A person is able to live without water and food for some time, but without access to oxygen, breathing will stop after 3 minutes. This process is called clinical death, when the brain is still alive, but the heart does not beat. A person can still be saved if you know the rules of emergency resuscitation. In this case, both doctors and the one who is next to the victim can help. The main thing is not to get confused, act quickly. This requires knowledge of the signs clinical death, her symptoms and resuscitation rules.

Symptoms of clinical death

Clinical death is a reversible state of dying, in which the work of the heart stops, breathing stops. Everything external signs vital functions disappear, it may seem that the person is dead. Such a process is a transitional stage between life and biological death, after which it is impossible to survive. During clinical death (3-6 minutes), oxygen starvation practically does not affect the subsequent work of organs, general condition. If more than 6 minutes have passed, then the person will be deprived of many vital functions due to the death of brain cells.

To recognize in time given state you need to know its symptoms. Signs of clinical death are as follows:

• Coma - loss of consciousness, cardiac arrest with cessation of blood circulation, the pupils do not react to light.
• Apnea - no respiratory movements chest, but the metabolism remains at the same level.
• Asystole - the pulse on both carotid arteries is not heard for more than 10 seconds, which indicates the beginning of the destruction of the cerebral cortex.

Duration

Under conditions of hypoxia, the cortex and subcortex of the brain are able to maintain viability. certain time. Based on this, the duration of clinical death is determined by two stages. The first one lasts about 3-5 minutes. During this period, subject to normal temperature body, there is no oxygen supply to all parts of the brain. Exceeding this time range increases the risk of irreversible conditions:

• decortication - destruction of the cerebral cortex;
• decerebration - the death of all parts of the brain.

The second stage of the state of reversible dying lasts 10 or more minutes. It is characteristic of an organism with a reduced temperature. This process can be natural (hypothermia, frostbite) and artificial (hypothermia). In a hospital setting, this state is achieved by several methods:

• hyperbaric oxygenation- saturation of the body with oxygen under pressure in a special chamber;
• hemosorption - blood purification by the apparatus;
• drugs that sharply reduce metabolism and cause suspended animation;
• transfusion of fresh donated blood.

Causes of clinical death

The state between life and death occurs for several reasons. They can be caused by the following factors:

• heart failure;
• blockage respiratory tract(lung disease, suffocation);
• anaphylactic shock- respiratory arrest with a rapid reaction of the body to the allergen;
• a large loss of blood during injuries, wounds;
• damage to tissues by electricity;
• extensive burns, wounds;
• toxic shock- poisoning toxic substances;
• vasospasm;
• the body's response to stress;
• excessive physical activity;
• violent death.

The main stages and methods of first aid

Before taking measures to provide first aid, one must be sure of the onset of a state of temporary death. If all of the following symptoms are present, it is necessary to proceed to the provision emergency assistance. You should make sure of the following:

• the victim is unconscious;
• the chest does not make inhalation-exhalation movements;
• no pulse, pupils do not react to light.

In the presence of symptoms of clinical death, it is necessary to call an ambulance resuscitation team. Before the arrival of doctors, it is necessary to maintain the vital functions of the victim as much as possible. To do this, apply a precordial blow with a fist on the chest in the region of the heart. The procedure can be repeated 2-3 times. If the condition of the victim remains unchanged, then it is necessary to proceed to artificial ventilation lungs (IVL) and cardiopulmonary resuscitation (CPR).

CPR is divided into two stages: basic and specialized. The first is performed by a person who is next to the victim. The second is by trained health workers on site or in a hospital. The algorithm for performing the first stage is as follows:

1. Lay the victim down on a flat, hard surface.
2. Put your hand on his forehead, slightly tilting his head. This will push the chin forward.
3. With one hand, pinch the victim's nose, with the other - stretch out the tongue, try to blow air into the mouth. The frequency is about 12 breaths per minute.
4. Go to chest compressions.

To do this, with the protrusion of the palm of one hand, you need to put pressure on the area of ​​\u200b\u200bthe lower third of the sternum, and put the second hand on top of the first. indentation chest wall performed to a depth of 3-5 cm, while the frequency should not exceed 100 cuts per minute. The pressure is performed without bending the elbows, i.e. straight position shoulders over palms. It is impossible to blow in and squeeze the chest at the same time. It is necessary to ensure that the nose is tightly clamped, otherwise the lungs will not receive required amount oxygen. If the breath is taken quickly, air will enter the stomach, causing vomiting.

Resuscitation of the patient in the clinic

Resuscitation of the victim in a hospital is carried out according to a certain system. It consists of following methods:

1. Electrical defibrillation - stimulation of breathing by exposure to electrodes with alternating current.
2. Medical resuscitation through intravenous or endotracheal administration of solutions (Adrenaline, Atropine, Naloxone).
3. Circulatory support with the introduction of Hecodese through the central venous catheter.
4. Correction acid-base balance intravenously (Sorbilact, Xylat).
5. Restoration of capillary circulation by drip(Rheosorbilact).

In case of successful resuscitation, the patient is transferred to the ward intensive care, where further treatment and condition monitoring. Resuscitation stops in the following cases:

• Ineffective resuscitation within 30 minutes.
• Statement of the state of biological death of a person due to brain death.

Signs of biological death

biological death is the final stage of the clinical, if resuscitation measures were ineffective. The tissues and cells of the body do not die immediately, it all depends on the ability of the organ to survive during hypoxia. Death is diagnosed on certain grounds. They are divided into reliable (early and late), and orienting - immobility of the body, lack of breathing, heartbeat, pulse.

Biological death can be distinguished from clinical death by early signs. They are noted after 60 minutes from the moment of dying. These include:

• lack of pupillary response to light or pressure;
• the appearance of triangles of dried skin (Larcher spots);
• drying of the lips - they become wrinkled, dense, brown in color;
• symptom of "cat's eye" - the pupil becomes elongated due to the absence of the eye and blood pressure;
• drying of the cornea - the iris is covered with a white film, the pupil becomes cloudy.

A day after death, late signs of biological death appear. These include:

• the appearance of cadaveric spots - localization mainly on the arms and legs. The spots are marbled.
• rigor mortis - the state of the body due to ongoing biochemical processes, disappears after 3 days.
• cadaveric cooling - states the completion of the onset of biological death, when the body temperature drops to a minimum level (below 30 degrees).

Consequences of clinical death

After successful resuscitation, a person from a state of clinical death returns to life. This process may be accompanied various violations. They can affect how physical development as well as psychological state. The damage caused to health depends on the time of oxygen starvation of important organs. In other words, than earlier man come back to life after a short death fewer complications he will be observed.

Based on the above, it is possible to identify temporal factors that determine the degree of complications after clinical death. These include:

• 3 minutes or less - the risk of destruction of the cerebral cortex is minimal, as well as the appearance of complications in the future.
• 3-6 minutes - Minor brain damage indicates that consequences may occur (impaired speech, motor function, coma).
• More than 6 minutes - the destruction of brain cells by 70-80%, which will lead to a complete lack of socialization (the ability to think, understand).

At the level psychological state certain changes are also observed. They are called transcendental experiences. Many people claim that being in a state of reversible death, they hovered in the air, saw a bright light, a tunnel. Some accurately list the actions of doctors during resuscitation procedures. Life values a person after this changes dramatically, because he escaped death and got a second chance at life.

Video

Following clinical death, biological death occurs, characterized by a complete stop of all physiological functions and processes in tissues and cells. With improvement medical technologies the death of man is pushed further and further away. Today, however, biological death is an irreversible condition.

Signs of a dying person

Clinical and biological (true) death are two stages of the same process. Biological death is stated if resuscitation during clinical death could not "start" the body.

Signs of clinical death

The main sign of clinical cardiac arrest is the absence of pulsation in the carotid artery, which means circulatory arrest.

The absence of breathing is checked by the movement of the chest or by putting the ear to the chest, as well as by bringing a dying mirror or glass to the mouth.

Lack of response to a sharp sound and painful stimuli is a sign of loss of consciousness or a state of clinical death.

If at least one of these symptoms is present, resuscitation should begin immediately. Timely resuscitation can bring a person back to life. If resuscitation was not carried out or was not effective, last stage dying is biological death.

Definition of biological death

Determination of the death of the organism occurs by a combination of early and late signs.

Signs of a person's biological death appear after the onset of clinical death, but not immediately, but after some time. It is generally accepted that biological dying occurs at the moment of cessation brain activity, approximately 5-15 minutes after clinical death.

The exact signs of biological death are the readings of medical devices that have recorded the cessation of the supply of electrical signals from the cerebral cortex.

Stages of human dying

Biological death is preceded by the following stages:

1. The predagonal state is characterized by a sharply depressed or absent consciousness. The skin is pale, blood pressure can drop to zero, the pulse is palpable only on the carotid and femoral arteries. Increasing oxygen starvation quickly worsens the patient's condition.
2. Terminal pause is a borderline state between dying and life. Without timely resuscitation, biological death is inevitable, since the body cannot cope with this condition on its own.
3. Agony - the last moments of life. The brain ceases to control life processes.

All three stages may be absent if the body was affected by powerful destructive processes (sudden death). The duration of the agonal and pre-agonal period can vary from several days and weeks to several minutes.

Agony ends with clinical death, which is characterized by the complete cessation of all vital processes. It is from this moment that a person can be considered dead. But irreversible changes in the body have not yet occurred, therefore, during the first 6-8 minutes after the onset of clinical death, active resuscitation measures are taken to help bring the person back to life.

The last stage of dying is considered irreversible biological death. The determination of the fact of the onset of true death occurs if all measures to bring a person out of a state of clinical death have not led to a result.

Differences in biological death

Differ biological death natural (physiological), premature (pathological) and violent.

Natural biological death occurs in old age, as a result of the natural extinction of all body functions.

Premature death is caused by a serious illness or damage to vital organs, sometimes it can be instantaneous (sudden).

Violent death occurs as a result of murder, suicide, or is the result of an accident.

Criteria for biological death

The main criteria for biological death are determined by the following criteria:

1. Traditional signs of cessation of life are cardiac and respiratory arrest, lack of pulse and reaction to external stimuli and pungent odors(ammonia).
2. Based on the dying of the brain - an irreversible process of cessation of the vital activity of the brain and its stem sections.

Biological death is a combination of the fact of the termination of the vital activity of the brain with the traditional criteria for determining death.

Signs of biological death

Biological death is The final stage dying of a person, replacing the clinical stage. Cells and tissues do not die simultaneously after death, the lifetime of each organ depends on the ability to survive with complete oxygen starvation.

The first to die is the central nervous system - the spinal cord and brain, this happens about 5-6 minutes after the onset of true death. The death of other organs can take several hours or even days, depending on the circumstances of the death and the conditions of the deceased body. Some tissues, such as hair and nails, retain their ability to grow for a long time.

Diagnosis of death consists of orienting and reliable signs.

Orienting signs include a motionless position of the body with a lack of breathing, pulse and heartbeat.

A reliable sign of biological death includes the presence of cadaveric spots and rigor mortis.

Also differ early symptoms biological death and later.

early signs

Early symptoms of biological death appear within an hour of dying and include the following:

1. Lack of pupillary response to light stimulation or pressure.
2. The appearance of Larcher spots - triangles of dried skin.
3. The appearance of a symptom of a "cat's eye" - when the eye is squeezed from both sides, the pupil takes an elongated shape and becomes similar to the pupil of a cat. The symptom of "cat's eye" means the absence intraocular pressure, directly related to the arterial.
4. Drying of the eye cornea - the iris loses its original color, as if covered with a white film, and the pupil becomes cloudy.
5. Dry lips - lips become dense and wrinkled, acquire a brown color.

Early signs of biological death indicate that resuscitation is already pointless.

late signs

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

1. The appearance of cadaveric spots - approximately 1.5-3 hours after the diagnosis of true death. The spots are located in the underlying parts of the body and have a marble color.
2. Rigor mortis is a reliable sign of biological death, which occurs as a result of biochemical processes occurring in the body. Rigor mortis reaches its full development in about a day, then it weakens and disappears altogether after about three days.
3. Cadaveric cooling - it is possible to state the complete onset of biological death if the body temperature has dropped to air temperature. The rate at which a body cools down depends on temperature. environment, but the average decrease is about 1°C per hour.

brain death

The diagnosis of "brain death" is made with complete necrosis of brain cells.

The diagnosis of the termination of the vital activity of the brain is made on the basis of the obtained electroencephalography, showing complete electrical silence in the cerebral cortex. Angiography will reveal the cessation of cerebral blood supply. Mechanical ventilation and medical support can keep the heart working for a while longer - from a few minutes to several days and even weeks.

The concept of "brain death" is not identical to the concept of biological death, although in fact it means the same thing, since the biological dying of an organism is inevitable in this case.

Time of onset of biological death

Determining the time of onset of biological death is of great importance for ascertaining the circumstances of the death of a person who died in non-obvious conditions.

The less time has passed since the onset of death, the easier it is to determine the time of its onset.

The age of death is determined by different indications in the study of tissues and organs of the corpse. Determination of the moment of death in early period carried out by studying the degree of development of cadaveric processes.

Statement of death

The biological death of a person is ascertained by a set of signs - reliable and orienting.

In case of death from an accident or violent death, the ascertainment of brain death is fundamentally impossible. Breathing and heartbeat may not be heard, but this also does not mean the onset of biological death.

Therefore, in the absence of early and late signs of dying, the diagnosis of "brain death", and therefore biological death, is established in medical institution doctor.

transplantology

Biological death is a state of irreversible death of an organism. After a person dies, their organs can be used as transplants. The development of modern transplantology allows saving thousands of human lives every year.

The emerging moral and legal issues are quite complex and are resolved in each case individually. The consent of the relatives of the deceased for the removal of organs is required without fail.

Organs and tissues for transplantation must be removed before they appear early signs biological death, that is, at the very a short time. Late declaration of death - about half an hour after death, makes organs and tissues unsuitable for transplantation.

The removed organs can be stored in special solution from 12 to 48 hours.

In order to remove the organs of a deceased person, biological death must be established by a group of doctors with a protocol. The conditions and procedure for the removal of organs and tissues from a deceased person is regulated by the law of the Russian Federation.

The death of a person is a socially significant phenomenon that includes a complex context of personal, religious and public relations. Nevertheless, dying is an integral part of the existence of any living organism.

Dying is the final result of the life of any organism in general, and of a person in particular. But the stages of dying are different, because they have distinct signs of clinical and biological death. An adult needs to know that clinical death is reversible, unlike biological. Therefore, knowing these differences, the dying person can be saved by applying resuscitation steps.

Despite the fact that in appearance a person who is in the clinical stage of dying looks already without obvious signs of life and at first glance he cannot be helped, in fact emergency resuscitation sometimes able to wrest him from the clutches of death.

Therefore, when you see a practically dead person, you should not rush to give up - you need to find out the stage of dying, and if there is slightest chance to revival - it is necessary to save it. This is where knowledge of how clinical death differs from irrevocable, biological death in terms of signs.

Dying stages

If this is not instantaneous death, but the process of dying, then the rule applies here - the body does not die at one moment, fading away in stages. Therefore, there are 4 stages - the phase of pre-agony, the actual agony, and then the subsequent phases - clinical and biological death.

• Pre-agonal phase. It is characterized by inhibition of the function nervous system, drop in blood pressure, circulatory disorders; from the side skin- pallor, spotting or cyanosis; from the side of consciousness - confusion, lethargy, hallucinations, collapse. The duration of the preagonal phase is extended in time and depends on numerous factors; it can be extended with medication.
• Phase of agony. The pre-death stage, when breathing, blood circulation, and cardiac function are still observed, albeit weakly and for a short time, is characterized by a complete imbalance of organs and systems, as well as a lack of regulation of life processes by the central nervous system. This leads to the cessation of oxygen supply to the cells and tissues, the pressure in the vessels drops sharply, the heart stops, breathing stops - the person enters the phase of clinical death.
• Clinical death phase. This is a short-term, having a clear time interval, a stage at which a return to the previous life activity is still possible, if there are conditions for the further uninterrupted functioning of the body. In general, at this short stage, the heart no longer contracts, the blood freezes and stops moving, there is no brain activity, but the tissues do not die yet - exchange reactions continue by inertia in them, fading. If, with the help of resuscitation steps, the heart and breathing are started, a person can be brought back to life, because the brain cells - and they die first - are still preserved in a viable state. At normal temperature the phase of clinical death lasts a maximum of 8 minutes, but with a decrease in temperature, it can be extended to tens of minutes. The stages of pre-agony, agony and clinical death are defined as "terminal", that is, the last state leading to the termination of a person's life.
• Phase of biological (final or true) death, which is characterized by irreversibility physiological changes inside cells, tissues and organs, caused by a prolonged lack of blood supply - primarily to the brain. This phase, with the development of nano- and cryo-technologies in medicine, continues to be closely studied in order to try to push back its onset as much as possible.

Remember! In the event of a sudden death, the obligatoriness and sequence of phases are erased, but inherent features are saved.

Signs of the onset of clinical death

The stage of clinical death, defined unequivocally as reversible, allows you to literally “breathe” life into the dying person by starting the heartbeat and respiratory function. Therefore, it is important to remember the signs inherent in the phase of clinical death, so as not to miss the chance to revive a person, especially when the count goes on for minutes.

The three main signs by which the onset of this phase is determined are:

• cessation of the heartbeat;
• cessation of breathing;
• termination brain activity.

Let's consider them in detail, how it looks in reality and how it manifests itself.

• The cessation of the heartbeat also has the definition of "asystole", which means the absence of activity from the heart and activity, which is shown on the bioelectric indicators of the cardiogram. Manifested by the inability to hear the pulse on both carotid arteries on the sides of the neck.
• The cessation of breathing, which is defined in medicine as "apnea", is recognized by the cessation of movement up and down the chest, as well as the absence of visible traces of fogging on the mirror brought to the mouth and nose, which inevitably appear when breathing is present.
• The cessation of brain activity, which has medical term"coma", characteristically total absence consciousness and reaction to light from the pupils, as well as reflexes to any stimuli.

At the stage of clinical death, the pupils are steadily dilated, regardless of the illumination, the skin has a pale, lifeless shade, the muscles throughout the body are relaxed, there are no signs of the slightest tone.

Remember! The less time has passed from the cessation of heartbeat and breathing, the more chances there are to bring the deceased back to life - the rescuer has only 3-5 minutes on average at his disposal! Sometimes in conditions low temperatures this period is extended to a maximum of 8 minutes.

Signs of the onset of biological death

biological human death means the final cessation of the existence of a person's personality, since it is characterized by irreversible changes in his body, caused by a prolonged absence of biological processes inside the body.

This stage is determined by early and late signs of true dying.

The early, initial signs characterizing biological death that overtook a person no later than 1 hour include:

• on the part of the eye cornea, first clouding - for 15 - 20 minutes, and then drying;
• from the side of the pupil - the effect of "cat's eye".

In practice, it looks like this. In the first minutes after the onset of irrevocable biological death, if you look at the eye carefully, you can notice on its surface the illusion of a floating ice floe, turning into a further clouding of the color of the iris, as if it is covered with a thin veil.

Then the phenomenon of the "cat's eye" becomes apparent, when, with slight pressure on the sides of the eyeball, the pupil takes the form of a narrow slit, which is never observed in a living person. Doctors called this symptom "Beloglazov's symptom". Both of these signs indicate the onset of the final phase of death no later than 1 hour.

symptom of Beloglazov

Late signs by which biological death that has overtaken a person are recognized include the following:

• complete dryness of the mucous and skin integuments;
• cooling of the deceased body and its cooling to the temperature of the surrounding atmosphere;
• the appearance of cadaveric spots in the sloping zones;
• rigor of the dead body;
• cadaveric decomposition.

Biological death alternately affects organs and systems, therefore it is also extended in time. The cells of the brain and its membranes are the first to die - it is this fact that makes further resuscitation impractical, since it will no longer be possible to return a person to a full life, although the rest of the tissues are still viable.

The heart, as an organ, loses its full viability within an hour or two from the moment of biological death, internal organs - for 3-4 hours, skin and mucous membranes - for 5-6 hours, and bones - for several days. These indicators are important for the conditions for successful transplantation or restoration of integrity in case of injuries.

Resuscitation steps in observed clinical death

The presence of three main signs accompanying clinical death - the absence of a pulse, breathing and consciousness - is already enough to start emergency resuscitation measures. They come down to immediate call ambulance, in parallel - artificial respiration and heart massage.

Competently carried out artificial respiration obeys the following algorithm.

• In preparation for artificial respiration, it is required to free the nasal and oral cavity from any contents, throw back your head so that between the neck and the back of the head you get sharp corner, and between the neck and chin - blunt, only in this position will the airways open.
• Having clamped the nostrils of the dying person with his hand, with his own mouth, after a deep breath, through a napkin or handkerchief tightly wrap around his mouth and exhale into it. After exhaling, remove the hand from the nose of the dying.
• Repeat these steps every 4 to 5 seconds until chest movement occurs.

Remember! You can’t throw your head back excessively - make sure that not a straight line forms between the chin and the neck, but an obtuse angle, otherwise the stomach will overflow with air!

It is necessary to correctly perform a parallel heart massage, following these rules.

• Massage is done exclusively in a horizontal position of the body on a hard surface.
• Arms are straight, without bending at the elbows.
• The shoulders of the rescuer are exactly above the chest of the dying person, outstretched straight arms are perpendicular to it.
• The palms, when pressed, are either placed one on top of the other, or in the castle.
• Pressing is carried out in the middle of the sternum, just below the nipples and just above the xiphoid process, where the ribs converge, with the base of the palm with raised fingers, without taking the hands off the chest.
• Massage must be carried out rhythmically, with a break to exhale into the mouth, at a pace of 100 clicks per minute and to a depth of about 5 cm.

Remember! Proportionality of the correct resuscitation- 1 inhalation-exhalation is done for 30 clicks.

The result of the revival of a person should be his return to such mandatory initial indicators - the reaction of the pupil to light, probing the pulse. But the resumption of spontaneous breathing is not always achievable - sometimes a person retains a temporary need for artificial lung ventilation, but this does not prevent him from coming to life.

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

IN modern medicine allocate clinical and biological (final) death. Brain death is considered separately.

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

What is clinical death of a person

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

Further in the article, the comparative signs of biological and clinical death will be considered in more detail. By the way, the state of a person between these two types of death of the body is called terminal. And clinical death may well pass into the next, irreversible stage - biological, the indisputable sign of which is the rigor of the body and the subsequent appearance of cadaveric spots on it.

What are the signs of clinical death: preagonal phase

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

The first of them is manifested in the inhibition of consciousness while maintaining it, as well as in violation of the functions of the central nervous system, expressed by stupor or coma. The pressure, as a rule, is low at the same time (maximum 60 mm Hg), and the pulse is rapid, weak, shortness of breath appears, the breathing rhythm is disturbed. This state can last for several minutes or several days.

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

Manifestation of agony

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

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

The agonal phase is usually accompanied by a lack of consciousness. The pupils of a person dilate and do not react to light. Blood pressure can not be determined, the pulse is practically not palpable. Heart tones in this case are muffled, and breathing is rare and shallow. These signs of clinical death, which is impending, can last for several minutes or several hours.

How does the state of clinical death manifest itself?

With the onset of clinical death, respiration, pulse, blood circulation and reflexes disappear, and cellular metabolism takes place anaerobically. But this does not last long, because the number of energy drinks in the brain of a dying person is depleted, and his nervous tissue dies.

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

Signs of clinical death are: pallor of the skin (they become cold to the touch), lack of respiration, pulse and corneal reflex. In this case, urgent resuscitation measures should be taken.

Three main signs of clinical death

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

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

Apnea - stopping breathing. It is manifested by the absence of movement of the chest, which indicates a stop in respiratory activity.

Asystole - main feature clinical death, expressed by cardiac arrest together with the lack of bio electrical activity.

What is sudden death

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

This type of death includes those that have arisen without apparent reason cases of cessation of the heart, which are caused by the occurrence of ventricular fibrillation (scattered and uncoordinated contraction of some groups muscle fibers) or (more rarely) an acute weakening of the heartbeat.

Signs of sudden clinical death are manifested by loss of consciousness, pallor of the skin, respiratory arrest and pulsation in the carotid artery (by the way, you can determine it if you put four fingers on the patient's neck between the Adam's apple and the sternocleidomastoid muscle). Sometimes this condition is accompanied by short-term tonic convulsions.

In medicine, there are a number of reasons that can cause sudden death. These are electrical injuries, lightning strikes, suffocation as a result of being hit foreign body into the trachea, as well as drowning and freezing.

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

How is heart massage done?

If the patient shows the first signs of clinical death, he is placed on his back on a hard surface (floor, table, bench, etc.), the belts are unfastened, tight clothing is removed, and an indirect heart massage is started.

The sequence of resuscitation actions looks like this:

• the assisting person takes a place to the left of the victim;
• puts his hands on top of each other on the lower third of the sternum;
• makes jerky pressures (15 times) at a frequency of 60 times per minute, while using your weight to achieve a deflection of the chest by about 6 cm;
• then grabs the chin and pinches the nose of the dying person, throws back his head, exhales as much as possible into his mouth;
• artificial respiration is done after 15 massage shocks in the form of two exhalations into the mouth or nose of the dying person for 2 seconds each (at the same time, you need to make sure that the victim’s chest rises).

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

How does an organism die?

In various human tissues and organs, resistance to oxygen starvation, as mentioned above, is not the same, and their death after the heart stops, occurs in a different time period.

As you know, the cerebral cortex dies first, then the subcortical centers, and finally spinal cord. Dies four hours after the heart stops working. Bone marrow, and a day later, the destruction of the skin, tendons and muscles of a person begins.

How does brain death manifest?

From the above, it is clear that precise definition signs of clinical death of a person is very important, because from the moment of cardiac arrest to the onset of brain death, which entails irreparable consequences, there are only 5 minutes.

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

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

What does biological death look like?

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

Biological or, in other words, the final death of the organism is the last stage of dying, which is characterized by irreversible changes that develop in all organs and tissues. At the same time, the functions of the main body systems cannot be restored.

The first signs of biological death include the following:

• when pressing on the eye, there is no reaction to this irritation;
• the cornea becomes cloudy, drying triangles form on it (the so-called Lyarche spots);
• if eyeball gently squeeze from the sides, the pupil transforms into a vertical slit (the so-called "cat's eye" symptom).

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

What happens during biological death

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

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

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

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

A few words in conclusion

To prevent the onset of biological death, it is important not to waste time and provide needed help dying.

It should be borne in mind that the duration of clinical death directly depends on what caused it, at what age the person is, and also on external conditions.

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

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

According to the instructions of the Ministry of Health of Russia (2003), resuscitation measures are stopped only when a human brain is dead or if it is ineffective medical care rendered within 30 minutes.

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 death of all cells occurs. internal organs(skin necrosis occurs only after a few hours, and sometimes days).

Reliable signs of 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. 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 skeletal muscle, creating an obstacle for 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 terms of decomposition are largely determined by the conditions of the 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 ambient temperature);

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 produces 2 breaths, after which - 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, inspiratory compression is beneficial because more blood from the lungs enters the heart and artificial circulation 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:

Resuscitation efficiency,

Efficiency of artificial respiration and blood circulation.

Resuscitation efficiency

The effectiveness of resuscitation is positive result 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. Second important symptom is the so-called retrograde amnesia, 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.