Clinical and biological death. The concept, signs of clinical and biological death

Biological death is an irreversible stop biological processes. Consider the main signs, causes, types and methods for diagnosing the extinction of the body.

Death is characterized by cardiac and respiratory arrest, but does not occur immediately. Modern methods cardiopulmonary resuscitation can prevent dying.

There are physiological, that is, natural death (gradual extinction of the main life processes) and pathological or premature. The second type can be sudden, that is, come on in a few seconds, or violent, as a result of a murder or accident.

ICD-10 code

The International Classification of Diseases, 10th Revision, has several categories in which death is considered. Most of the deaths are due to nosological units having specific code by mcb.

• R96.1 Death occurring less than 24 hours after onset of symptoms, not otherwise explained

R95-R99 Causes of death ill-defined and unknown:

• R96.0 Instant death
• R96 Other species sudden death By unknown reason
• R98 Death without witnesses
• R99 Other ill-defined and unspecified causes of death
• I46.1 Sudden cardiac death as 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 cardio-vascular system. Hypertensive disease can be identified by ICD 10 as the main cause of death if the deceased does not have indications of ischemic (I20-I25) or cerebrovascular disease (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, the establishment of thanatogenesis and the exclusion of other damage that could cause death.

Main etiological factors:

Primary reasons:

• Damage incompatible with life
• Abundant and acute blood loss
• Squeezing and concussion of vital organs
• Asphyxia with aspirated blood
• state of shock
• Embolism

Secondary reasons:

• Infectious diseases
• Body intoxication
• Diseases of a non-infectious nature.

Signs of biological death

Signs of biological death are considered true fact death. After 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 circulatory arrest (spontaneously passes for 3-4 days). Consider the main signs that allow you to recognize dying:

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

The above manifestations are not considered the main ones for ascertaining death when they occur in conditions of deep cooling of the body or with a depressing effect. medicines to the central nervous system.

biological dying does not mean the simultaneous death of organs and tissues of the body. Their time of death depends on their ability to survive in conditions of anoxia and hypoxia. In all tissues and organs, this ability is different. The tissues of the brain (cerebral cortex and subcortical structures) die the fastest. The spinal cord and stem sections are resistant to anoxia. The heart is viable within 1.5-2 hours after the declaration of death, and the kidneys and liver within 3-4 hours. Skin and muscle tissues are viable up to 5-6 hours. Bone tissue is considered the most inert, as it retains its functions for several days. The phenomenon of survival 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 dying. Consider them:

• With pressure or light stimulation, there is no reaction of the pupils.
• Triangles of dry skin appear on the body (Larcher spots).
• When squeezing the eye from both sides, the pupil takes an elongated shape due to the lack of intraocular pressure, which depends on the arterial (syndrome cat eye).
• The iris of the eye loses its original color, the pupil becomes cloudy, covered with a white film.
• The lips turn brown, become wrinkled and dense.

The appearance of the above symptoms indicates that the resuscitation meaningless.

Late signs of biological death

Late signs appear within a day from the moment of death.

• Corpse 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 surest signs of death. It occurs due to biochemical processes in the body. Rigor rigor sets in after 24 hours and disappears on its own after 2-3 days.
• Cadaveric cooling - diagnosed when the body temperature has dropped to air temperature. The rate of body cooling 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 state the death. This category includes phenomena that are irreversible, that is, a set of physiological processes in tissue cells.

• Drying of the white of the eye and cornea.
• The pupils are wide, do not react to light and touch.
• Change in the shape of the pupil when squeezing the eye (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, stiffness, drying, autolysis.
• No pulse on main arteries, no spontaneous breathing and heartbeats.
• Blood hypostasis spots are pale skin and blue-violet spots that disappear with pressure.
• Transformation cadaveric changes- rotting, fat wax, mummification, peat tanning.

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

Stages of biological death

Stages biological death- these are stages characterized by gradual oppression and stoppage of basic vital functions.

• Predagonal state - a sharp depression or complete absence consciousness. Pale skin, the pulse is weakly palpable on the femoral and carotid arteries, the pressure drops to zero. Oxygen starvation rapidly increases, worsening the patient's condition.
• The terminal pause is an intermediate stage between life and death. If resuscitation measures are not taken at this stage, then death is inevitable.
• Agony - the brain stops regulating the functioning of the body and life processes.

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

Types of biological death

Types of biological death is a classification that allows doctors, in each case of death, to establish the main signs that determine the type, gender, category and cause of death. Today in medicine there are two main categories - violent and non-violent death. The second sign of dying is the gender - physiological, pathological or sudden death. At the same time, violent death is divided into: murder, accident, suicide. The last classifying feature is the species. Its definition is associated with the identification of the main factors that caused death and combined according to the 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.
• Sudden - diseases of the respiratory system, cardiovascular system, gastrointestinal tract, infectious lesions, diseases of the central nervous system and other organs and systems.

Special attention assigned to the cause of death. It could be the disease or underlying injury that caused the cardiac arrest. With violent death, these are injuries caused by gross traumatization of the body, blood loss, concussion and contusion of the brain and heart, shock of 3-4 degrees, embolism, reflex cardiac arrest.

Statement of biological death

The statement of biological death comes after the dying of the brain. The statement is based on the presence of cadaveric changes, that is, early and late signs. It is diagnosed in healthcare institutions that have all the conditions for such a statement. Consider the main signs that allow you to determine the death:

• Lack of consciousness.
• Absence 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 the death of the brain.

Exist instrumental research used to confirm brain nonviability. For this, 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 the signs of dying. The fear of making a mistake in determining death pushes doctors to constantly improve and develop methods of life 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 man who had woken up from lethargic sleep to the patient, it turned out that it was the resolution of rigor mortis. But in medical practice cases of erroneous ascertainment of cardiac arrest are known.

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 conditions external environment they use a cold mirror, listening to the breath or the Winslow test (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 on the peripheral and central vessels, auscultation is used. These methods are recommended to be carried out at short intervals of no more than 1 minute.
• Magnus test (tight constriction of the finger) is used to detect blood circulation. The lumen of the earlobe can also provide certain 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 position body and reactions to external stimuli (pain effects, 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 the Jose test, the folds of the skin were infringed on the person with special forceps, causing pain. During the Degrange test, boiling oil was injected into the nipple, the Razet test involved cauterization of the heels and other parts of the body with a red-hot iron. Such peculiar and cruel methods show what tricks the doctors went to when ascertaining 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. It continues to live for some time, which depends on the ability of the brain to survive without oxygen, usually 4-6 minutes. During this period, the fading vital processes of the body are reversible. This is called clinical death. It may arise due to heavy bleeding, at acute poisoning, drowning, electrical injury or reflex cardiac arrest.

The main signs of clinical dying:

• Absence of a pulse in the femur or carotid artery- a sign of circulatory arrest.
• Lack of breathing - check for visible movements chest during exhalation and inhalation. To hear the sound of breathing, you can put your ear to your chest, bring a glass or mirror to your lips.
• Loss of consciousness - lack of response to pain and sound stimuli.
• The expansion of the pupils and the absence of their reaction to light - the victim is lifted upper eyelid to determine the pupil. As soon as the eyelid falls, it must be raised again. If the pupil does not narrow, then this indicates a lack of reaction to light.

If there are the first two of the above signs, 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

difference clinical death from biological in that in the first case, the brain has not yet died and timely resuscitation can revive all its functions and functions of the body. Biological dying occurs gradually and has certain stages. There is a terminal state, that is, a period that is 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.

• Predogony - at this stage there is a sharp decline vital activity of all organs and systems. The work of the heart muscles, the respiratory system is disrupted, the pressure drops to a critical level. The pupils are still reactive to light.
• Agony - is considered the stage of the last surge of life. A weak pulse beat is observed, a 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 system, stop respiratory tract- these are signs that combine clinical and biological death. In the first case, resuscitation measures allow the victim to return to life with a complete restoration of the main functions of the body. If during resuscitation the state of health improves, the complexion normalizes and there is a reaction of the pupils to light, then the person will live. If after the emergency assistance improvements are not observed, this indicates a stop in the functioning of the main 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 (electric current, low or high temperatures, squeezing the body with weights) and adverse conditions (extraction from water, release from a burning building, and so on).
• First medical and first aid depending on the type and nature of injury, illness or accident.
• Transportation of 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 unconscious or when vomiting, best on the side.

When providing the first medical care the following principles must be followed:

• 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 the condition of a person. To do this, find out the circumstances under which the injury or illness occurred. This is especially important if the victim is unconscious.
• Determine what means are needed to provide assistance and prepare the patient for transportation.

What to do with biological death?

What to do with biological death and how to normalize the condition of the victim? The fact of death is established by a paramedic or a doctor in the presence of reliable signs or a combination of certain symptoms:

• Absence of cardiac activity for more than 25 minutes.
• Lack of spontaneous breathing.
• Maximum pupil dilation, no reaction to light and no corneal reflex.
• Postmortem hypostasis in sloping parts of the body.

Resuscitation measures are the actions of doctors aimed at maintaining breathing, circulatory functions and reviving the body of a dying person. In the process of resuscitation, 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. A prerequisite revitalization is a constant monitoring of efficiency. If there is a positive effect of the actions taken, then they continue until the permanent disappearance of the dying signs.

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 a life.

Clinical death is a rather rare occurrence. It got its name for a reason. And the thing is that such a state is transitional between death and life, but it has one important feature- it is quite reversible. And only competently rendered medical care can help in case of clinical death.

A little information

This phenomenon overtakes a person when the blood flow is disturbed in vital organs and systems. This happens due to problems in the functioning of the heart. And the reasons for failures can be varied.

First aid in case of clinical death should be provided immediately, because in this state, the count is almost seconds. If resuscitation is not timely, then it will be impossible to return the patient to the damaged organs.

First aid methods and signs of clinical death should be well known to every person, because from similar situation not even fully insured healthy people.

Signs of the phenomenon

In such a pathological state, all the processes necessary for a full-fledged life activity stop. So, the signs of clinical death are precisely in the absence of noticeable phenomena: for example, pulse, respiration.

• The person loses consciousness. Due to disruptions in the circulation of blood to the brain, this symptom occurs literally immediately: in the first few seconds.
• The person does not feel a pulse. This symptom is also explained by circulatory arrest. You can make sure that there is no pulse by feeling it in the neck area under the jaw. This is where the carotid artery passes, which transports blood to the brain. That is why it is very important to feel the pulse just in this place. In children, it is quite difficult to feel the heartbeat on the neck, so you can control it on the wrist.
• The person has no breath. You can verify the presence of this sign by paying attention to the characteristic sounds of breaths and chest movements. Trying to determine the breath with a simple mirror - bad decision because it takes too long. And first aid in case of clinical death must be provided as quickly as possible.
• Human pupils do not react to light. Despite the fact that this sign is unambiguously present during clinical death, it is not paramount. And all because it can be seen only after a minute and a half, so it’s definitely not worth waiting for.

In addition, before the onset of this condition, a person may complain of chest pain, severe shortness of breath and dizziness. Loss of consciousness can occur in parallel with convulsions, after which the pupils dilate.

Causes

As already mentioned, clinical death occurs due to violations of the heart.

Causes of failures in the functioning of such important body can be varied:

However, despite the exact reasons that led to such a condition, clinical death requires an immediate response in the form of competent first aid.

stages

Since this pathological condition is borderline, there are two options for the outcome of events: either the person returns to consciousness, or final death occurs. The duration of clinical death without first aid is as long as the brain can maintain viability without necessary nutrition. Experts distinguish two stages of this phenomenon:

• The first stage takes only 5 minutes. During this time, the body is still able to maintain vital activity. However, if the person is not helped, the risk of death is extremely high. If the body was resuscitated, but more than after 5 minutes, the patient may well survive, remaining inferior. Indeed, with prolonged clinical death, irreversible processes develop in the brain, as a result of which some of its sections simply die off.
• The second stage is longer, but does not occur in all cases. Sometimes all processes in the body slow down, as, in fact, the death of tissues. This happens, for example, with hypothermia. As a result, clinical death can last even several tens of minutes. But this is more of a rarity than a rule.

Providing first aid in case of clinical death

It is desirable to carry out all resuscitation manipulations together, but if necessary, one person can handle it. The provision of first aid in case of clinical death is primarily aimed at stabilizing blood circulation and normalizing full breathing. Before proceeding with resuscitation manipulations, it is imperative to call specialists. So, how to provide first aid for clinical death?

• In order to resume contractions of the cardiac ventricles, it is necessary to produce the so-called precordial blow - a sudden and rather strong push with a fist to the chest area. If there is no result from it, you should move on to other manipulations.
• Now you need to carry out To do this, you need to do an indirect heart massage, alternating it with artificial respiration "mouth to mouth". At the same time, it is very important to control that oxygen enters the lungs, and not the stomach. And for this, breaths must be taken not very often, while tightly clamping the nose. It is good if, during artificial ventilation of the lungs, the patient will rise rib cage. An indirect heart massage consists in strong pushes with both hands in the same area. You need to alternate pressing and inhaling according to the standard scheme: 30 through 2. It is necessary to repeat the manipulations systematically. After five cycles, the patient's breathing and heartbeat should be checked.

When resuscitation is not needed

In certain cases, it is not necessary to provide first aid for clinical death in such ways:

• if the patient is conscious;
• if there are signs of life: be it breathing or pulse;
• in case of symptoms of biological death - rigor mortis or the appearance of cadaveric spots;
• if before this pathological condition a person already suffered from an incurable disease and practically died.

Possible consequence

In some situations, with correctly rendered first aid in case of clinical death, the vital activity of the human body stabilizes, however, it does not come to consciousness. In this case, the patient goes from a pathological state into a coma, in which he can stay for quite a long time.

It is noteworthy that in this case the human heart functions, as well as respiratory system. The depth of this condition and further predictions can only be determined by how badly the patient's brain was injured.

Topic No. 2 First aid when exposed to high and low temperatures, defeat electric shock, syncope, heat and sunstroke functional damage. Resuscitation.

Lesson number 3 Methods of resuscitation

Purpose of the lesson: to study the signs of clinical and biological death, the concept of resuscitation, principles, indications and contraindications for its implementation. Learn and practice technique indirect massage heart, artificial respiration and the entire basic resuscitation complex.

Literature:

1. On approval of the list of conditions under which first aid is provided, and the list of first aid measures: Order of the Ministry of Social Health of the Russian Federation dated 04.05.2012 No. 477n. // ATP "Consultant plus".

2. Velichko N. N., Kudrich L. A. First aid: textbook. - DGSK of the Ministry of Internal Affairs of Russia - Ed. 2nd, revised. and additional - M: TsOKR of the Ministry of Internal Affairs of Russia, 2008 - 624 p.

3. Tuzov A. I. Provision of first aid by employees of the internal affairs bodies to the victims: Memo. - M .: DGSK of the Ministry of Internal Affairs of Russia, 2011. - 112p.

4. Bogoyavlensky I. F. First aid at the scene and in the outbreaks emergencies: handbook. - St. Petersburg: "OAO Medius", 2014. - 306 p.

5. Sannikova E. L. First aid: tutorial. - Izhevsk. CPP Ministry of Internal Affairs for SD, 2015. - 85s.

The concept, signs of clinical and biological death

clinical death – short period time (no more than 5 minutes) after stopping breathing and blood circulation, in which it is still possible to restore vital important functions organism.

The main signs of clinical death:

Loss of consciousness, lack of response to sound and tactile stimuli;

Lack of breath

Absence of a pulse in the carotid arteries;

The skin is pale with an earthy tint;

The pupils are wide (in the entire iris), do not react to light.

Resuscitation measures initiated at this time may lead to full recovery bodily functions, including consciousness. On the contrary, after this period, medical care can contribute to the appearance of cardiac activity, respiration, but does not lead to the restoration of the function of the cells of the cerebral cortex and consciousness. In these cases, "brain death" occurs, i.e. social death. With a persistent and irreversible loss of body functions, they speak of the onset of biological death.

Obvious signs of biological death that do not appear immediately include:

Cooling of the body below 200 C after 1-2 hours;

Softening eyeball, clouding and drying of the pupil (no shine) and the presence of the "cat's eye" symptom - when the eye is squeezed, the pupil is deformed and resembles a cat's eye;

The appearance of cadaveric spots on the skin. Cadaveric spots are formed as a result of the post-mortem redistribution of blood in the corpse to the underlying parts of the body. They appear 2-3 hours after death. In forensic medicine, cadaveric spots are an indisputable reliable sign of death. According to the degree of severity of the cadaveric spot, they judge the prescription of the onset of death (by the location of the cadaveric spots, you can determine the position of the corpse, its movement);

Rigor mortis develops after 2-4 hours descending type top down. Fully it comes in 8-14 hours. After 2-3 days, rigor mortis disappears. The main value in the resolution of rigor mortis is the ambient temperature, with high temperature it disappears faster.

Determination of signs of life:

Demonstrated by the teacher using the simulator-dummy "Maxim"

The presence of a heartbeat (determined by hand or ear on the chest). The pulse is determined on the neck on the carotid artery;

The presence of breathing (determined by the movement of the chest and abdomen, by moistening the screen cell phone applied to the nose and mouth of the victim;

Pupil reaction to light. If you illuminate the eye with a beam of light (for example, a flashlight), then a narrowing of the pupil is observed ( positive reaction pupil to the light) or in daylight, this reaction can be checked as follows: for a while they close the eye with their hand, then quickly move the hand to the side, while constriction of the pupil is noticeable.

2. Resuscitation: principles, indications, contraindications to its implementation

REANIMATION is a set of measures aimed at the timely restoration of blood circulation and respiration in order to bring the victim out of the terminal state.

The effectiveness of resuscitation is determined by compliance with the basic principles:

1. Timeliness. If a person suddenly died literally in front of your eyes, then you should immediately start resuscitation. Resuscitation is most effective if started no later than 1-2 minutes after cardiac arrest and breathing. If you were not an eyewitness to death and the moment of death is not known, then you need to make sure that there are no signs of biological death (they are listed above).

2. Subsequence. Determine the following sequence of events:

Releasing and maintaining airway patency;

Outdoor massage hearts;

Artificial respiration;

Stop bleeding;

Dealing with shock;

Giving the victim a sparing position, the most favorable for breathing and blood circulation. Knowing the sequence during resuscitation allows you to carry it out clearly and quickly, without fuss and nervousness.

3. Continuity is dictated by the fact that vital processes are maintained at the lower limit, and a break in their implementation may have adverse consequences for the patient.

The duration of resuscitation is determined by the restoration of lost respiratory and cardiac functions, the arrival of medical transport and the start of rendering specialized care or the appearance of signs of biological death, which is determined by the doctor.

resuscitation assistance it is necessary to provide in sudden death in cases of electric shock and lightning, with blows to the heart or solar plexus, in cases of drowning or hanging, with a heart attack, complicated epileptic fit, hit foreign body in the respiratory tract, general freezing and a number of other cases when death occurs suddenly.

Contraindications for resuscitation:

Clear signs of death;

Injuries incompatible with life;

With clinical death against the background of incurable diseases (cancer of the 4th stage, etc.);

Violation of the integrity of the chest.

Resuscitation can be terminated:

if an independent pulse is felt on the carotid artery, and the chest rises and falls, that is, the victim breathes on his own, previously dilated pupils constrict, the natural (pale pink) color of the skin is restored;

if resuscitation is undertaken by the arrived ambulance team;

if the doctor gives an order to terminate it due to inefficiency (stated death);

with the ineffectiveness of resuscitation measures aimed at restoring vital functions during 30 minutes.

Biochemical death (or true death) is an irreversible cessation of physiological processes in cells and tissues. Irreversible termination is usually understood as "irreversible within the framework of modern medical technologies" termination of processes. Over time, the possibilities of medicine for resuscitation of deceased patients change, as a result of which, the border of death is pushed into the future. From the point of view of scientists - supporters of cryonics and nanomedicine, most of the people who are dying now can be revived in the future if their brain structure is preserved now.

Early signs of biological death include:

1. Lack of reaction of the eye to irritation (pressure)

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

3. The appearance of the symptom of "cat's eye": with lateral compression of the eyeball, the pupil transforms into a vertical spindle-shaped slit.

In the future, cadaveric spots are found with localization in sloping places 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, upper limbs. The time of appearance and duration of these signs depend on the initial background, temperature and humidity of the environment, the reasons for the development of irreversible changes in the body.

The biological death of the subject does not mean the simultaneous biological death of the tissues and organs that make up his body. The time to death of the tissues that make up the human body is mainly determined by their ability to survive in conditions of hypoxia and anoxia. In different tissues and organs, this ability is different. Most a short time life under conditions of anoxia is observed in the brain tissue, to be more precise, in the cerebral cortex and subcortical structures. The stem sections and the spinal cord have a greater resistance, or rather resistance to anoxia. Other tissues of the human body have this property to a more pronounced degree. So, the heart retains its viability for 1.5-2 hours after the onset, according to modern ideas, biological death. Kidneys, liver and some other organs remain viable for up to 3-4 hours. Muscle, 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. The phenomenon of survivability of organs and tissues of the human body is associated with the possibility of transplanting them and more early dates after the onset of biological death, organs are removed for transplantation, 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 it is not yet death. This emergence of a new quality is 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 the onset of death.

Signs of clinical death include:

1. Lack of breath.

2. Lack of heartbeat.

3. Generalized pallor or generalized cyanosis.

4. Lack of pupillary response 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 in anoxic conditions. Describing clinical death, V.A. Negovsky speaks of two terms.

The first term 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 normothermic conditions. 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, which doctors have to deal with when providing assistance or in special conditions. The second term of clinical death can last tens of minutes, and resuscitation will be very effective. The second term of clinical death is observed when special conditions 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 under conditions of hypothermia, electric shock, and drowning. In conditions clinical practice this can be achieved through physical influences(head hypothermia, hyperbaric oxygen therapy), using pharmacological substances, creating states similar to suspended animation, hemosorption, transfusion of fresh (not canned) donated 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 Application modern method cardiopulmonary resuscitation (revival) can prevent the onset of biological death.

Resuscitation. Two stages of resuscitation should be distinguished. 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 application medications and related equipment and can be carried out in a specialized ambulance, a helicopter specialized for these purposes, in conditions 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 anyone medical worker or a person well trained in resuscitation techniques. The second stage and the ability to carry out only a specialist, as a rule, is an anesthesiologist-resuscitator.

Here it is appropriate to give the techniques and rules of only the first stage, since the manipulations of the second stage do not directly relate to traumatology.

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

Restoration of airway patency. The closure of the respiratory tract may be due mainly to vomit, blood, mucus, from which the patient, being in an unconscious state, cannot get rid of coughing or swallowing. In addition, in the absence of consciousness, when the muscles are relaxed, with the neck bent forward, the root of the tongue can rest against the back wall of the pharynx. Therefore, the first step is to bend your head back. Wherein lower jaw should be pushed forward, the mouth open, which leads to the movement of the root of the tongue from rear wall throats. If the tongue still sinks, and there are no extra hands to hold the jaw in an advanced anterior position, you can pierce the tongue with a pin or flash it with a needle, pull it out of the mouth and fasten the thread or pin behind the victim's ear. In the presence of foreign contents, it is necessary 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) somewhat 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 of the spine, it is not necessary to bend the head backwards because of the risk of aggravating damage spinal cord. In this case, they are limited to fixing an elongated tongue or an air duct is introduced.

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. Blowing air into the mouth, as mentioned above, it is necessary to push 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 carried out through a handkerchief or gauze placed on the nose and mouth of the patient. Should be produced deep breath, place your lips tightly around the patient's mouth and exhale sharply. When air is injected, it is necessary to monitor whether the chest rises from the air blown into the lungs. Further, conditions are created for passive exhalation: the chest, subsiding, will lead to the expulsion of a portion of air from the lungs. After vigorously carried out 3-5 deep breaths of air into the lungs of the victim, a pulse is felt on the carotid artery. If the pulse is determined, continue to inflate the lungs with a rhythm of 12 breaths in 1 min (one breath in 5 s).

For artificial respiration through the nose, the patient's mouth must be closed at the time of inhalation, while exhaling, the mouth must be opened to facilitate the release of air from the respiratory tract.

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

Cardiopulmonary bypass (heart massage). The diagnosis of cardiac arrest is based on the following signs: loss of consciousness, respiratory arrest, dilated pupils, lack of pulse;) on large vessels - carotid, femoral. The last sign is the most reliable evidence of cardiac arrest. The pulse should be determined from the side closest to the caregiver. To determine the pulse on the carotid artery, you must use the following technique: index and middle finger stacked on thyroid cartilage patient, and then promoted to side surface neck, trying to palpate the vessel flat, and not with the tailbones of the fingers.

To restore blood circulation during cardiac arrest, you can use an external heart massage, that is, rhythmic compression of the heart between the sternum and spinal column. When compressed, blood from the left ventricle flows through the vessels to the brain and heart. After the cessation of pressure on the sternum, it again fills the cavity of the heart.

Technique of external heart massage. The palm of one hand is placed on the lower part of the 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, squeezing the sternum is carried out only with the hands). Having pressed the sternum as much as possible, it is necessary to delay the compression for 1/2 s, after which the pressure is quickly removed. It is necessary to repeat the compression of the sternum at least 1 time in 1 s, because a rarer pressure does not create sufficient blood flow. In children, the frequency of compressions of the sternum should be higher - up to 100 compressions per 1 minute. In the intervals between pressures, the hands do not need to be removed from the sternum. The effectiveness of the massage is judged by: a) pulse shocks on the carotid artery in time with the massage; b) narrowing of the pupils; c) the appearance of independent respiratory movements. Changes in the color of the skin are also taken into account.

Combination of cardiac massage with lung ventilation. External massage alone, without simultaneous blowing of air into the lungs, cannot lead to resuscitation. Therefore, both of these methods of revitalization must be combined. In the event that revival is carried out by 1 person, it is necessary to produce 15 compressions of the sternum within 15 seconds every 2 quick blows of air into the lungs (according to the mouth-to-mouth or mouth-to-nose system). The patient's head must be thrown back. If resuscitation is carried out by 2 people, then one of them produces 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 respiration occurs.

When moving the victim to vehicle, transfer on a stretcher, transportation, resuscitation, if necessary, must be continued in the same mode: for 2 deep intensive air injections, produce 15 compressions of the sternum.

Clinical death is a reversible process of dying, a kind of portal between life and death. The condition is characterized by the cessation of the activity of the heart, breathing stops, and signs of vital activity of the body are completely absent. It is known that at this moment hypoxia (oxygen starvation) of all organs and systems occurs, but to irreversible changes it doesn't result. The terminal state of a person in most cases can last no more than four minutes, but in history there have been cases of a longer clinical sweep (up to 6 minutes), while the body temperature remains at the same level, or slightly decreases.

Signs of clinical death

The main signs of clinical death are:

• coma (a severe pathological condition characterized by loss of functions of the central nervous system and consciousness), diagnosed at the time of the appearance of dilated pupils that do not respond to light;
• apnea (stop breathing), which we mentioned with the example of snoring; is diagnosed as the absence of movements of the respiratory cell, indicating the cessation of respiratory activity;
• asystole (cardiac arrest with the cessation of bioelectrical activity), diagnosed as the absence of a pulse in the two main arteries.

The combination of these symptoms is characteristic only in the first stages of this condition, but is absent when biological death occurs. And the life of a person in a terminal state depends entirely on the efficiency and effectiveness of resuscitation.

The duration of clinical death is influenced by the higher parts of the brain, or rather, their ability to maintain viability in conditions critical condition(hypoxia). It is possible to significantly increase the duration of this state by cooling the body or the head (hypothermia), by drowning, by applying an electric current.

Despite the level of development modern medicine, a clear list of unified recommendations applicable to resuscitation of the body was developed and approved only in 2000 during the I World Scientific Conference on Cardiopulmonary Resuscitation, during which they were divided into two stages:
1. Basic cardiopulmonary resuscitation - restoration of the function and patency of the respiratory tract (can be carried out by any person who knows the skills of first aid, or a physician conducting artificial ventilation lungs).
2. Specialized cardiopulmonary resuscitation - carrying out the same techniques for restoring airway patency, but carried out by a specially trained medical staff using appropriate equipment, medicines, etc.

Myths and truth about clinical death

Today, anywhere you can hear the revelations of people who have experienced such a state as clinical death. At the same time, they all claim that they saw the afterlife, communicated with deceased relatives, famous people, heavenly angels or the Lord God himself. Almost all stories tell about the unusual lightness of the body, about its flight, about the light at the end of the tunnel, etc. Doctors tend to be very skeptical about such stories, because it has been scientifically proven that in the terminal state the human brain is completely turned off, which means that he cannot see or feel anything at that moment. However, here those who prove that a person can exist outside of his brain enter the arena, but no one has yet been able to confirm or refute this.

Skeptical scientists explain everything by hallucinations and brain hypoxia, which is not at all surprising, because for the state oxygen starvation The brain is characterized by a different algorithm of its work - from top to bottom. Under the influence of oppression of the cerebral cortex, the effect of "tunnel vision" may appear, which all patients who are on the verge of death unanimously claim. The function responsible for pattern recognition is completely turned off and instead of a dot glowing in the distance, a person begins to see bright light, calling these visions the glow of paradise, the approach of angels, moving to the afterlife, etc. In fact, the signal reverberation process in the visual cortex amplifies the effect of light approaching and spreading around. By the way, a completely blind person can also see these light spots, the signal of which enters his brain from the visual analyzer.

The phenomenon of such a phenomenon as the sensation of flight has also found its explanation in scientific circles and is due to ordinary ischemia. The lack of oxygen entering the body, in the form of a kind of signal, enters the vestibular analyzer, and from there - to the brain, which gradually loses the function of adequate perception of data.

The question of what clinical death is can be answered by both believers who sacredly revere the scriptures about the existence of an afterlife, and physicians who rely on bare facts and scientifically proven studies. How do you interpret this concept for yourself? Perhaps it is your point of view that will be of interest to users of our resource. Share your guesses on this subject so that everyone can find their own answer to this question.