biological death

Biological death follows clinical death and is an irreversible state when the revival of the organism as a whole is no longer possible.

Biological death is a necrotic process in all tissues, starting with the neurons of the cerebral cortex, the necrosis of which occurs within 1 hour after the cessation of blood circulation, and then within 2 hours the cells of all internal organs die (skin necrosis occurs only after a few hours, and sometimes days).

Reliable signs biological death are cadaveric spots, rigor mortis and cadaveric decomposition.

Cadaverous spots are a kind of blue-violet or purple-violet staining of the skin due to draining and accumulation of blood in the lower parts of the body. They begin to form 2-4 hours after the cessation of cardiac activity. The initial stage (hypostasis) - up to 12-14 hours: the spots disappear with pressure, then reappear within a few seconds. Formed cadaveric spots do not disappear when pressed.

Rigor mortis - compaction and shortening of skeletal muscles, creating an obstacle to passive movements in the joints. It manifests itself in 2-4 hours from the moment of cardiac arrest, reaches a maximum in a day, and resolves in 3-4 days.

Corpse decomposition - occurs in late dates, is manifested by the decomposition and decay of tissues. The timing of decomposition is largely determined by the conditions external environment.

Statement of biological death

The fact of the onset of biological death can be established by a doctor or paramedic by the presence of reliable signs, and before they form - in total the following symptoms:

Lack of cardiac activity (no pulse on large arteries; heart sounds are not heard, there is no bioelectrical activity of the heart);

The time of the absence of cardiac activity is significantly more than 25 minutes (at normal temperature environment);

Lack of spontaneous breathing;

The maximum expansion of the pupils and the absence of their reaction to light;

Lack of corneal reflex;

The presence of postmortem hypostasis in sloping parts of the body.

brain death

The diagnosis of brain death is very difficult to make. There are the following criteria:

Complete and permanent absence of consciousness;

Sustained lack of spontaneous breathing;

The disappearance of any reactions to external stimuli and any kind of reflexes;

Atony of all muscles;

The disappearance of thermoregulation;

Complete and persistent absence of spontaneous and induced electrical activity of the brain (according to electroencephalogram data). The diagnosis of brain death has implications for organ transplantation. After its ascertainment, it is possible to remove organs for transplantation to recipients.

In such cases, when making a diagnosis, it is additionally necessary:

Angiography of cerebral vessels, which indicates the absence of blood flow or its level is below critical;

Conclusions of specialists: neuropathologist, resuscitator, forensic medical expert, as well as an official representative of the hospital, confirming brain death.

According to the legislation existing in most countries, "brain death" is equated with biological.

Resuscitation measures

Resuscitation measures are the actions of a doctor in case of clinical death, aimed at maintaining the functions of blood circulation, respiration and revitalizing the body.

Reanimator one

The resuscitator delivers 2 breaths followed by 15 chest compressions. Then this cycle is repeated.

Two resuscitators

One resuscitator performs mechanical ventilation, the other - heart massage. In this case, the ratio of respiratory rate and chest compressions should be 1:5. During inspiration, the second rescuer should pause the compressions to prevent gastric regurgitation. However, during massage on the background of mechanical ventilation through an endotracheal tube, such pauses are not necessary; moreover, compression during inhalation is beneficial, as more blood from the lungs flows to the heart and cardiopulmonary bypass becomes more effective.

The effectiveness of resuscitation

A prerequisite for carrying out resuscitation measures is the constant monitoring of their effectiveness. Two concepts should be distinguished:

efficiency of resuscitation

Efficiency of artificial respiration and blood circulation.

Resuscitation efficiency

The effectiveness of resuscitation is understood as a positive result of resuscitation of the patient. Resuscitation measures are considered effective when sinus rhythm heart contractions, restoration of blood circulation with the registration of blood pressure not lower than 70 mm Hg. Art., constriction of the pupils and the appearance of a reaction to light, restoration of the color of the skin and the resumption of spontaneous breathing (the latter is not necessary).

Efficiency of artificial respiration and circulation

The effectiveness of artificial respiration and blood circulation is said when resuscitation measures have not yet led to the revival of the body (there are no independent blood circulation and respiration), but the ongoing measures artificially support metabolic processes in tissues and thereby lengthen the duration of clinical death.

The effectiveness of artificial respiration and blood circulation is evaluated by the following indicators.

Constriction of the pupils.

The appearance of transmission pulsation on the carotid (femoral) arteries (assessed by one resuscitator when another chest compressions are performed).

Change in the color of the skin (reduction of cyanosis and pallor).

With the effectiveness of artificial respiration and blood circulation, resuscitation continues for an arbitrarily long time until a positive effect is achieved or until the indicated signs disappear permanently, after which resuscitation can be stopped after 30 minutes.

Skull injuries. Concussion, bruise, compression. First aid, transportation. Principles of treatment.

Closed injuries of the skull and brain.

Injury to the soft tissues of the skull in its course almost does not differ from damage to other areas. Differences appear when the brain is damaged. Allocate concussion, contusion, compression of the brain, fractures of the vault and base of the skull.

A concussion develops when a significant force is applied to the skull as a result of hitting it with an object or bruising it during a fall. The essence of the changes occurring in this case is the concussion of the delicate brain tissue and the violation of the histological relationships of cells.

Symptoms and course.

Loss of consciousness that develops at the time of injury is the main symptom of a concussion. Depending on the severity, it can be short-term (within a few minutes) or last for several hours or even days. The second important symptom is the so-called retrograde amnesia, which is expressed in the fact that a person, having regained consciousness, does not remember what happened immediately before the injury.

First aid is to provide rest and carry out activities that reduce swelling and swelling of the brain. Locally - cold, sedatives, sleeping pills, diuretics.

All patients with concussion should be hospitalized with the appointment of bed rest. With a sharp increase intracranial pressure, manifested by severe headaches, vomiting, etc., to clarify the diagnosis, a puncture is shown, which allows you to determine the pressure cerebrospinal fluid and the content of blood in it (which happens with brain bruises and subarachnoid hemorrhages). Removal of 5-8 ml of cerebrospinal fluid during puncture usually improves the patient's condition and is completely harmless.

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

Signs of clinical death:

1) lack of pulse on 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 respiration in a sick or injured person.

Feature definition clinical death:

1. No pulse on carotid artery- 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 putting your ear to your chest, hear the sound of breathing, feel (the movement of air during exhalation is felt on your cheek), and also by bringing a mirror, glass or glass to your lips watch glass, as well as cotton wool or thread, holding them with tweezers. But it is precisely on the definition of this feature 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 definition;

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

4. Rises upper eyelid the victim and the size of the pupil is determined visually, the eyelid falls and immediately rises again. If the pupil remains wide and does not narrow after repeated eyelid lift, then it can be considered that there is no reaction to light.

If one of the first two of the 4 signs of clinical death is determined, then you need to immediately start resuscitation. Since only timely resuscitation (within 3-4 minutes after cardiac arrest) can bring the victim back to life. Do not do resuscitation only in case of biological (irreversible) death, when irreversible changes occur in the tissues of the brain and many organs.

:

1) drying of the cornea; 2) the phenomenon of "cat's pupil"; 3) decrease in temperature; 4) body cadaveric spots; 5) rigor mortis

Feature definition biological death:

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

2. Large and index fingers squeeze the eyeball, if a person is dead, then his pupil will change shape and turn into a narrow slit - the "cat's pupil". It is impossible for a living person to do this. If these 2 signs appear, then 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, according to these signs, death can be certified only after 2-4 hours and later.

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

5. Rigor mortis - 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 a day after death. Before proceeding with the resuscitation of the victim, it is necessary first of all determine the presence of clinical death.

! Proceed to resuscitation only in the absence of a pulse (on the carotid artery) or breathing.

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

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

To activities cardiopulmonary resuscitation relate: precordial beat , indirect heart massage and artificial lung ventilation (IVL) method "mouth-to-mouth".

Cardiopulmonary resuscitation consists of sequential stages: precordial beat; artificial maintenance of blood circulation (external heart massage); restoration of airway patency; artificial lung ventilation (ALV);

Preparing the victim for resuscitation

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

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

For airway management you need to: 1) clear oral cavity from mucus, vomit with a cloth wound around the index finger. 2) to eliminate the retraction of the tongue in two ways: by tilting the head back or by protruding the lower jaw.

Tilt your head back the victim is necessary so 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 roll of clothing or under the neck or under the shoulder blades. (Attention! ), but not in the back!

Forbidden! Place hard objects under the neck or back: a satchel, a brick, a board, a stone. In this case, during an indirect heart massage, you can break the spine.

If there is a suspicion of a fracture of the cervical vertebrae, without bending the neck, nominate only lower jaw . To do this, put the index fingers on the corners of the lower jaw under the left and right earlobe, push the jaw forward and fix it in this position. thumb right hand. Left hand is released, so with it (thumb and forefinger) it is necessary to pinch the nose of the victim. So the victim is prepared for artificial lung ventilation (ALV).

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

When the heart stops, the supply of oxygen to all cells in the body is cut off. 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 the state of clinical death. V.A. Negovsky defines it this way: "No longer life, but not yet death." If during this time to restore cardiac activity and breathing, then the victim can be revived. Otherwise, biological death occurs.

Causes clinical death can be: obstruction of the respiratory tract by vomit and earth, electrical injury, drowning, poisoning with OM, flooding with earth, myocardial infarction, severe jar of Hearts(fear or joy), etc.

Signs of clinical death.

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

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

The constant 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 cessation of breathing and cardiac activity

In life, such a (or similar) situation may occur: 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 cessation of breathing and cardiac activity, only people who are nearby at that 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 turned pale, lost consciousness, but breathing persists (the chest or epigastric region rises) and the heart works (pulsation on the carotid artery is determined), then the victim faints. In those cases when the cyanosis of his lips, fingertips, face grows, one must think about the primary cessation of breathing. Secondary respiratory arrest occurs shortly after cardiac arrest. The victim's face is pale grey.

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

After stopping breathing, cardiac activity stops very soon, so you need to hurry with helping the victim. If the victim's heart is still working, then first aid will consist of 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 their back. Release the chest and abdomen from clothing. Place a cushion under your shoulders and tilt your head back so that your chin is almost in line with your neck. Pull up the tongue if it sinks deep. These techniques allow you to create better air permeability into the lungs.

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

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 that, 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. The palm of the other hand is pressed on the forehead, and the nose is squeezed with the first and second fingers so that when blowing in, the air does not come out through it. After that, the assisting person presses his lips tightly to the victim's lips and makes an energetic blow. In this case, the chest of the victim expands (inhale). Exhalation is passive. In order not to interfere with exhalation, the caregiver after each inhalation should turn his head to the side. Artificial respiration is usually performed at a frequency of 12-14 per minute.

In children, blowing is performed at a frequency of about 20 per minute, and the volume of air must be appropriate for 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, then air will enter the stomach, and not the lungs. You can notice this by the increasing in size of the epigastric region. If this happens, it is necessary to turn the head of the victim on its side and gently press on the epigastric region to remove air from the stomach. After that, inspect the oral cavity, remove the contents of the stomach from it, throw back the head and continue artificial respiration.

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

However, there are cases when the heart stops first, and then breathing stops. Cells of tissues and organs deprived of oxygen and nutrients begin to die off. Before others die brain cells, as the most sensitive to lack of oxygen. At normal temperature, 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 diagnosed with a state of clinical death, it is necessary to urgently carry out a set of resuscitation measures at the scene of the incident - artificial respiration and external (indirect) heart massage. With the help of resuscitation measures, the victim can be saved. If they themselves fail to restore cardiac activity, then these measures will artificially maintain blood circulation and respiration until the arrival of a medical worker.

clinical death

clinical death- a reversible stage of dying, a transitional period between life and biological death. At this stage, the activity of the heart and the process of breathing cease, all external signs of the vital activity of the organism completely disappear. At the same time, hypoxia (oxygen starvation) does not cause irreversible changes in the organs and systems 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, a maximum of 5-6 minutes (with an initially low or normal body temperature). Possibly survival.

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 cases where there are already clear signs of biological death. The shorter the period between the statement of clinical death and the start of resuscitation, the greater the chances of life for the patient, so diagnosis and treatment are carried out in parallel.

Coma is diagnosed based on the absence 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 a pulse in the two carotid arteries. Before determining the pulse, it is recommended that the victim be artificially ventilated.

Treatment

Main article: Cardiopulmonary resuscitation

In 2000, the I 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 may conduct non-professional rescuers (trained volunteers, firefighters, and others), as well as should carried out by medical workers.

Basic CPR is airway management ( A irway), artificial lung ventilation ( B reathing) and chest compressions ( C circulation). In fact, basic CPR is the initial stage of recovery, when the rescuer often finds himself alone with the victim, and is forced to carry out resuscitation "empty-handed".

2. Advanced Cardiovascular Life Support- specialized resuscitation measures (specialized or extended CPR), which must be performed by medical personnel trained and equipped with appropriate equipment and medicines (ambulance service, doctors of the intensive care unit and intensive care unit).

Specialized CPR implies the consistent implementation of the same techniques as in basic CPR, however, with the use of resuscitation equipment, medicines, which makes it much 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 normothermic conditions (body temperature - 36.5 ° C). All world practice shows that if this period is exceeded, people can be revived, but as a result, decortication (death of the cerebral cortex) or even decerebration (death of all parts of the brain) occurs.
• 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 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 (decrease in the 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 whole body), with electric shocks, and with drowning. In conditions clinical practice this can be achieved through physical influences (hypothermia of the head, hyperbaric oxygenation- breathing oxygen at high pressure in a special chamber), using pharmacological substances, creating a state similar to hibernation (a sharp decrease in metabolism), hemosorption (hardware blood purification), 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 " afterworld". Some patients who have experienced near-death experience describe similar experiences (see Near-Death Experiences). Common to all these observations is often the feeling of flying, moving through a dark tunnel towards the light, a feeling of calm and peace, meeting with deceased relatives, etc. This phenomenon is called near-death experiences.

The main problem is that the brain almost completely stops its work 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 independently of the human brain. And near-death experiences could well serve as confirmation of the existence of the afterlife. Most scientists consider such experiences to be hallucinations caused by brain hypoxia. According to this point of view, near-death experiences are experienced by people not in a state of clinical death, but in the earlier stages of brain death during the preagonal state or agony, as well as during the coma period, after the patient has been resuscitated. Despite this, science knows cases when patients, leaving the state of clinical death due to resuscitation, later said that they remember what happened in the place where they were resuscitated, including the actions of resuscitators to the smallest detail [ source not specified 434 days]. With medical point vision is impossible, if only because the activity of the brain is practically absent.

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

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

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, as it were, approaches the light, this illusion arises due to signal reverberation in the visual cortex of the brain, which imitates the amplification and propagation of light in front of the eyes sick. This also explains the phenomenon of seeing light spots in the blind, when the eyes are damaged, the visual cortex, as a rule, does not suffer, and is quite capable of generating a signal that imitates the flow 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 ceases to analyze and adequately perceive the data coming from the receptors of the vestibular apparatus.

Also, in some cases, this condition 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. At the heart of modern dialectical-materialist ideas about S. is the idea expressed by F. Engels: “Even now, they do not consider scientific that physiology that does not consider death as an essential moment of life ... that does not understand that the denial of life essentially contains in life itself, so that life is always conceived in relation to its necessary result, which is constantly in its embryo - death "(K. Marx and F. Engels, Soch., 2nd ed., g. 20, p. 610 ).

Sometimes the concept of partial S. is distinguished, that is, S. of a group of cells, part or whole organ (see. Necrosis). In unicellular organisms protozoa- 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 instead of it. The page of an individual is usually followed by formation of a corpse. Depending on the reasons for the onset of S., in higher animals and humans, there are: natural S. (also called physiological), which occurs as a result of a long, sequentially 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, lesions of vital organs (brain, heart, lungs, liver, etc.). Premature S. can be sudden, that is, it can occur within a few minutes and even seconds (for example, with a heart attack). S. violent can be the result of an accident, suicide, murder.

The page of warm-blooded animals and the person is connected with the termination first of all breath 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 full recovery is still possible vital functions, biological S. occurs - the irreversible cessation of physiological processes in cells and tissues. All processes connected with S., studies 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 of life and death, Kish., 1955; Lunts A. M., On the evolution of death in connection with the evolution of reproduction, "Journal general biology", 1961, v. 22, No. 2; Polikar A., ​​Bessie M., Elements of cell pathology, translated from French, M., 1970.

clinical death

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

biological death comes after the clinical 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 symptom " cat eye' (to discover this symptom, you need to squeeze the eyeball. The symptom is considered positive if the pupil is deformed and stretched in length). By late signs of biological death include cadaveric spots and rigor mortis.

biological death(irreversible cessation of biological processes in the cells and tissues of the body). Distinguish between natural (physiological) death, which occurs as a result of a long, successively developing extinction of the body's main vital functions, and premature (pathological) death, which is caused by a diseased state of the body, damage to vital organs. premature death may be sudden, i.e. occur within minutes or even seconds. Violent death can be the result of an accident, suicide, murder.

The biological death of an individual after stopping breathing and cardiac activity does not occur immediately. The most vulnerable to hypoxia and circulatory arrest is the brain. 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 onset of biological death can be established by the presence of reliable signs, and before they appear - by the totality of signs.

Reliable signs of biological death:

1. Cadaverous spots - begin to form 2-4 hours after cardiac arrest. 2. Rigor mortis - manifests itself 2-4 hours after circulatory arrest, reaches a maximum by the end of the first day and spontaneously disappears on 3-4 days. A set of signs that allows stating biological death before the appearance of reliable signs:

1. Absence of cardiac activity (no pulse on the carotid arteries, heart sounds are not heard). 2. The time of the absence of cardiac activity was reliably established for more than 30 minutes under conditions of normal (room) ambient temperature. 3. Lack of breath. 4. Maximum expansion of the pupils and the absence of their reaction to light. 5. Lack of corneal reflex. 6. The presence of postmortem hypostasis (dark blue spots) in the sloping parts of the body. These signs are not grounds for ascertaining 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 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, being the most inert tissue of the human body, retains its vitality 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 the new organism.

Diagnosis of death

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

The biological death of a person is ascertained by a set of signs associated with the "vital tripod": the activity of the heart, the safety 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, fluff, auscultate (listen to) breathing or Winslow's test, which consists in placing a vessel with water on the patient's chest and the presence of respiratory movements of the chest wall is judged by fluctuations in the water level. A gust of wind or draft, increased humidity and temperature in the room, or passing traffic can affect the results of these studies, and conclusions about the presence or absence of breathing will be incorrect.

More informative for the diagnosis of death are tests that indicate the preservation of cardiovascular function. Auscultation of the heart, palpation of the pulse on the central and peripheral vessels, palpation of the heart impulse - these studies cannot be fully considered reliable. Even when examining the function of cardio-vascular system in the clinic, very weak heartbeats may not be noticed by the doctor, or the contractions of one's own heart will be assessed as having such a function. Clinicians advise auscultation of the heart and palpation of the pulse at short intervals, lasting no more than 1 minute. Very interesting and conclusive, even with minimal blood circulation, is the Magnus test, which consists in a tight constriction of the finger. With the existing blood circulation at the site of the constriction, the skin turns pale, and the peripheral one acquires a cyanotic hue. After removing the constriction, the color is restored. Certain information can be given by viewing the earlobe through the lumen, which in the presence of blood circulation has a reddish-pink color, and in a corpse it is gray-white. In the last century, very specific tests were proposed to diagnose the preservation of the function of the cardiovascular system, for example: Verne's test - an arteriotomy (opening) of the temporal artery, or Bush's test - a steel needle injected into the body, loses its shine in a living person in half an hour, the first Icarus test - intravenous administration fluorescein solution gives a rapid staining of the skin in a living person in yellowish color, and the sclera - in greenish and some others. These samples are currently only of historical and not practical interest. It is hardly reasonable to perform an arteriotomy in a person who is in a state of shock and at the scene where it is impossible to comply with the conditions of asepsis and antisepsis, 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).

Preservation of the function of the central nervous system is the most important indicator of life. At the scene of the incident, the ascertainment of brain death is fundamentally impossible. The function of the nervous system is checked by the preservation or absence of consciousness, the passive position of the body, the relaxation of the muscles and the absence of its tone, the absence of a reaction to external stimuli - ammonia, weak pain effects (needle pricking, rubbing the earlobe, tapping on the cheeks and others). Valuable signs are the absence of a corneal reflex, the reaction of pupils to light. But both these and the previous signs, in principle, may be absent in a living person, for example, in case of poisoning with sleeping pills, drugs, collapse and in other conditions. Therefore, it is impossible to treat these signs unambiguously, they must be evaluated critically, taking into account a possible disease or pathological condition. In the last century, extremely unusual and sometimes very cruel ways. So, the Josa test was proposed, for which special forceps were invented and patented. When a skin fold was pinched in these forceps, a person experienced strong pain. Also based on the pain reaction, the Degrange test is based - 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 peculiar, cruel, showing what tricks the doctors reached in difficult problem ascertaining the function of the central nervous system.

One of the earliest and most valuable signs of the onset of death is the "feline pupil phenomenon", sometimes called Beloglazov's sign. The shape of the pupil in a person is determined by two parameters, namely: the tone of the muscle that narrows the pupil, and intraocular pressure. And the main factor is muscle tone. In the absence of the function of the nervous system, the innervation (connection of organs and tissues with the central nervous system with the help of nerves) of the muscle that narrows the pupil stops, and its tone is absent. When squeezing the fingers in the lateral or vertical directions, which must be done carefully so as not to damage the eyeball, the pupil becomes oval. Facilitating moment 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 sign of Beloglazov, or "the phenomenon of the cat's pupil" indicates the absence of innervation of the muscle and, at the same time, a drop in intraocular pressure, which is associated with arterial pressure.

Declaring the death of a person Ascertaining the death of a person occurs with brain death or biological death of a person (irreversible death of a person). Biological death is established on the basis of 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, 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 these patients have already undergone irreversible changes in the brain.

The diagnosis of brain death is established in health care facilities that have the necessary conditions to determine brain death. The death of a person on the basis of brain death is established in accordance with Instructions for ascertaining the death of a person on the basis of the diagnosis of brain death approved by the order of the Ministry of Health Russian Federation dated 20.12.2001 No. 460 "On Approval of the Instructions for Ascertaining the Death of a Person Based on the Diagnosis of Brain Death" (the order was 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

The signs of life are:

retained breath. 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 ball of cotton wool or a bandage brought to the nostrils;

the presence of cardiac activity. It is determined by probing the pulse - jerky, periodic oscillations of the walls of peripheral vessels. You can determine the pulse radial artery located under the skin between the styloid process radius and 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 posterior tibial artery). Typically, the pulse rate healthy person 60-75 beats / min, the pulse rhythm is correct, uniform, the filling is good (it is judged by squeezing the artery with fingers with different strengths).

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

The absence of all of the above is a signal for immediate resuscitation (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 kind of struggle between life and death) and clinical death (a reversible state of deep oppression of all vital important functions)

Agony is characterized by:

darkened consciousness,

lack of pulse

respiratory disorder, which becomes irregular, superficial, convulsive,

lowering blood pressure.

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

after the agony comes clinical death.

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

heartbeat;

1. 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. After this time, biological death occurs.

Signs of biological death are:

lack of breathing;

lack of heartbeat;

lack of sensitivity to pain and thermal stimuli;

decrease in body temperature;

clouding and drying of the cornea of ​​\u200b\u200bthe eye;

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

lack of a 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 state in which there are no visible signs of life (cardiac activity, respiration), the functions of the central nervous system fade away, but metabolic processes in tissues remain. It lasts for several minutes (up to 3-5, less often - up to 7), is replaced by biological death - an irreversible condition in which the restoration of vital functions is impossible.

Clinical death diagnosis based on the main and additional features.

Main:

Lack of consciousness - the victim does not respond to speech addressed to him, pain stimuli;

Absence of a pulse in the carotid artery;

Absence of breath.

Additional:

Discoloration of the skin (severe pallor or cyanosis)

Pupil dilation.

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

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

Reliable signs of death include a complex of cadaveric changes - early (cadaveric cooling, local cadaveric drying, muscle rigor mortis, cadaveric spots), or late (rotting, preserving 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 squeezed in the 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 circular muscle of the eye, which determines round shape the pupil of a person during life. Damage incompatible with life (for example, dismemberment of the body) also indicates a reliably occurring biological death.

For the human condition, the social and 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 there is a total death of the entire brain, while with the help of resuscitation measures, the function of the heart 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 whole organism. Currently, "brain death" means 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, provided with the help of continuous artificial ventilation of the lungs. Brain death is caused by the cessation of blood circulation in the brain. The actual synonym for brain death is the concept of "transcendental coma", the treatment of which is meaningless. The patient, who has been diagnosed with brain death, is a living corpse, as they say, the drug "heart - lungs". The introduction of the concept was dictated primarily by the tasks of transplantology (the science of tissue or organ transplantation). The concept is legal. With brain death, the functions of respiration and cardiac activity can be artificially maintained by medical measures or sometimes be preserved. Human brain death naturally and irreversibly eventually 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 does not yet occur. Quite often, in various literature, including scientific literature, the state of relative life during brain death is defined by the term "plant life".

Ascertaining brain death is a rather rare situation in medical practice. Much more often in clinical practice and at the scene, doctors have to state biological death. The problem of ascertaining death is extremely complex and requires an integrated approach for a correct solution; it is most closely connected with the professional, ethical and legal side of the activity of a doctor of any specialty. Questions of life and death have always excited and excited the minds of mankind. And when problems arose correct definition death, its certificates, the layman cannot always correctly assess the actions of a professional doctor and correctly interpret his actions. Diagnosis (stating) of death, or rather an assessment of the actions of a doctor, is 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 of those buried alive have been around for a long time. In a number of cases, they are based on quite understandable facts, the cause of which is some post-mortem processes. P.A. Minakov at the beginning of our century listed post-mortem phenomena that can simulate intravital processes and cause suspicion of being buried alive. First of all - this is "birth in a coffin." During the burial of 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. Change in the posture of the corpse, due to the resolution (destruction) of rigor mortis. Deposition of drops of moisture from the air on the body of a corpse, which is perceived as intravital sweating. Pink coloration of the skin and visible mucous membranes upon death from poisoning carbon monoxide(waste), which are perceived by others as a natural skin color. Rigor rigor or its resolution can cause air to be squeezed out of their lungs, accompanied by sounds. Leakage of blood from wounds, especially if the wounds are localized on the lower parts 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, create special life tests, or create special conditions for burial. So, in Munich for more than 100 years there was a tomb in which the hand of the deceased was wrapped with a cord from the bells. The bell rang only once, and when the attendants came to help the patient who had woken up from a lethargic sleep, it turned out that rigor mortis had resolved.

Thus, summing up the issue under consideration, it should be noted that the social and legal concept of "brain death" is defined for the human condition - the death of the higher parts of the central nervous system, which is ascertained 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 probabilistic signs of the onset of which include the absence of the activity of the nervous system, heartbeat and external respiration (i.e. signs of clinical death), and the reliable - a complex of cadaveric changes.

biological death.

Early: " cat's eye", clouding and softening of the cornea, a symptom of "floating ice", soft eye.

Later: hypostatic spots, symmetrical face, marbling of the skin, rigor mortis 2-4 hours.

social death - death of the brain with preserved respiratory and cardiac activity (up to 6 hours of death of the cortex - brain death; true death - social).

Question Stages of Cardiopulmonary Resuscitation

Resuscitation is a set of measures aimed at temporarily replacing vital functions, restoring their management until complete recovery.

Indications for BSLR

clinical death.

Basic resuscitation.

Volume of BSLR:

1) We carry out the diagnosis of clinical death (loss of consciousness, dilated pupil, absence of Ps on the carotid artery, pale skin, no breathing)

2) Cardiac arrest can be different, it depends on the cause of clinical death. Distinguish between asystole and fibrillation (simultaneous contraction of individual muscle groups of the myocardium without a common systole)

3) Electromechanical dissociation. In which the impulse to contract the muscles penetrates the heart, but the muscles do not respond ( sinus node bundles of hys, purkinje fibers)

Clinically, the type of cardiac arrest manifests itself in the same way. Heart massage during fibrillation is not very effective, so it is necessary to defebrel the heart. It can be mechanical - (precordial blow) a punch to the region of the heart. After diagnosing clinical death, the patient must be transferred to a hard surface, the clothes and belt should be unfastened with a jerk.

1) The blow is applied to the region of the lower third of the body of the sternum from a height of 20-30 cm double blow. We check the pulse. Precordial shock to children is not carried out!!

2) If there is no pulse, we proceed to a heart massage. Chest compression is performed with both hands. The bases of the palms are strictly on the lower third of the sternum. The arms are straightened. In adults, the chest is pressed 3-4 cm 80-100 compressions per minute. For 1 time, 30 compressions are performed.

If there are foreign bodies in the oral cavity, perform sonation of the oral cavity.

4) We start ventilation at the scene of the incident mouth to mouth. We close the nose, completely grasp the mouth and make a full long exhalation. 2 breaths.

Every 3-5 minutes check the pulse. When a pulse appears, IVL continues.

During resuscitation, the effectiveness of cardiac massage is checked. AND IVL

Massage: on the carotid artery, a pulsation synchronous with massage is determined. With mechanical ventilation, a clearly visible excursion of the chest.

Monitoring the effectiveness of resuscitation:

1) Independent pulse on the carotid artery

2) The pupil narrows

3) The skin turns pink

Effective resuscitation measures will be carried out until the restoration of cardiac activity or until the arrival of an ambulance. In case of ineffectiveness, the measures are held for 30 minutes.

Resuscitation is not carried out:

1. In persons with severe trauma incompatible with life

2. In persons with stage 4 malignant diseases

3. In persons with long chronic diseases in the stage of persistent decompensation

4. In persons with refusal of resuscitation

5. In persons in a state of biological death

Question Basic Rules closed massage heart Precordial beat first

The blow is applied to the region of the lower third sternum, 20-30 cm, the force is 70 kg, after the blow, we must watch the pulse (children are not done) if there is no pulse, heart massage is not done.

Compression of the chest is carried out with two hands of each other on the lower third of the sternum, the arms are straightened, the joint is not compressed. In adults, the chest is pressed 4-6 cm. Pressure 100-80 per minute

Massage is carried out 30 pressures

We throw back our heads

Safar triple reception, throw back the head and open the mouth and jaw protrusion, examine the oral cavity. We quickly carry out sanitation of the oral cavity. After sanitation proceeds to IVL.

At the scene of the accident

- mouth to mouth

-nose to mouth

Fully grasp the mouth tightly before these make an extended exhalation, 2 breaths away from the patient

Check heartbeat. The course of resuscitation is checked by the effectiveness of cardiac massage and the effectiveness of mechanical ventilation. On the carotid artery, synchronization with pulsation massage is determined

Question 6 Criteria for the effectiveness of cardiac massage

With proper ventilation on inspiration, chest excursion is visible

Monitoring the effectiveness of resuscitation

self pulsation

The pupil narrows, the skin of the face turns pink.

Question 7 Bleeding - the release of blood outside the vascular bed.

1) Injury to the vessel wall

2) Destruction of the vessel wall inflammatory process

3) Violation of the permeability of the vessel wall

4) Blood diseases

5) Violation of blood clotting

6) congenital pathology vessel walls

7) Liver disease (ALD)

8) Drug bleeding (asperin)

Classification.

1) By the nature of the damaged vessel

Arterial

wine

capillary

Parenchymal

2) In connection with the external environment

outdoor

internal

3) By duration

Chronic

4) By the time of occurrence

Primary (after injury)

Secondary (early 2nd day, late)

5) By manifestations

Hidden

profuse

Distinguish

1) Single

2) Repeat

3) multiple

Signs of bleeding.

General: retardation weakness dizziness tinnitus before eyes pale cold sticky sweat. Tachycardia, decrease in blood pressure, decrease in CVP (normal 100-120), shortness of breath, thirst, dry mouth, mouth, decrease in diuresis.

Local: hematoma, impaired consciousness, hemoptysis, DN hematemesis, tarry stools, peritonitis, hematuria, hemarthrosis.

Degrees of blood loss:

1) pulse 90-100 BP 100-120 HB 100-120

2) pulse110-120 Ad90-60 HB 80-100

3) pulse 140 BP 80 HB70-80

4) pulse 160 BP 60 HB less than 70

Question 8 Temporary stopping methods.

With arterial.

1) Finger pressure.

Temporal artery to the temporal bone above the tragus of the ear by 2 transverse fingers

Carotid artery to the transverse process of the 6th cervical vertebra at the lower edge of the wound between the anterior edge of the sternocleidomastoid muscle and the trachea.

Humerus to humerus at mid-shoulder.

The femur to the pubic bone of the pelvis at a point on the border between the inner and middle third of the inguinal fold.

2) Tourniquet for arterial bleeding above the wound, slaughter for 30 minutes. in the summer for an hour.

3) Maximum flexion limbs at the joint

4) Tight tamponade of the wound

5) Clamping the vessel during transportation to the health facility

Venous bleeding.

1) pressing

2) Tight tomponade

3) Flexion at the joint

4) Clamp on vessel

5) Elevated position of the limb

6) Pressure bandage.

capillary

1) pressure bandage

2) Wound tomponade

3) Ice pack

internal bleeding

1) Rest of the sick

2) Bubble with forehead

3) Hemostatics (Vikasol 1% 1 ml dicenone 12.5% ​​1.2 ml i.v. m. Ca chloride copronic acid 20-40 ml)

Question 9 How to apply a tourniquet:

– a tourniquet is applied in case of damage large arteries limbs above the wound so that it completely occludes the artery;

- a tourniquet is applied with a raised limb, placing a soft tissue under it (bandage, clothes, etc.), make several turns until the bleeding stops completely. The coils should lie close to each other so that folds of clothing do not fall between them. The ends of the tourniquet are securely fixed (tied or fastened with a chain and a hook). A properly tightened tourniquet should stop the bleeding and disappearance of the peripheral pulse;

- a note must be attached to the tourniquet indicating the time the tourniquet was applied;

- the tourniquet is applied for no more than 1.5–2 hours, and in the cold season, the duration of the tourniquet is reduced to 1 hour;

- if it is absolutely necessary for a longer stay of the tourniquet on the limb, it is weakened for 5-10 minutes (until the blood supply to the limb is restored), producing for this time finger pressure damaged vessel. Such a manipulation can be repeated several times, but at the same time, each time reducing the time between manipulations by 1.5-2 times compared to the previous one. The tourniquet must lie so that it is visible. The victim with a tourniquet applied is immediately sent to a medical facility for the final stop of bleeding.

Question 10

Types of terminal states:

1. predagonic state(dullness of consciousness, a sharp pallor of the skin with cyanosis, blood pressure is not determined, there is no pulse on the peripheral arteries, except for the carotid and femoral, breathing is frequent and shallow)

2. Agonic state(consciousness is absent, motor excitation is possible, pronounced cyanosis, the pulse is determined only on carotid femoral arteries, severe respiratory disorders of the Cheyne-Stokes type)

3. clinical death since the last breath and cardiac arrest is manifested total absence signs of life: loss of consciousness, no pulse on the carotid and femoral arteries, heart sounds, respiratory movement of the chest, maximum pupil dilation with no reaction to light.

4. Period of clinical death last 5-7 minutes, followed by biological death, clear signs death is rigor mortis, a decrease in body temperature, the appearance of cadaveric spots

There is also social death(brain death) while maintaining cardiac and respiratory activity.

clinical death- this is when there are no signs of life, and all organs and tissues of the body are still alive. Clinical death is a reversible state. biological death- this is when the main organs of a person die: the brain, heart, kidneys, lungs. Biological death is an irreversible condition.

Without resuscitation, biological death of the brain occurs 5 minutes after cardiac arrest - in the warm season, or ~ 15 minutes later - in the cold season. Against the background of artificial respiration and indirect heart massage, this time increases to 20-40 minutes.

The only reliably determined sign of clinical death is the absence of a pulse on the carotid artery. That is, if you approached a “broken” participant and found that there was no pulse on the carotid artery, the participant is dead and you need to immediately start resuscitation according to the ABC scheme.

Do not waste time determining the reaction of the pupils to light. Firstly, you need to be able to conduct the test correctly, and secondly, on a sunny day you will not determine anything reliably.

Similar don't try to check for breath with the help of fluffs, threads, a mirror, etc. Found the absence of a pulse - start resuscitation.

With biological death, resuscitation is not carried out. If signs of biological death appear during resuscitation, resuscitation is stopped.

Of the early reliable signs of biological death, the presence of cadaveric spots and (sometimes) a sign of "cat's eye" should be checked.

cadaveric spots- this is a change in skin color to bluish / dark red / purple-red in those places that are facing downwards. For example, on the lower part of the neck, the lower edge of the ears, the back of the head, shoulder blades, lower back, buttocks. Corpse spots begin to appear 30-40 minutes after death. With blood loss, as well as in the cold, their appearance slows down, or they may not exist at all. The appearance of cadaveric spots is probably the most reliable and realistically determined early sign of biological death.

"Cat's eye"- this is a reliable sign of death (if it is correctly checked), which is determined 30-40 minutes after dying. To check, you need to squeeze hard enough (!) from the sides the eyeball of the deceased. In this case, the pupil, which is normally round, becomes oval and does not take its original shape. This sign should be checked only when it’s completely incomprehensible to you whether the person has died or not. Usually it is enough to detect emerging cadaveric spots.

resuscitation

Resuscitation should be carried out on the most horizontal, even and hard surface. Hanging on a wall or in a crack, you will not be able to carry out effective resuscitation. Therefore, first place the participant on a (if possible) flat, hard surface. If resuscitation takes place on a slope, then the head of the victim should be at the level of his legs or slightly lower.

Before the very beginning of resuscitation, it is necessary to at least approximately find out the mechanism of injury and the cause of death - this will determine the caution in handling a person, the ability to move him once again, the decision to administer / not administer any drugs.

So, the dead participant lies with his back on the ground, on skis placed under his back, on stones, on a glacier, on a shelf in a steep slope. The lifeguards are safe.

BUT- restore airway patency by tilting the victim's head back and raising his neck with his hand. Clean his mouth of saliva, blood, water, snow, or any other foreign matter.

AT- start artificial respiration: with the fingers of the hand that you press on the forehead, pinch the victim's nose. Cover your lips with a handkerchief (if any) and take two full slow exhalations with a pause between them of 3 ... 5 seconds. If it was not possible to inhale air into the lungs of the victim due to strong resistance, tilt his head back more before the second breath. If artificial respiration is carried out correctly, then in response to inhalation, the victim’s chest rises, and after inhalation, a passive “exhalation” occurs.

With- Open the victim's chest as much as possible. Usually it is enough to unzip the puff and lift up the thick polar / fleece, but if this is difficult to do, work through a minimum of clothing. Find (grope) a point on the victim's sternum between its middle and lower thirds. Place your palm across the sternum, with your fingers on the left side, with your wrist at the found point. Place the second palm across the first, with maximum contact in the wrist area (you can clasp the wrist with the thumb of the “upper” palm). The participant performing the heart massage should bend over the victim and apply pressure on the sternum with all his weight. The frequency of pressure is 100 per minute.

Signs of correct chest compressions:

• The fingers do not touch the ribs.
• The arms at the elbows are absolutely straight during the pressure.
• The sternum is "pressed through" 4-5 cm deep.
• The second person, who puts his fingers on the carotid artery of the victim, feels a pulsation in response to your pressure.
• It is possible, but not necessarily the appearance of a slight "crunch" during pressing. This torn thin tendon fibers passing from the ribs to the sternum.

During resuscitation, breaths and pressures on the heart area alternate: one person performs two artificial breaths, then the second makes 30 pressures on the heart area (in about 20 seconds). Once every two minutes, resuscitation is stopped and the pulse on the carotid artery is checked quickly (5-10 seconds). If there is no pulse, resuscitation is resumed. If there is, they monitor the pulse and breathing, administer drugs if necessary (see below), and organize the fastest possible rescues.

During resuscitation, it may be necessary to change the participant who is doing chest compressions. Resuscitation is difficult, and often people do not endure longer than 10 minutes out of habit. You have to be prepared for this, it's normal.

How long to resuscitate?

During resuscitation, every 2 minutes you need to stop for 10 seconds and check for a pulse and spontaneous breathing in the victim. If they are, then indirect heart massage is stopped, but the pulse and breathing are constantly monitored. If there is a pulse, but spontaneous breathing has not recovered, artificial respiration is performed and the pulse is monitored.

If resuscitation lasts 30 minutes, but it was not possible to revive the person, resuscitation measures are stopped. Make sure there is no pulse. It is advisable to examine the body for the appearance of cadaveric spots.

The human body is laid flat, arms along the body or on the chest. The eyelids are covered. The jaw, if necessary, is fixed with a bandage or a roller placed under the chin. If possible, they transport the body on their own, tightly wrapping it with karemats. If this is not possible, or living victims descend in priority, then the body is hidden from the sun's rays and (possible) wild animals, the place is marked with clearly visible landmarks, and the group descends for help.

Can drugs be administered during resuscitation?

There are medications that increase the chances of successful resuscitation. And these drugs need to be able to apply in a timely manner.

The most efficient of available drugs- it's adrenaline. During resuscitation, a first-aid kit appears by 3 ... 5 minutes of active resuscitation, and if by this time the heart has not been started, you can inject 1 ml of adrenaline into the soft tissues under the tongue (through the mouth). To do this, the head is thrown back and the mouth is opened (as during artificial respiration), and one ml of adrenaline solution is injected under the tongue of the victim using a 2-milliliter syringe. Due to the fact that the tongue has a very rich blood supply, part of the adrenaline will reach the heart with venous blood. The only condition is ongoing resuscitation.

After reviving a person, it makes sense to inject 3 ml of dexamethasone into an accessible muscle (shoulder, buttock, thigh) - this drug will begin to act in 15-20 minutes and will maintain pressure and reduce the severity of cerebral edema in case of injury.

If necessary, after revival, an anesthetic is administered: Ketanov 1-2 ml intramuscularly, analgin 2 ml intramuscularly, or Tramadol - 1 ml intramuscularly.

Signs of correctly conducted resuscitation measures:

• After 3-5 minutes of proper resuscitation, the skin color becomes closer to normal.
• During an indirect heart massage, the second resuscitator feels the pulsation of the victim's carotid artery.
• During artificial respiration, the second resuscitator sees the rise of the victim's chest in response to inspiration.
• Constriction of the pupils: when examining the eyes of the resuscitated, the pupils have a diameter of 2-3 mm.

Typical problems and mistakes during resuscitation:

• Unable to give artificial breath. Causes: Foreign objects in the mouth, or insufficient tilting of the head, or insufficient exhaling effort.
• During artificial respiration, the abdomen is inflated, or the victim begins to vomit. The reason is insufficient tilting of the head and, as a result, inhalation of air into the stomach of the victim.
• There is no pulsation on the carotid artery in response to pressure on the chest. Reason - wrong position hands on the sternum, or slight pressure on the sternum (for example, when bending the elbows when pressing).
• Putting a cushion or an impromptu “pillow” under the victim’s head makes spontaneous breathing almost impossible. The roller can be placed only under the shoulder blades of the victim, so that the head “hangs” back a little.
• Attempts to find out whether the victim is breathing or not (search for feathers, threads, a mirror, glass, etc.) take precious time. You need to focus mainly on the pulse. Performing artificial respiration to a person who is barely breathing on his own will not bring any harm.

Resuscitation in severe, combined trauma:

The participant has a spinal injury, a fractured jaw, or other injuries that prevent him from tilting his head back. What to do?

All the same, the ABC algorithm is respected to the maximum extent possible. The head still throws back, the jaw opens - all this just needs to be done as carefully as possible.

The participant has a fractured rib(s) or fractured the ribs during the cardiac massage.

If one or two ribs are broken, then this usually does not lead to any terrible consequences. Indirect massage carry out in the same way, paying special attention to the fact that the fingers do not touch the ribs (!). If there are multiple rib fractures, this dramatically worsens the prognosis, since the sharp edges of the ribs can damage the lungs (pneumothorax will develop), cut through large arteries (internal bleeding will occur), or damage the heart (cardiac arrest will occur). Resuscitation is carried out as carefully as possible according to the same rules.

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. The shortest lifetime under anoxic conditions 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. 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. The phenomenon of survival of organs and tissues of the human body is associated with the possibility of their transplantation, and the earlier 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. AT 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 dates.

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 shows that if this period is exceeded, people can be revived, 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 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 under conditions of hypothermia, electric shock, and drowning. In clinical practice, this can be achieved through physical effects (hypothermia of the head, 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 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 a medical facility 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 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 lung ventilation 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 resuscitation.

Restoration of airway patency. The closure of the respiratory tract may be due mainly to vomit, blood, mucus, from which the patient, being unconscious, 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. 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 the back of the pharynx. 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, a 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 a cervical spine injury is suspected, it is not necessary to bend the head backwards because of the risk of aggravating damage to the 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 done through a handkerchief or gauze placed on the nose and mouth of the patient. You should take a 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, along with the air from the stomach, its contents can enter the pharynx and oral cavity, in which case the head and shoulders of the victim are turned to the side and the mouth is cleaned (see above),

Cardiopulmonary bypass (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 a pulse;) on large vessels- sleepy, 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 need to use next trick: the index and middle fingers are placed on the thyroid cartilage of the patient, and then advanced on 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. Place the palm of one hand on lower part sternum, the palm of the other hand is placed on top of the first. The sternum is pressed towards 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. Outdoor massage by itself, without simultaneous insufflation 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 for 15 seconds every 2 quick blows of air into the lungs (according to the mouth-to-mouth or mouth-to-nose system). The head of the patient 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 a vehicle, transferring on a stretcher, transporting resuscitation measures, if necessary, must be continued in the same mode: 15 compressions of the sternum for 2 deep intensive breaths of air.