The human eye has a complex structure, its components are connected to each other and function according to a single algorithm. Ultimately, they form a picture of the surrounding world. This complex process works thanks to the functional part of the eye, the basis of which is the pupil. Pupils before death or after it change their qualitative state, therefore, knowing these features, it is possible to determine how long ago a person died.

Anatomical features of the structure of the pupil

The pupil looks like a round hole in the center of the iris. It can change its diameter by adjusting the area of ​​absorption of light rays falling on the eye. This opportunity is provided to him by the eye muscles: sphincter and dilator. The sphincter surrounds the pupil, and when contracted, it narrows. The dilator, on the contrary, expands, communicating not only with the pupillary opening, but also with the iris itself.

The pupillary muscles perform the following functions:

• Change the diametrical size of the pupil under the action of light and other stimuli that enter the retina.
• Set the diameter of the pupillary hole depending on the distance at which the image is located.
• Converge and diverge on the visual axes of the eyes.

The pupil and the muscles surrounding it work according to a reflex mechanism that is not associated with mechanical irritation of the eye. Since the impulses passing through the nerve endings of the eye are sensitively perceived by the pupil itself, it is able to respond to the emotions experienced by a person (fear, anxiety, fright, death). Under the influence of such a strong emotional arousal, the pupillary openings expand. If the excitability is low, they narrow.

Causes of narrowing of the pupillary openings

With physical and mental stress, the eye holes in people can narrow to ¼ of their usual size, but after rest they quickly recover to their usual dimensions.

The pupil is very sensitive to certain medicines that affect the cholinergic system, such as cardiac and sleeping pills. That is why the pupil temporarily narrows when they are taken. There is a professional deformation of the pupil in people whose activities are associated with the use of a monocle - master jewelers and watchmakers. In diseases of the eye, such as corneal ulcer, inflammation of the vessels of the eye, omission of the eyelid, internal hemorrhage, the pupillary opening also narrows. Such a phenomenon as a cat's pupil at death (Beloglazov's symptom) also passes through the mechanisms inherent in the eyes and muscles of those around them.

pupil dilation

Under normal circumstances, pupillary enlargement occurs in dark time days, in low light conditions, with the manifestation strong emotions: joy, anger, fear, due to the release of hormones into the blood, including endorphins.

Strong expansion is observed with injuries, drug use and eye diseases. A constantly dilated pupil may indicate intoxication of the body associated with exposure to chemicals, hallucinogens. With craniocerebral injuries, in addition to a headache, the pupillary openings will be unnaturally wide. After taking atropine or scopolamine, there may be a temporary expansion of them - this is normal. adverse reaction. In diabetes mellitus and hyperthyroidism, the phenomenon occurs quite often.

Pupil dilation at death is a normal reaction of the body. The same symptom is characteristic of coma.

Classification of pupillary reactions

Pupils in a normal physiological state are round, of the same diameter. When the light changes, a reflex expansion or contraction occurs.

Constriction of the pupils depending on the reaction

What do pupils look like when you die?

The reaction of pupils to light at death passes first by the mechanism of field expansion, and then by their narrowing. Pupils during biological death (final) have their own characteristics when compared by pupils with a living person. One of the criteria for establishing a post-mortem examination is to check the eyes of the deceased.

First of all, one of the signs will be the "drying" of the cornea of ​​​​the eyes, as well as the "fading" of the iris. Also, a kind of whitish film is formed before the eyes, called “herring shine” - the pupil becomes cloudy and dull. This is due to the fact that after death, the lacrimal glands stop functioning, producing tears that moisturize the eyeball.
In order to fully verify death, the victim's eye is gently squeezed between the large and index fingers. If the pupil turns into a narrow slit (a symptom of "cat's eye"), a specific reaction of the pupil to death is stated. In a living person, such symptoms are never detected.

Attention! If the deceased had the above signs, then death occurred no more than 60 minutes ago.

Near-death pupils will be unnaturally wide, without any reaction to lighting. With successful resuscitation, the victim will begin to pulsate. The cornea, whites of the eyes, and pupils acquire brownish-yellow stripes after death, called Larcher spots. They are formed if the eyes remain ajar after death and indicate a strong drying of the mucous membrane of the eyes.

Pupils at death (clinical or biological) change their characteristics. Therefore, knowing these features, one can accurately state the fact of death or immediately proceed to save the victim, more precisely, to cardiopulmonary resuscitation. The popular phrase “Eyes are the reflection of the soul” perfectly describes the human condition. Focusing on the reaction of the pupils, in many situations it is possible to understand what is happening to a person and what actions to take.

Video

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 heavy bleeding, electrical injury, drowning, reflex cardiac arrest, acute poisoning, etc.

Signs of clinical death:

1) the absence of a 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. The absence of a pulse on the carotid artery is the main sign of circulatory arrest;

2. Lack of breathing can be checked by visible movements chest when inhaling and exhaling or putting your ear to your chest, hear the sound of breathing, feel (the movement of air during exhalation is felt by the 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 the 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 " cat 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. The eyeball is squeezed with the thumb and forefinger, if the person is dead, then his pupil will change shape and turn into a narrow slit - the “cat 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. Corpse spots purple 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 circulatory support ( outdoor massage hearts); 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, as under his clothes on the sternum there may be pectoral cross, medallion, buttons, etc., which can become sources of additional injury, as well as unfasten the waist belt.

For airway management it is necessary: ​​1) to clean the oral cavity from mucus, vomit with a cloth wound around the index finger. 2) to eliminate the sinking of the tongue in two ways: by tilting the head back or by pushing mandible.

Tilt your head back the victim is necessary in order to back wall pharynx moved away from the root of the sunken tongue, and air could 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, protrude only the 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 with the 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: blockage of the respiratory tract by vomit and earth, electrical injury, drowning, poisoning with OM, blockage by 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 large arteries(sleepy and femoral) and 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, first of all, the obstruction of the respiratory tract, caused by the ingress of foreign bodies, the 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 in case of damage to the respiratory center by electric current or lightning, poisoning with sleeping pills or narcotic 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 is best done using 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 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. 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 temperature bodies). Possibly survival.

Signs of clinical death

Signs of clinical death include: coma, apnea, asystole. This triad concerns early period 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 on 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 in the field of revitalization 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). Essentially, basic CPR is initial stage revival, when the rescuer often finds himself alone with the victim, and is forced to carry out resuscitation measures "empty-handed".

2. Advanced Cardiovascular Life Support- specialized resuscitation measures (specialized or 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 involves the consistent implementation of the same techniques as in basic CPR, but 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 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 (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 clinical practice, this can be achieved through physical effects (hypothermia of the head, hyperbaric oxygenation- breathing oxygen at high pressure in a special chamber), the use of pharmacological substances that create a state similar to suspended animation ( a sharp decline metabolism), hemosorption (hardware blood purification), transfusion of fresh (not canned) donor blood, and some others.

If resuscitation was not carried out or was unsuccessful, biological or true death occurs, which is an irreversible cessation 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 the “afterlife”. 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 regardless of 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]. From a medical point of view, this 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 visual analyzer, and foci of stable excitation of the cortex are formed, supporting the picture of continuous illumination, the person seems to be approaching the light, this illusion arises due to signal reverberation in the visual cortex of the brain, which imitates the amplification and propagation of light in front of the patient's eyes. 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 given state may be accompanied by specific hallucinations. For religious people, these can indeed be pictures of the afterlife, and what a person sees can vary significantly depending on his life experience and individual characteristics. These hallucinations are often very similar to similar experiences in mental illness.

/ Death

Death, cessation of the vital activity of the organism and, as a result, the death of the individual as a separate living system, accompanied by decomposition proteins and others biopolymers, which are the main material substrate life. 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- the natural S. of an individual manifests itself in the form of division, since it is associated with the cessation of the existence of a given individual and the emergence of two new ones 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 about life and death, Kish., 1955; Lunts AM, On the evolution of death in connection with the evolution of reproduction, "Journal of General Biology", 1961, vol. 22, no. 2; Polikar A., ​​Bessie M., Elements of cell pathology, trans. from French, Moscow, 1970.

clinical death

clinical death, a state of the body characterized by the absence of external signs of life (cardiac 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 of "cat's eye" (to detect 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 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 has been reliably established for more than 30 minutes under normal (room) temperature conditions environment. 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 in 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. 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, according to modern concepts, of 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 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 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 bell. The bell rang only once, and when the ministers came to help the awakened lethargic sleep the patient, it turned out that there was a resolution of rigor mortis. At the same time, from the literature and medical practice, there are known cases of delivery of living people to the morgue, to whom doctors mistakenly diagnosed death.

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 conditions external environment 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 is judged by fluctuations in the water level chest wall. 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 of a solution of fluorescein gives a quick staining of the skin of a living person in a yellowish color, and the sclera in a 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 lack of response to external stimuli - ammonia, weak pain effects (tingling with a needle, 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 possible disease or pathological condition. In the last century, extremely unusual and sometimes quite cruel methods have been used to test the function of the nervous system. 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 to what tricks the doctors reached in the difficult problem of ascertaining the function of the central nervous system.

One of the earliest and most valuable signs of the onset of death is the "cat's 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. Contributing moment for changing the shape of the pupil is the drop in 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 of the Russian Federation dated December 20, 2001 No. 460 "On approval of the Instruction for ascertaining the death of a person on the basis of 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 of the radius and the tendon of the internal radial muscle. In cases where it is impossible to examine the pulse on the radial artery, it is determined either on the carotid or temporal artery, or on the legs (on the dorsal artery of the foot and posterior tibial artery). Usually, the pulse rate in a healthy person is 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 a 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 life of the organism - 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(reversible state of deep depression of all vital 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:

Color change skin(severe pallor or blueness)

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.

Probable signs of death include lack 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 is not determined ( arterial pressure, pulse, any other signs of heart contractions), 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 the round shape of the pupil in humans during life. Injuries that are incompatible with life (for example, dismemberment of the body) also indicate 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 lung ventilation. 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 integrated approach for the right decision; 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, such a state of the body in which the main functions are 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.

Signs of biological death do not appear immediately after the end of the stage of clinical death, but some time later. Moreover, each of the signs is manifested in different time and not all at the same time. Therefore, we will analyze these signs in the chronological order of their occurrence.

"Cat's eye" (symptom of Beloglazov). Appears 25-30 minutes after death. Where does this name come from? A person has a pupil round shape, and in a cat it is elongated. After death, human tissues lose their elasticity and firmness, and if squeezed from both sides of the eyes dead man, it is deformed, and together with the eyeball, the pupil is also deformed, taking an elongated shape, like in a cat. In a living person, it is very difficult to deform the eyeball, if not impossible. In various accidents, when the victim has no breathing and signs of heart contraction, it is necessary to start artificial ventilation of the lungs as soon as possible and to closed massage hearts.

Drying of the cornea of ​​the eye and mucous membranes. Appears 1.5-2 hours after death. After death, the lacrimal glands cease to function, which produce tear fluid, which, in turn, serves to moisten the eyeball. A living person's eyes are moist and shiny. The cornea of ​​the eye of a dead person, as a result of drying, loses its natural human luster, becomes cloudy, sometimes a grayish-yellowish coating appears. The mucous membranes, which were more hydrated during life, dry out quickly. For example, lips become dark brown, wrinkled, dense.

Dead spots. Arise as a result of the post-mortem redistribution of blood in the corpse under the influence of gravity. After cardiac arrest, the movement of blood through the vessels stops, and the blood, due to its gravity, begins to gradually flow into the lower parts of the corpse, overflowing and expanding the capillaries and small venous vessels; the latter are translucent through the skin in the form of bluish-purple spots, which are called cadaveric. The color of cadaveric spots is not uniform, but spotty, has a so-called “marble” pattern. They appear approximately 1.5-3 hours (sometimes 20-30 minutes) after death. Dead spots are located in the underlying parts of the body. When the corpse is on the back, cadaveric spots are located on the back and back - lateral surfaces of the body, on the stomach - on the front surface of the body, face, with the vertical position of the corpse (hanging) - on lower limbs and lower abdomen. In some poisonings, cadaveric spots have unusual coloring: pinkish-reddish (carbon monoxide), cherry (hydrocyanic acid and its salts), grayish-brown (berthollet salt, nitrites). In some cases, the color of cadaveric spots may change when the environment changes. For example, when the corpse of a drowned man is taken ashore, the bluish-purple cadaveric spots on his body, due to the penetration of air oxygen through loosened skin, can change color to pink-red. If death occurred as a result of a large blood loss, then the cadaveric spots will have a much paler shade or be absent altogether. When a corpse is kept at low temperatures, cadaveric spots will form later, up to 5-6 hours. The formation of cadaveric spots takes place in two stages. As you know, cadaveric blood does not coagulate during the first day after death. Thus, on the first day after death, when the blood has not yet coagulated, the location of cadaveric spots is not constant and can change when the position of the corpse changes as a result of the flow of uncoagulated blood. In the future, after blood clotting, cadaveric spots will not change their position. Determining the presence or absence of blood clotting is very simple - you need to press on the spot with your finger. If the blood has not clotted, when pressed, the cadaveric spot at the site of pressure will turn white. Knowing the properties of cadaveric spots, it is possible to determine the approximate prescription of death at the scene of the incident, and also to find out whether the corpse was turned over after death or not.

Rigor mortis. After the onset of death, biochemical processes occur in the corpse, leading first to muscle relaxation, and then to contraction and hardening - rigor mortis. Rigor mortis develops within 2-4 hours after death. The mechanism of rigor mortis formation is not yet fully understood. Some researchers believe that the basis is biochemical changes in the muscles, others - in nervous system. In this state, the muscles of the corpse create an obstacle to passive movements in the joints, therefore, to straighten the limbs, which are in a state of pronounced rigor mortis, it is necessary to use physical force. The full development of rigor mortis in all muscle groups is achieved on average by the end of the day. Rigor mortis develops not in all muscle groups at the same time, but gradually, from the center to the periphery (first, the muscles of the face, then the neck, chest, back, abdomen, limbs undergo rigor mortis). After 1.5-3 days, stiffness disappears (allowed), which is expressed in muscle relaxation. Rigor mortis is resolved in the reverse order of development. The development of rigor mortis is accelerated at high temperatures, and at low temperatures it is delayed. If death occurs as a result of trauma to the cerebellum, rigor mortis develops very quickly (0.5-2 seconds) and fixes the posture of the corpse at the time of death. Rigor mortis is allowed before the deadline in case of forced muscle stretching.

Corpse cooling. Body temperature due to discontinuation metabolic processes and energy production in the body is gradually reduced to ambient temperature. The onset of death can be considered reliable when the body temperature drops below 25 degrees (according to some authors, below 20). It is better to determine the temperature of a corpse in areas closed from environmental influences (armpit, oral cavity), since the skin temperature completely depends on the ambient temperature, the presence of clothing, etc. The rate of cooling of the body may vary depending on the ambient temperature, but on average it is 1 degree / hour.

All signs of death can be divided into two groups - probable and reliable.

Likely signs of death

By likely signs death is expected. In everyday life, there are cases of a person developing a deep coma, fainting and other similar conditions that can be mistakenly taken as death.

Possible signs of death:

1) immobility of the body;

2) pallor of the skin;

3) lack of response to sound, pain, thermal and other stimuli;

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

5) lack of reaction of the cornea of ​​the eyeball to mechanical impact;

6) lack of pulse on large arteries, especially on the carotid artery;

7) lack of heartbeat - according to auscultation or electrocardiography;

8) cessation of breathing - there is no visible excursion of the chest, the mirror brought to the nose of the victim does not fog up.

Reliable signs of death

The presence of reliable signs of death indicates the development of irreversible physical and biochemical changes that are not characteristic of a living organism, the onset of biological death. By the severity of these changes, the time of death is determined. Reliable signs of death according to the time of manifestation are divided into early and late.

Early cadaveric changes develop within the first 24 hours after death. These include cadaveric cooling, rigor mortis, cadaveric spots, partial cadaveric drying, cadaveric autolysis.

Corpse cooling. A reliable sign of death is a decrease in the temperature in the rectum to 25 ° C and below.

Normally, a person's body temperature is in the range of 36.4-36.9 ° C when measured in the armpit. In the internal organs, it is 0.5 °C higher, the temperature in the rectum is 37.0 °C. After death, the processes of thermoregulation cease and the body temperature tends to catch up with the ambient temperature. At an ambient temperature of 20 °C, the cooling time lasts up to 24-30 hours, at 10 °C - up to 40 hours.

At the time of death, body temperature may be 2–3 °C higher than normal due to the development infectious diseases, in case of poisoning, overheating, after physical work. The rate of cooling of a corpse is influenced by the humidity of the environment, wind speed, ventilation of the premises, the presence of contact of the body with massive cold (warm) objects, the presence and quality of clothing on the body, the severity of subcutaneous fatty tissue, etc.

To the touch, a noticeable cooling of the hands and face is noted after 1.5–2 hours, the body remains warm under clothing for 6–8 hours.

With instrumental thermometry, the time of death is determined quite accurately. Approximately, body temperature decreases by 1 °C in 1 hour in the first 7–9 hours, then it decreases by 1 °C in 1.5 hours. Body temperature should be measured twice with an interval of 1 hour, at the beginning and at the end of the examination of the corpse.

Rigor mortis. This is a kind of state of muscle tissue, which causes a restriction of movement in the joints. The expert with his own hands tries to make this or that movement in any part of the body, limbs of the corpse. Encountering resistance, an expert on its strength and limited range of motion in the joints determines the severity of muscle stiffness. To the touch, stiff muscles become dense.

Immediately after death, all muscles, as a rule, are relaxed and passive movements in all joints are possible in full. Rigor mortis is noticeable 2–4 hours after death and develops from top to bottom. The muscles of the face stiffen faster (opening and closing the mouth is difficult, lateral displacements of the lower jaw are limited) and hands, then the neck muscles (movements of the head and cervical spine are difficult), then the muscles of the limbs, etc. The corpse completely stiffens in 14–24 hours When determining the degree of stiffness, it is necessary to compare its severity in the right and left parts of the body.

Rigor mortis persists for 2–3 days, after which it resolves due to the activation of the actomyosin protein putrefaction process in the muscles. This protein causes muscle contraction. The resolution of rigor mortis also occurs from top to bottom.

Rigor mortis develops not only in skeletal muscles, but also in many internal organs (heart, gastrointestinal tract, bladder etc.), having smooth muscles. Their condition is judged during an autopsy.

The degree of rigor mortis at the time of examination of the corpse depends on a number of reasons, which must be taken into account when determining the time of death. At low ambient temperatures, stiffness develops slowly and can last up to 7 days. On the contrary, at room and higher temperatures, this process accelerates and complete rigor develops faster. Rigor is strongly pronounced if death was preceded by convulsions (tetanus, strychnine poisoning, etc.). Rigor mortis also develops more strongly in individuals:

1) having well-developed muscles;

2) younger;

3) who do not have diseases of the muscular apparatus.

Muscle contraction is due to the breakdown of ATP (adenosine triphosphate) in it. After death, some of the ATP is free from binding to carrier proteins, which is enough to completely relax the muscles in the first 2–4 hours. Gradually, all ATP is utilized and rigor mortis develops. The period of complete utilization of ATP is approximately 10–12 hours. It is during this period that the state of the muscles can change under external influence, for example, you can unbend the hand and put some object into it. After a change in the position of a body part, stiffness is restored, but to a lesser extent. The difference in the degree of stiffness is established by comparing different parts of the body. The difference will be the smaller, the sooner after death the position of the corpse or its part of the body is changed. After 12 hours from the moment of death, ATP completely disappears. If the position of the limb is disturbed after this period, then stiffness in this place is not restored.

The state of stiffness is judged by the results of mechanical and electrical effects on the muscles. When hit with a hard object (stick) on the muscle, an idiomuscular tumor is formed at the site of impact, which is determined visually in the first 6 hours after death. At a later date, such a reaction can only be determined by palpation. When a current of a certain strength is applied to the ends of the muscle, its contraction is observed, assessed on a three-point scale: a strong contraction is observed in the period up to 2–2.5 hours, an average contraction is observed up to 2–4 hours, and a weak contraction is observed up to 4–6 hours.

Dead spots. The formation of cadaveric spots is based on the process of redistribution of blood in the vessels after death. During life, the tone of the muscles of the walls of the vessels and the contraction of the myocardium of the heart contribute to the movement of blood in a certain direction. After death, these regulatory factors disappear and the blood is redistributed to the lower parts of the body and organs. For example, if a person lies on his back, then the blood flows into the back area. If the corpse is in a vertical position (hanging, etc.), then the blood flows into the lower parts of the abdomen, lower limbs.

The color of the spots is most often bluish-purple. In case of carbon monoxide poisoning, carboxyhemoglobin is formed, and therefore the color of the spot is reddish-pink; when poisoned by some poisons, the color is grayish-brown (formation of methemoglobin).

The blood is redistributed to areas that are not pressed. With severe blood loss, the spots form slowly and are poorly expressed. With asphyxia, blood thinning occurs and the spots are abundant, spilled and strongly pronounced.

In a living organism, the components of blood pass through the wall of blood vessels only in capillaries, the smallest vessels. In all other vessels (arteries and veins), blood does not pass through the wall. Only when certain diseases or after the death of the vascular wall, its structure changes and it becomes permeable to blood and interstitial fluid.

Cadaverous spots in their development go through three stages.

Stage I - hypostasis, develops after 2–4 hours. If you press on the spot at this stage, it completely disappears. In this case, the blood is squeezed out of the vessels, the wall of which is still impermeable, i.e., the components of the blood do not pass through it into the tissue. If the pressure is stopped, the stain is restored. Rapid recovery of the spot in 3–10 s corresponds to 2–4 hours ago of death, a time equal to 20–40 s corresponds to 6–12 h. When the position of the corpse changes at this stage, the spots in the old place disappear, but other spots appear in the new place ("spot migration").

Stage II - diffusion (stasis), develops after 14–20 hours. At this stage, the vessel wall becomes permeable to a certain extent; intercellular fluid diffuses through the wall into the vessels and dilutes the plasma; hemolysis (destruction) of red blood cells occurs. At the same time, blood and its decay products diffuse into the tissue. When pressed, the stain fades, but does not disappear completely. Recovery of the spot occurs slowly, in 5-30 minutes, which corresponds to 18-24 hours ago of death. When the position of the corpse changes, the old spots turn pale, but new ones appear in those places that are located below the locations of the previous spots.

Stage III - hypostatic imbibition, develops after 20-24 hours or more. The vessel wall is completely saturated with blood plasma and interstitial fluid. Blood as a liquid system is completely destroyed. Instead, in the vessels and in the surrounding tissues there is a liquid formed from the mixing of destroyed blood and interstitial fluid that has soaked the tissues. Therefore, when pressed, the spots do not turn pale, retaining their color and shade. When the position of the corpse changes, they do not "migrate".

All of the above changes are also observed in the internal organs, more precisely, in those departments that are located below other areas. There is an accumulation of fluid in the cavities of the pleura, pericardium, peritoneum. The walls of all vessels, especially large ones, are saturated with liquid.

Partial cadaveric desiccation. Drying is based on the process of evaporation of moisture from the surface of the skin, mucous membranes and other open areas of the body. In living people, the evaporated liquid is compensated by the newly incoming one. There is no compensation process after death. Drying begins immediately after death. But the first visually noticeable manifestations of it are observed after a few hours.

If the eyes are open or half-open, drying quickly manifests itself in the form of clouding of the cornea, which acquires a grayish tint. When pushing the eyelids, triangular opacities are visible. The time of appearance of these spots is 4-6 hours.

Next, the border of the lips dries out (6–8 hours); the surface of the lip becomes dense, wrinkled, red-brown in color (very similar to lifetime sedimentation). If the mouth is ajar or the tongue protrudes from the oral cavity (mechanical asphyxia), then its surface is dense, brown.

The same changes are observed on the genitals, especially if they are naked. Thinner areas of the skin dry out faster: the glans penis, the foreskin, the scrotum. The skin in these places becomes dense, brown-red, wrinkled (similar to lifetime trauma).

Drying is faster if the body is naked; with dry air. Skin areas with post-mortem abrasions dry out faster. Their color is brown-red (on the underlying parts of the corpse) or "waxy" (on the overlying parts of the corpse). These are “parchment spots”, the central section of which is located below the edges. Abrasions are lifetime. Their surface also dries quickly, the color is red-brown, but it slightly protrudes due to tissue edema. Microscopic picture - plethoric vessels, swelling, hemorrhage, leukocyte infiltration.

Cadaveric autolysis. In the human body, a number of glands produce chemically active secretions. After death, these secrets begin to destroy the tissue of the glands themselves, since the organ's own defense mechanisms are absent. Self-destruction of the gland occurs. This is especially true for the pancreas and liver. At the same time, secretions leave the glands to other organs (into the gastrointestinal tract) and change it. Organs become flabby, dull. The action of enzymes on the structure of organs is stronger, the faster death occurs. The shorter the agony lasts, the less time the body has time to utilize the enzymes and the faster the cadaveric changes develop. All changes caused by autolysis can be seen only at autopsy.

Pupil reaction. During the first day, the pupils retain the ability to respond to the effects of certain pharmacological substances introduced into the anterior chamber of the eye. The reaction rate of the pupils decreases with increasing time of death. After the introduction of pilocarpine, pupillary constriction after 3–5 s corresponds to 3–5 h after death, after 6–15 s – 6–14 h, 20–30 s – 14–24 h.

The phenomenon of Beloglazov. 15-20 minutes after the onset of death in the eyeballs decreases intraocular pressure. Therefore, when the eyeball is compressed, the pupil takes an oval shape. Living people don't.

Late cadaveric changes change dramatically appearance corpse. Their beginning is noted in the period of manifestation of early cadaveric changes. But outwardly they appear later, some - by the end of 3 days, others - after months and years.

depending on save individual signs of a person and injuries on a corpse, late cadaveric changes are divided into types:

1) destructive - rotting;

2) preservatives: fat wax, mummification, peat tanning, freezing.

During conservation, the appearance changes, but individual features and damage are preserved to a certain extent.

Rotting. Decay is a complex process of decomposition of organic compounds under the influence of microorganisms and their enzymes. According to the conditions of vital activity, microorganisms are divided into aerobes and anaerobes (living with or without oxygen). Aerobes produce destruction more intensively. Anaerobes slowly destroy tissues, while unpleasant odors are released.

Microorganisms decompose protein to peptones, amino acids. Further, valeric, acetic, oxalic acids, creosol, phenol, methane, ammonia, nitrogen, hydrogen, carbon dioxide, hydrogen sulfide, methyl mercaptan, ethyl mercaptan are formed. The latter have an unpleasant odor. During decay, unstable substances are formed - putrescine, cadaverine.

The optimal conditions for decay are 30-40 ° C. The rate of decay is highest in air. The process is slower in water, even slower in soil, and very slowly in coffins. At temperatures of 1 °C and less, 50 °C and above, the process of decay slows down sharply and even stops. Decay is accelerated if death was preceded by prolonged agony (rapid destruction of the tissue barrier of the colon), purulent infection, sepsis.

After death, putrefaction occurs immediately in the large intestine, where a living person has certain types Anaerobic bacteria that continue to live after death. Microorganisms contribute to the formation of gases, especially hydrogen sulfide. It penetrates through the intestinal wall and its vessels into the blood. In the blood, hydrogen sulfide combines with hemoglobin and forms sulfohemoglobin, which has a greenish color. Spreading through the vessels, sulfohemoglobin penetrates into the venous network of the skin and subcutaneous tissue of the anterior wall of the abdomen, its hypogastric region. All this explains the greenish coloration of the skin of the inguinal regions 36–48 hours after death. Further, the color is enhanced by an increase in the concentration of sulfohemoglobin and the formation of iron sulfide (greenish-gray color).

The accumulation of gases in the intestines leads to bloating of the intestines, the entire abdomen. This pressure is so strong that pregnant women experience miscarriage of the fetus (the so-called "postmortem birth") and uterine inversion. Gas penetrates into the subcutaneous tissue of the entire body and causes swelling of the face, lips, mammary glands, neck, scrotum. The tongue protrudes from the mouth. Gas puts pressure on the stomach, which leads to post-mortem vomiting.

Sulfohemoglobin and iron sulfide, spreading through the vessels, stain them, which is noted in the form of a "putrid venous network" of a dirty green color after 3-5 days. After 8–12 days, the skin of the entire corpse has a dirty green color. The epidermis exfoliates, blisters with bloody contents form. Hair changes its color after 3 years. Damage to the bones, traces of a shot on the skin and its pattern, traces of cardiosclerosis persist for a relatively long time.

Zhirovovsk. Synonyms - saponification, saponification of fats. Formation conditions - a humid environment without air access. This phenomenon is well expressed in people with significant subcutaneous adipose tissue.

Water penetrates through the skin (the phenomenon of maceration), then penetrates into the intestines and washes out microorganisms from it. Decay sharply weakens and even stops. Under the action of water, fat decomposes into glycerol and fatty acids: oleic, palmitic, stearic, etc. These acids combine with alkali and alkaline earth metals, which are abundant in body tissues and in the water of reservoirs. A fat wax is formed, which has a gelatinous consistency of a dirty gray color (compounds of potassium and sodium), or a dense substance of a gray-white color (compounds of calcium and magnesium). This process is subject to subcutaneous tissue, fat accumulations in the chest and abdominal cavities, brain, liver. However, individual traits, the shape of organs, traces of damage to tissues and organs are preserved.

The first signs of saponification of the tissues of the corpse are observed from 25 days to 3 months. Complete saponification occurs no earlier than 6–12 months on the corpses of adults, and faster on the corpses of children.

Mummification. Natural mummification occurs at different ambient temperatures (often at high temperatures), lack of moisture in it, access and movement of dry air, and rapid release of fluid from the corpse. In the first days after the onset of death, the processes of decay intensively occur in the corpse. Parenchymal organs (lungs, liver, kidneys and other organs) turn into a liquid mass, which flows out through decayed tissues. Reducing the amount of fluid creates unfavorable conditions for life putrefactive microorganisms, as a result of which decay gradually stops and the corpse begins to dry out quickly. Drying begins, as a rule, in areas devoid of epidermis, in macerated areas of the skin, with open eyes- in the area of ​​the cornea and conjunctiva, on the lips, fingertips, etc. Complete drying of the corpse is most often observed in dry, loose, well-ventilated and moisture-absorbing soil, in rooms with sufficient ventilation.

The corpses of lean and emaciated individuals are easily mummified. On average, the mummification of a corpse occurs in 6–12 months; in some cases, the corpse of an adult can be mummified in 2–3 months. The mass of the mummy is 1/10 of the original body weight. Skin color - parchment, yellowish-brown or dark brown. The internal organs dry out and become flat. The tissues become dense. When mummified in varying degrees preserved appearance person. You can determine gender, age, anatomical features. There are traces of a shot, acute wounds, a strangulation furrow.

Peat tanning. Impregnation and tanning of tissues and organs with humic acids, which are decay products of dead plants, occurs in peat bogs. The skin becomes dark brown, dense. Internal organs are reduced. Mineral salts are washed out of the bones, so the shape of the latter changes. Bones look like cartilage. All damage is preserved. In this state, corpses can be preserved for a very long time, sometimes for centuries.

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biological death

biological death(or true death) is an irreversible cessation of physiological processes in cells and tissues. See death. Irreversible termination is usually understood as “irreversible within the framework of modern medical technologies» termination of processes. Over time, the possibilities of medicine for the 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 people dying now can be revived in the future if their brain structure is preserved now.

Early signs of biological death include:

1. Lack of eye response 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, similar to a cat's pupil.

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 with the muscles of the face and 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 under conditions of hypoxia and anoxia. In different tissues and organs, this ability is different. The shortest lifetime under anoxic conditions is observed in brain tissue, more precisely, in the cerebral cortex and subcortical structures. The stem sections and the spinal cord have 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 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 survivability 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 another organism.

see also

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