturally and irreversibly ultimately leads to biological death. However, even before the onset of biological death, with the death of the higher parts of the central nervous system, a person completely ceases to exist as a social individual, although biological death as such has not yet occurred. Often in various literature, including scientific literature, the state of relative life during brain death is defined by the term “plant life.”

Declaration of brain death is a rather rare situation in medical practice. Much more often in clinical practice and at the scene of an accident, doctors have to declare biological death. The problem of ascertaining death is extremely complex and requires integrated approach For the right decision; it is closely related to the professional, ethical and legal aspects of the activities of a doctor of any specialty. Questions of life and death have always worried and excited the minds of mankind. And when problems arise in correctly determining death and certifying it, the average person cannot always correctly assess the actions of a professional doctor and correctly interpret his actions. Diagnosis (statement) of death, or rather the assessment of the doctor’s actions, are associated with widely held ideas about burial in a state of lethargic sleep (imaginary death), that is, a state of the body in which main functions expressed so weakly that they are invisible to an outside observer. Legends about people buried alive have existed for a long time. They are based, in some cases, on completely explainable facts, the cause of which are certain post-mortem processes. P.A. Minakov at the beginning of our century listed post-mortem phenomena, which can simulate intravital processes and raise suspicion of burial alive. First of all, this is “birth in a coffin.” When burying the corpse of a pregnant woman, as a result of the pressure of putrefactive gases and rigor mortis, the fetus is mechanically squeezed out of the uterus; and during exhumation, the skeleton of the fetus is found between the legs of the corpse. A change in the posture of a corpse due to the resolution (destruction) of rigor mortis. The deposition of moisture droplets from the air on the body of a corpse, which is perceived as intravital sweating. Pink coloration of the skin and visible mucous membranes during death from carbon monoxide poisoning (carbon monoxide poisoning), which is perceived by others as the natural coloration of the skin. Rigidity of the diaphragm or its resolution can cause air to be squeezed out of their lungs, accompanied by sounds. Flow of blood from wounds, especially if the wounds are localized in lower areas of the body in the area of cadaveric spots.

The fear of making a mistake in diagnosing death pushed doctors to develop methods for diagnosing death, creating special vital samples, or creating special burial conditions. Thus, in Munich, for more than 100 years, there was a tomb in which the hand of the deceased was wrapped with a bell cord. The bell rang only once, and when the attendants came to assist the patient who had awakened from his lethargic sleep, it turned out that rigor mortis had resolved.

Thus, to summarize the issue under consideration, it should be noted that for the human condition, the socio-legal concept of “brain death” is defined - the death of the higher parts of the central nervous system, which is diagnosed by a doctor in a medical institution. At the scene of the incident and in the morgue, a statement of biological death is made, the probable signs of the occurrence of which include the absence of activity of the nervous system, heartbeat and external respiration (i.e., signs of clinical death), and the reliable signs include a complex of cadaveric changes.

Biological death (or true death) is the irreversible cessation of physiological processes in cells and tissues. Irreversible cessation usually means “irreversible within the framework of modern medical technologies” cessation of processes. Over time, medicine’s ability to resuscitate dead patients changes, as a result of which the borderline of death is pushed into the future. From the point of view of scientists who support cryonics and nanomedicine, most people who are dying now can be revived in the future if the structure of their brain is preserved now.

Early signs of biological death include:

1. Lack of eye reaction to irritation (pressure)

2. Clouding of the cornea, formation of drying triangles (Larche spots).

3. The appearance of the “cat's eye” symptom: with lateral compression of the eyeball, the pupil transforms into a vertical fusiform slit.

Subsequently, cadaveric spots are found localized in sloping areas of the body, then rigor mortis occurs, then cadaveric relaxation, cadaveric decomposition. Rigor mortis and cadaveric decomposition usually begin in the muscles of the face and upper extremities. The time of appearance and duration of these signs depend on the initial background, temperature and humidity of the environment, and the reasons for the development of irreversible changes in the body.

The biological death of a subject does not mean the immediate biological death of the tissues and organs that make up his body. The time before death of the tissues that make up the human body is mainly determined by their ability to survive under conditions of hypoxia and anoxia. This ability is different for different tissues and organs. The shortest life time under anoxic conditions is observed in brain tissue, to be more precise, in the cerebral cortex and subcortical structures. The stem sections and spinal cord have greater resistance, or rather resistance to anoxia. Other tissues of the human body have this property to a more pronounced extent. Thus, the heart retains its viability for 1.5-2 hours after the onset of, according to modern concepts, biological death. Kidneys, liver and some other organs remain viable for up to 3-4 hours. Muscle tissue, skin and some other tissues may well be viable up to 5-6 hours after the onset of biological death. Bone tissue, being the most inert tissue of the human body, retains its vitality for up to several days. Associated with the phenomenon of survivability of organs and tissues of the human body is the possibility of transplanting them, and the earlier the organs are removed for transplantation after the onset of biological death, the more viable they are, the greater the likelihood of their successful further functioning in a new organism.

Clinical death is the last stage of dying. According to the definition of Academician V.A. Negovsky, “clinical death is no longer life, but is not yet death. This is the emergence of a new quality - a break in continuity. In a biological sense, this state resembles suspended animation, although it is not identical to this concept.” Clinical death is a reversible condition and the mere fact of cessation of breathing or blood circulation is not proof of death.

Signs of clinical death include:

1. Lack of breathing.

2. Absence of heartbeat.

3. Generalized pallor or generalized cyanosis.

4. Lack of pupil reaction to light

Definition of clinical death

The duration of clinical death is determined by the period during which the higher parts of the brain (subcortex and especially the cortex) are able to maintain viability under conditions of anoxia. Characterizing clinical death, V.A. Negovsky talks about two terms.

· The first period of clinical death lasts only 5-6 minutes. This is the time during which the higher parts of the brain retain their viability during anoxia under conditions of normothermia. All world practice indicates that if this period is exceeded, the revival of people is possible, but as a result, decortication or even decerebration occurs.

· But there may be a second term of clinical death that doctors have to deal with when providing care or in special conditions. The second period of clinical death can last tens of minutes, and resuscitation measures will be very effective. The second period of clinical death is observed when special conditions are created to slow down the processes of degeneration of the higher parts of the brain during hypoxia or anoxia.

The duration of clinical death is prolonged in conditions of hypothermia, electric shock, and drowning. In clinical practice, this can be achieved through physical influences (head hypothermia, hyperbaric oxygenation), the use of pharmacological substances that create states similar to suspended animation, hemosorption, transfusion of fresh (not canned) donor blood and some others.

If resuscitation measures were not carried out or were unsuccessful, biological or true death occurs, which is an irreversible cessation of physiological processes in cells and tissues.

Immediate use modern methods Cardiopulmonary resuscitation (resuscitation) can prevent the onset of biological death.

Resuscitation. It is necessary to distinguish between 2 stages of resuscitation. The first stage is immediate, carried out at the scene of the incident (for example, at the scene of a traffic accident) by a person who is in close proximity to the victims. The second stage (specialized) requires the use medications and corresponding equipment and can be carried out in a specialized ambulance, a helicopter specialized for these purposes, in a medical institution adapted for such purposes as anti-shock measures and resuscitation (introduction medications, infusion of blood and blood substitutes, electrocardiography, defibrillation, etc.).

The first stage can be carried out by almost any medical professional or person well trained in resuscitation techniques. The second stage can only be carried out by a specialist, usually an anesthesiologist-resuscitator.

Here it is appropriate to present the techniques and rules of only the first stage, since the manipulations of the second stage are not directly related to traumatology.

The first stage of resuscitation includes: a) restoration of airway patency; b) artificial respiration; c) restoration of blood circulation by external cardiac massage. Resuscitation efforts should begin as quickly as possible. The artificial circulation and ventilation created provide only minimal blood flow and minimal oxygenation, so everything possible must be done to connect as quickly as possible specialized assistance to carry out the second stage of resuscitation and intensive care, to consolidate the initial results of revival.

Restoration of airway patency. Closure of the airways can be caused mostly by vomit, blood, mucus, which the patient, being unconscious, cannot get rid of by coughing or swallowing. In addition, in the absence of consciousness, when the muscles are relaxed, with the neck bent anteriorly, the root of the tongue may rest against the back wall of the pharynx. Therefore, the first thing you should do is bend your head back. In this case, the lower jaw should be pushed forward, the mouth should be opened, which leads to the movement of the root of the tongue from back wall throats. If the tongue still sinks, and there are no extra hands to hold the jaw in an advanced position, you can pierce the tongue with a pin or stitch it with a needle, pull it out of the mouth and secure a thread or pin behind the victim’s ear. If there is foreign content, you need to clean the mouth and throat with a finger wrapped in a bandage, handkerchief, etc. To do this, turn the patient's head and shoulders (if the patient is lying on his back) slightly to one side, open the patient's mouth, clean the oral cavity with a finger (or suction, if he is). If damage is suspected cervical region spine, bending the head back is not necessary due to the risk of worsening spinal cord damage. In this case, they are limited to fixing the extended tongue or introducing an air duct.

Artificial respiration. Ventilation of the respiratory tract should begin by forcing air through the mouth. If it is not possible to blow air into the lungs through the mouth due to the closure of the nasopharynx, then they try to blow air into the nose. When blowing air into the mouth, as mentioned above, it is necessary to move the victim’s jaw forward and tilt his head back. To prevent the howling spirit from leaking through the nose, you need to pinch it with one hand or cover the nasal passages with your cheek. Direct ventilation with exhaled air through the mouth-to-mouth or mouth-to-nose system can be carried out more hygienically if blowing is done through a scarf or gauze placed over the patient’s nose and mouth. You should take a deep breath, place your lips tightly around the patient’s mouth and exhale sharply. When pumping air, it is necessary to monitor whether the chest rises from the air blown into the lungs. Next, conditions are created for passive exhalation: the chest, collapsing, will push out a portion of air from the lungs. After energetically carrying out 3-5 deep blows of air into the victim’s lungs, the pulse in the carotid artery is felt. If the pulse is detected, continue to inflate the lungs at a rhythm of 12 breaths per 1 minute (one breath per 5 seconds).

To carry out artificial respiration through the nose, the patient’s mouth must be closed at the time of insufflation; when exhaling, the mouth must be opened to facilitate the release of air from the respiratory tract.

Sometimes when air is blown in, it enters not only the lungs, but also the stomach, which can be determined by swelling epigastric region, To remove air, press the stomach area with your hand. In this case, along with the air from the stomach, its contents may enter the pharynx and oral cavity; in this case, turn the victim’s head and shoulders to the side and clean the mouth (see above),

Artificial circulation (heart massage). The diagnosis of cardiac arrest is made on the basis of the following signs: loss of consciousness, respiratory arrest, dilated pupils, absence of pulse;) in large vessels - carotid, femoral. The last sign most reliably indicates cardiac arrest. The pulse should be determined from the side closest to the person providing assistance. To determine the pulse on the carotid artery, you must use the following technique: the index and middle fingers are placed on thyroid cartilage the patient, and then move it to the side of the neck, trying to palpate the vessel flat and not with the tailbones of the fingers.

Blood circulation can be restored during cardiac arrest using external cardiac massage, that is, rhythmic compression of the heart between the sternum and the spinal column. When compressed, blood from the left ventricle flows through the vessels to the brain and heart. After the pressure on the sternum ceases, it fills the cavities of the heart again.

External cardiac massage technique. The palm of one hand is placed on bottom part sternum, the palm of the other hand is placed on top of the first. The sternum is pressed towards the spinal column, leaning on the hands and body weight (in children, compression of the sternum is carried out only with the hands). Having pressed the sternum as much as possible, you need to hold the compression for 1/2 second, after which the pressure is quickly released. It is necessary to repeat compression of the sternum at least once every 1 second, because less frequent pressure does not create sufficient blood flow. In children, the frequency of sternum compressions should be higher - up to 100 compressions per minute. In the intervals between pressures, there is no need to remove your hands from the sternum. The effectiveness of the massage is judged by: a) pulse impulses on the carotid artery in time with the massage; b) constriction of the pupils; c) the appearance of independent respiratory movements. Changes in skin color are also taken into account.

A combination of cardiac massage and ventilation. External massage by itself, without simultaneously blowing air into the lungs, cannot lead to resuscitation. Therefore, both of these methods of revival must be combined. If the revival is carried out by 1 person, it is necessary to perform 15 compressions of the sternum for 15 seconds every 2 quick blows of air into the lungs (using the mouth-to-mouth or mouth-to-nose system). The patient's head must be tilted back. If resuscitation measures are carried out by 2 people, then one of them performs one deep inflation of the lungs after every fifth chest compression.

Cardiopulmonary resuscitation continues until a spontaneous pulse occurs; after this, artificial respiration should be continued until spontaneous breathing occurs.

When moving the victim onto a vehicle, carrying him on a stretcher, or transporting resuscitation measures, if necessary, it is necessary to continue in the same mode: perform 15 sternum compressions for 2 deep intense air injections.

Biological death is the irreversible cessation of biological processes. Let's consider the main signs, causes, types and methods of diagnosing the decline of the body.

Death is characterized by cessation of cardiac activity and breathing, but does not occur immediately. Modern methods Cardiopulmonary resuscitation can prevent death.

A distinction is made between physiological, that is, natural death (the gradual extinction of basic life processes) and pathological or premature. The second type can be sudden, that is, occur in a few seconds, or violent, as a result of murder or an accident.

ICD-10 code

The International Classification of Diseases, 10th revision, has several categories in which death is considered. Most of the deaths are caused by nosological units that have a specific ICD code.

R96.1 Death occurring less than 24 hours after the onset of symptoms and with no other explanation

R95-R99 Ill-defined and unknown causes of death:

R96.0 Instant death
R96 Other sudden death of unknown cause
R98 Death without witnesses
R99 Other ill-defined and unspecified causes of death
I46.1 Sudden cardiac death, so described

Thus, cardiac arrest caused by essential hypertension I10 is not considered the main cause of death and is indicated in the death certificate as a concomitant or background lesion in the presence of nosologies of ischemic diseases of the cardiovascular system. Hypertensive disease can be identified by ICD 10 as the main cause of death if the deceased has no indications of ischemic (I20-I25) or cerebrovascular diseases (I60-I69).

ICD-10 code

R96.0 Instant death

Causes of biological death

Establishing the cause of biological cardiac arrest is necessary for its ascertainment and identification according to the ICD. This requires determining the signs of the action of damaging factors on the body, the duration of the damage, establishing thanatogenesis and excluding other damage that could cause death.

Main etiological factors:

Primary reasons:

Injuries incompatible with life
Abundant and acute blood loss
Compression and shaking of vital organs
Asphyxia with aspirated blood
State of shock
Embolism

Secondary causes:

Infectious diseases
Intoxication of the body
Non-infectious diseases.

Signs of biological death

Signs of biological death are considered a reliable fact of death. 2-4 hours after cardiac arrest, cadaveric spots begin to form on the body. At this time, rigor mortis sets in, which is caused by cessation of blood circulation (it goes away spontaneously within 3-4 days). Let's consider the main signs that allow us to recognize dying:

Absence of cardiac activity and breathing - the pulse is not palpable in the carotid arteries, heart sounds are not heard.
There is no cardiac activity for more than 30 minutes (at room temperature).
Postmortem hypostasis, that is, dark blue spots in sloping parts of the body.

The above-described manifestations are not considered to be the main ones for ascertaining death when they occur under conditions of deep cooling of the body or during the inhibitory effect of drugs on the central nervous system.

Biological dying does not mean the immediate death of organs and tissues of the body. Their time of death depends on their ability to survive in anoxic and hypoxic conditions. This ability is different for all tissues and organs. Brain tissue (cerebral cortex and subcortical structures) die most quickly. The spinal cord and stem sections are resistant to anoxia. The heart is viable for 1.5-2 hours after death is declared, and the kidneys and liver for 3-4 hours. Skin and muscle tissue viable up to 5-6 hours. Considered the most inert bone, since it retains its functions for several days. The phenomenon of survivability of human tissues and organs makes it possible to transplant them and further work in a new organism.

Early signs of biological death

Early signs appear within 60 minutes of death. Let's look at them:

When pressed or light stimulation there is no reaction of the pupils.
Triangles of dried skin (Larche's spots) appear on the body.
When the eye is compressed on both sides, the pupil takes on an elongated shape due to the lack of intraocular pressure, which depends on arterial pressure (cat's eye syndrome).
The iris of the eye loses its original color, the pupil becomes cloudy, becoming covered with a white film.
The lips acquire a brown color, become wrinkled and dense.

The appearance of the symptoms described above indicates that resuscitation measures are pointless.

Late signs of biological death

Late signs appear within 24 hours from the moment of death.

Cadaveric spots - appear 1.5-3 hours after cardiac arrest, have a marble color and are located in the underlying parts of the body.
Rigor mortis is one of the reliable signs of death. Occurs due to biochemical processes in the body. Complete rigor occurs within 24 hours and disappears on its own after 2-3 days.
Cadaveric chilling is diagnosed when the body temperature has dropped to air temperature. The rate at which the body cools depends on the ambient temperature; on average it decreases by 1°C per hour.

Reliable signs of biological death

Reliable signs of biological death allow us to confirm death. This category includes phenomena that are irreversible, that is, a set of physiological processes in tissue cells.

Drying of the white membrane of the eye and cornea.
The pupils are wide and do not respond to light or touch.
Change in the shape of the pupil when the eye is compressed (Beloglazov’s sign or cat’s eye syndrome).
Decrease in body temperature to 20 °C, and in the rectum to 23 °C.
Cadaveric changes - characteristic spots on the body, rigor, drying out, autolysis.
Absence of pulse in the main arteries, no spontaneous breathing and no heartbeat.
Blood hypostasis spots are pale skin and blue-violet spots that disappear with pressure.
Transformation of cadaveric changes - rotting, fat wax, mummification, peat tanning.

If the above-described signs appear, resuscitation measures are not carried out.

Stages of biological death

The stages of biological death are stages characterized by gradual suppression and cessation of basic life functions.

Pregonal state - sharp depression or complete absence consciousness. The skin is pale, the pulse is weakly palpable in the femoral and carotid arteries, the pressure drops to zero. Oxygen starvation quickly increases, worsening the patient's condition.
Terminal pause is an intermediate stage between life and dying. If resuscitation measures are not carried out at this stage, then death is inevitable.
Agony - the brain stops regulating the functioning of the body and vital processes.

If the body has been affected by destructive processes, then all three stages may be absent. Duration of the first and last stage can be from several weeks or days to a couple of minutes. The end of agony is considered to be clinical death, which is accompanied by a complete stop of vital processes. From this moment it is possible to state cardiac arrest. But irreversible changes have not yet occurred, so there are 6-8 minutes for active resuscitation measures to bring a person back to life. The last stage of dying is irreversible biological death.

Types of biological death

Types of biological death are a classification that allows doctors, in each case of death, to establish the main signs that determine the type, genus, category and cause of death. Today in medicine there are two main categories - violent and non-violent death. The second sign of dying is genus - physiological, pathological or sudden death. In this case, violent death is divided into: murder, accident, suicide. The last classifying feature is the species. Its definition is associated with identifying the main factors that caused death and are combined by their effect on the body and origin.

The type of death is determined by the nature of the factors that caused it:

Violent – mechanical damage, asphyxia, extreme temperatures and electric current.
Acute - diseases of the respiratory system, cardiovascular system, gastrointestinal tract, infectious lesions, diseases of the central nervous system and other organs and systems.

Particular attention is paid to the cause of death. It could be a disease or underlying injury that caused the heart to stop. In case of violent death, these are injuries caused by gross trauma to the body, blood loss, concussion and contusion of the brain and heart, shock of 3-4 degrees, embolism, reflex cardiac arrest.

Ascertainment of biological death

Biological death is declared after the brain dies. The statement is based on the presence of cadaveric changes, that is, early and late signs. It is diagnosed in health care institutions that have all the conditions for such a diagnosis. Let's look at the main signs that help determine death:

Lack of consciousness.
Lack of motor reactions and movements to painful stimuli.
Lack of pupillary response to light and corneal reflex on both sides.
Absence of oculocephalic and oculovestibular reflexes.
Absence of pharyngeal and cough reflexes.

In addition, a spontaneous breathing test can be used. It is carried out only after receiving complete data confirming brain death.

Exist instrumental studies, used to confirm brain non-viability. For this purpose, cerebral angiography, electroencephalography, transcranial Doppler ultrasonography or nuclear magnetic resonance angiography are used.

Diagnosis of clinical and biological death

Diagnosis of clinical and biological death is based on signs of dying. The fear of making a mistake in determining death pushes doctors to constantly improve and develop methods for vital tests. So, more than 100 years ago in Munich there was a special tomb in which a cord with a bell was tied to the hand of the deceased, hoping that they had made a mistake in determining death. The bell rang once, but when the doctors came to help the patient who had awakened from lethargic sleep, it turned out that this was the resolution of rigor mortis. But in medical practice, there are cases of erroneous diagnosis of cardiac arrest.

Biological death is determined by a set of signs that are associated with the “vital tripod”: cardiac activity, functions of the central nervous system and respiration.

To date no reliable symptoms, which would confirm the safety of breathing. Depending on the environmental conditions, a cold mirror, listening to breathing or the Winslow test are used (a vessel with water is placed on the chest of the dying person, by the vibration of which the respiratory movements of the sternum are judged).
To check the activity of the cardiovascular system, palpation of the pulse in the peripheral and central vessels and auscultation are used. These methods are recommended to be carried out at short intervals of no more than 1 minute.
To detect blood circulation, use the Magnus test (tight constriction of the finger). The lumen of the earlobe can also provide some information. In the presence of blood circulation, the ear has a reddish-pink color, while in a corpse it is gray-white.
The most important indicator life is the preservation of the function of the central nervous system. The performance of the nervous system is checked by the absence or presence of consciousness, muscle relaxation, passive body position and reaction to external stimuli (pain, ammonia). Particular attention is paid to the reaction of the pupils to light and the corneal reflex.

In the last century, cruel methods were used to test the functioning of the nervous system. For example, during Jose’s test, a person’s skin folds were pinched with special forceps, causing pain. When carrying out the Desgrange test, boiling oil was injected into the nipple; the Raze test involved burning the heels and other parts of the body with a hot iron. Such peculiar and cruel methods show the lengths to which doctors went to determine death.

Clinical and biological death

There are such concepts as clinical and biological death, each of which has certain signs. This is due to the fact that a living organism does not die simultaneously with the cessation of cardiac activity and respiratory arrest. He continues to live for some time, which depends on the brain's ability to survive without oxygen, usually 4-6 minutes. During this period, the fading life processes of the body are reversible. This is called clinical death. It can occur due to heavy bleeding, with acute poisoning, drowning, electrical injuries or reflex cardiac arrest.

The main signs of clinical dying:

The absence of a pulse in the femoral or carotid artery is a sign of circulatory arrest.
Lack of breathing - checked by visible movements of the chest during exhalation and inhalation. To hear the sound of breathing, you can put your ear to your chest, or bring a glass or mirror to your lips.
Loss of consciousness – lack of response to painful and sound stimuli.
Dilation of the pupils and their lack of reaction to light - the victim’s upper eyelid is lifted to determine the pupil. As soon as the eyelid drops, it needs to be raised again. If the pupil does not constrict, this indicates a lack of reaction to light.

If the first two of the above signs are present, then resuscitation is urgently needed. If irreversible processes have begun in the tissues of organs and the brain, resuscitation is not effective and biological death occurs.

The difference between clinical death and biological death

The difference between clinical death and biological death is that in the first case the brain has not yet died and timely resuscitation can revive all its functions and the functions of the body. Biological dying occurs gradually and has certain stages. There is a terminal state, that is, a period characterized by a sharp failure in the functioning of all organs and systems to a critical level. This period consists of stages by which biological death can be distinguished from clinical death.

Predagonia - at this stage there is a sharp decrease in the vital activity of all organs and systems. The functioning of the heart muscles is impaired, respiratory system, the pressure drops to a critical level. Pupils still react to light.
Agony is considered the stage of the last surge of life. A weak pulse beat is observed, the person inhales air, the reaction of the pupils to light slows down.
Clinical death is an intermediate stage between death and life. Lasts no more than 5-6 minutes.

Complete shutdown of the circulatory and central nervous systems, and arrest of the respiratory tract are signs that combine clinical and biological death. In the first case, resuscitation measures allow the victim to be brought back to life with complete restoration of the main functions of the body. If during resuscitation your health improves, your complexion normalizes, and your pupils react to light, then the person will live. If no improvement is observed after emergency assistance, this indicates a stop in the functioning of basic life processes. Such losses are irreversible, so further resuscitation is useless.

First aid for biological death

First aid for biological death is a set of resuscitation measures that allow you to restore the functioning of all organs and systems.

Immediate cessation of exposure to damaging factors ( electricity, low or high temperatures, compression of the body by weights) and unfavorable conditions (extraction from water, liberation from a burning building, and so on).
First medical and first aid depending on the type and nature of the injury, disease or accident.
Transporting the victim to a medical facility.

Of particular importance is the rapid delivery of a person to the hospital. It is necessary to transport not only quickly, but also correctly, that is, in a safe position. For example, in an unconscious state or when vomiting, it is best to lie on your side.

When providing first aid, you must adhere to the following principles:

All actions must be expedient, quick, deliberate and calm.
It is necessary to assess the environment and take measures to stop the effects of factors damaging the body.
Correctly and quickly assess a person's condition. To do this, you need to find out the circumstances under which the injury or illness occurred. This is especially important if the victim is unconscious.
Determine what tools are needed to provide assistance and prepare the patient for transportation.

What to do in case of biological death?

What to do in case of biological death and how to normalize the victim’s condition? The fact of death is established by a paramedic or doctor if there are reliable signs or based on a combination of certain symptoms:

Absence of cardiac activity for more than 25 minutes.
Lack of spontaneous breathing.
Maximum pupil dilation, lack of reaction to light and corneal reflex.
Postmortem hypostasis in sloping parts of the body.

Resuscitation measures are the actions of doctors aimed at maintaining breathing, circulatory function and reviving the body of a dying person. During the resuscitation process, cardiac massage is mandatory. The basic CPR complex includes 30 compressions and 2 breaths, regardless of the number of rescuers, after which the cycle is repeated. Required condition revitalization is constant monitoring of efficiency. If a positive effect of the actions taken is observed, they continue until the signs of death disappear permanently.

Biological death is considered the last stage of dying, which without timely assistance becomes irreversible. When the first symptoms of death appear, it is necessary to carry out urgent resuscitation, which can save lives.

The death of a person is the complete cessation of biological and physiological processes in his body. The fear of making a mistake in recognizing it forced doctors and researchers to develop accurate methods for diagnosing it and identifying the main signs indicating the onset of death of the human body.

In modern medicine, clinical and biological (final) death are distinguished. Brain death is considered separately.

We will talk about what the main signs of clinical death look like, as well as how biological death manifests itself, in this article.

What is clinical death of a person

This is a reversible process, which means stopping the heartbeat and breathing. That is, life in a person has not yet died out, and, therefore, restoration of vital processes with the help of resuscitation actions is possible.

Later in the article, the comparative signs of biological and clinical death will be discussed in more detail. By the way, the human condition between these two types of death of the body is called terminal. And clinical death may well move into the next, irreversible stage - biological, an indisputable sign of which is the rigor of the body and the subsequent appearance of cadaveric spots on it.

What are the signs of clinical death: preagonal phase

Clinical death may not occur immediately, but may go through several phases, characterized as preagonal and agonal.

The first of them manifests itself in inhibition of consciousness while it is preserved, as well as in dysfunction of the central nervous system, expressed by stupor or coma. The pressure, as a rule, is low (maximum 60 mm Hg), and the pulse is rapid, weak, shortness of breath appears, and the breathing rhythm is disturbed. This condition can last for several minutes or several days.

The preagonal signs of clinical death listed above contribute to the appearance of oxygen starvation in tissues and the development of so-called tissue acidosis (due to a decrease in pH). By the way, in the preagonal state the main type of metabolism is oxidative.

Manifestation of agony

The onset of agony is marked by a short series of breaths, and sometimes by a single breath. Due to the fact that a dying person has simultaneous excitation of the muscles that carry out both inhalation and exhalation, ventilation of the lungs almost completely stops. The higher parts of the central nervous system are switched off, and the role of the regulator of vital functions, as proven by researchers, at this moment passes to the spinal cord and medulla oblongata. This regulation is aimed at mobilizing the last possibilities of preserving the life of the human body.

By the way, it is during agony that a person’s body loses that notorious 60-80 g of weight, which is attributed to the soul leaving it. True, scientists prove that in fact weight loss occurs due to the complete combustion of ATP in the cells (enzymes that supply energy to the cells of a living organism).

The agonal phase is usually accompanied by a lack of consciousness. A person's pupils dilate and do not respond to light. Arterial pressure It is impossible to determine, the pulse is practically not palpable. In this case, the heart sounds are muffled, and breathing is rare and shallow. These signs of clinical death, which is approaching, can last several minutes or several hours.

How does the state of clinical death manifest?

When clinical death occurs, breathing, pulse, blood circulation and reflexes disappear, and cellular metabolism proceeds anaerobically. But this does not last long, because the amount of energy in the dying person’s brain is depleted, and his nervous tissue dies.

By the way, modern medicine has established that after the cessation of blood circulation, death different organs does not occur simultaneously in the human body. So, the brain dies first, because it is most sensitive to lack of oxygen. After 5-6 minutes, irreversible changes occur in brain cells.

Signs of clinical death are: pale skin (they become cold to the touch), absence of breathing, pulse and corneal reflex. In this case, urgent resuscitation measures should be carried out.

Three main signs of clinical death

The main signs of clinical death in medicine include coma, apnea and asystole. We will look at each of them in more detail.

Coma is serious condition, which is manifested by loss of consciousness and loss of central nervous system functions. As a rule, its onset is diagnosed if the patient’s pupils do not react to light.

Apnea - cessation of breathing. It is manifested by a lack of movement of the chest, which indicates a cessation of respiratory activity.

Asystole - main feature clinical death, expressed by cardiac arrest together with the absence of bioelectrical activity.

What is sudden death

A special place in medicine is given to the concept of sudden death. It is defined as non-violent and occurring unexpectedly within 6 hours after the onset of the first acute symptoms.

This type of death includes those that occurred without apparent reason cases of cardiac arrest, which are caused by the occurrence of ventricular fibrillation (disjointed and uncoordinated contraction of some groups muscle fibers) or (less often) acute weakening of heart contractions.

Signs of sudden clinical death are manifested by loss of consciousness, pale skin, cessation of breathing and pulsation in the carotid artery (by the way, it can be determined by placing four fingers on the patient’s neck between the Adam’s apple and the sternocleidomastoid muscle). Sometimes this condition is accompanied by short-term tonic convulsions.

In medicine, there are a number of other reasons that can cause sudden death. These include electrical injuries, lightning, suffocation due to a foreign body entering the trachea, as well as drowning and freezing.

As a rule, in all these cases, a person’s life directly depends on the efficiency and correctness of resuscitation measures.

How is cardiac massage done?

If the patient shows the first signs of clinical death, he is placed on his back on a hard surface (floor, table, bench, etc.), the belts are unfastened, restrictive clothing is removed and chest compressions begin.

The sequence of resuscitation actions looks like this:

the person providing assistance takes a place to the left of the victim;
places hands one on top of the other on the lower third of the sternum;
pushes (15 times) at a rate of 60 times per minute, using your body weight to achieve a flexion of the chest of approximately 6 cm;
then grabs the chin and pinches the nose of the dying person, throws back his head, exhales as much as possible into his mouth;
artificial respiration is done after 15 massage pushes in the form of two exhalations into the mouth or nose of the dying person for 2 seconds each (you need to make sure that the victim’s chest rises).

Indirect massage helps compress the heart muscle between chest and spine. Thus, the blood is pushed into large vessels, and during the pause between beats the heart is filled with blood again. In this way, cardiac activity is resumed, which after some time can become independent. The situation can be checked after 5 minutes: if the victim’s signs of clinical death disappear and a pulse appears, the skin turns pink and the pupils constrict, then the massage was effective.

How does an organism die?

Different human tissues and organs have different resistance to oxygen starvation, as mentioned above, and their death after the heart stops occurs in different time periods.

As is known, the cerebral cortex dies first, then the subcortical centers, and finally the spinal cord. Four hours after the heart stops working, the bone marrow dies, and a day later the destruction of human skin, tendons and muscles begins.

How does brain death manifest?

From the above it is clear that precise definition Signs of clinical death of a person are very important, because from the moment the heart stops until the onset of brain death, leading to irreparable consequences, there are only 5 minutes.

Brain death is the irreversible cessation of all its functions. And its main diagnostic sign is the absence of any reactions to stimulation, which indicates the cessation of the functioning of the hemispheres, as well as the so-called EEG silence even in the presence of artificial stimulation.

Doctors also consider the absence of intracranial circulation to be a sufficient sign of brain death. And, as a rule, this means the onset of biological death of a person.

What does biological death look like?

To make it easier to navigate the situation, you should distinguish between the signs of biological and clinical death.

Biological or, in other words, the final death of the organism is the last stage of dying, which is characterized by irreversible changes, developing in all organs and tissues. In this case, the functions of the main body systems cannot be restored.

The first signs of biological death include the following:

when pressing on the eye there is no reaction to this irritation;
the cornea becomes cloudy, drying triangles form on it (the so-called Larche spots);
if the eyeball is gently squeezed from the sides, the pupil turns into a vertical slit (the so-called “cat’s eye” symptom).

By the way, the signs listed above also indicate that death occurred at least an hour ago.

What happens during biological death

The main signs of clinical death are difficult to confuse with late signs of biological death. The latter appear:

redistribution of blood in the body of the deceased;
purple cadaveric spots, which are localized in lower places on the body;
rigor mortis;
and, finally, cadaveric decomposition.

The cessation of blood circulation causes a redistribution of blood: it collects in the veins, while the arteries are practically empty. The post-mortem process of blood coagulation occurs in the veins, and with a quick death there are few clots, and with a slow death there are many.

Rigor mortis usually begins in the facial muscles and hands of a person. And the time of its appearance and the duration of the process strongly depend on the cause of death, as well as on the temperature and humidity at the location of the dying person. Typically, the development of these signs occurs within 24 hours after death, and after 2-3 days after death they disappear in the same sequence.

A few words in conclusion

To prevent the onset of biological death, it is important not to waste time and provide the necessary assistance to the dying person.

It must be taken into account that the duration of clinical death directly depends on what caused it, what age the person is, as well as on external conditions.

There are cases when signs of clinical death could be observed for half an hour if it occurred, for example, due to drowning in cold water. Exchange processes throughout the body and in the brain in such a situation are greatly slowed down. And with artificial hypothermia, the duration of clinical death is increased to 2 hours.

Severe blood loss, on the contrary, provokes the rapid development of pathological processes in nerve tissues even before cardiac arrest, and restoration of life in these cases is impossible.

According to the instructions of the Russian Ministry of Health (2003), resuscitation measures are stopped only when a person’s brain death is determined or if they are ineffective medical care provided within 30 minutes.

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2. Clinical death, its causes and signs. Biological death.

3. First aid for sudden stop of breathing and cardiac activity

Clinical death

Signs of clinical death

Treatment

Pathophysiological basis of clinical death

Clinical death in culture

/ Death

35. Signs of life and absolute signs of death.

Question 2. Clinical and biological death, brain death

ICD-10 code

ICD-10 code

Causes of biological death

Signs of biological death

Early signs of biological death

Late signs of biological death

Reliable signs of biological death

Stages of biological death

Types of biological death

Ascertainment of biological death

Diagnosis of clinical and biological death

Clinical and biological death

The difference between clinical death and biological death

First aid for biological death

What to do in case of biological death?

What is clinical death of a person

What are the signs of clinical death: preagonal phase

Manifestation of agony

How does the state of clinical death manifest?

Three main signs of clinical death

What is sudden death

How is cardiac massage done?

How does an organism die?

How does brain death manifest?

What does biological death look like?

What happens during biological death

A few words in conclusion

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