Signs of obvious physical biological death of the victim. Signs of clinical death are important to know

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

Signs clinical death:

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

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

Determination of signs of clinical death:

1. No pulse on carotid artery– the main sign of circulatory arrest;

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

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

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

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

Signs of biological death:

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

Determination of signs of biological death:

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

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

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

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

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

Full development of signs occurs within 24 hours after death.

More on the topic Signs of clinical and biological death:

1. Basics of first aid for terminal conditions. Concepts of clinical and biological death.
2. Theoretical foundations of medical practice. Theory of diagnosis and medical statement of death. Signs of death and postmortem changes. Opening.

Viewed as final stage terminal state, which begins from the moment the basic functions of the body’s vital functions cease (blood circulation, breathing) and continues until the onset of irreversible changes in the cerebral cortex. In a state of clinical death it is possible full recovery human life. Its duration is normal conditions is about 3-4 minutes, so to save the victim it is necessary to begin resuscitation measures as early as possible.

The duration of clinical death depends on many factors, but the determining factor is the supply of glycogen in neurons, because glycogenolysis is the only source of energy in the absence of blood circulation. Because neurons are one of those cells that function quickly, they cannot contain a large supply of glycogen. Under normal conditions, it is enough for exactly 3-4 minutes of anaerobic metabolism. With absence resuscitation care or if it is carried out incorrectly, after a specified time, energy production in the cells completely stops. This leads to disruption of all energy-dependent processes and, above all, the maintenance of the integrity of intracellular and extracellular membranes.

Signs of clinical death

All symptoms that can be used to establish a diagnosis of clinical death are divided into basic and additional. The main signs are those that are determined during direct contact with the victim and allow one to reliably diagnose clinical death, the additional ones are those signs that indicate a critical condition and allow one to suspect the presence of clinical death even before contact with the patient. In many cases, this allows you to speed up the start of resuscitation measures and can save the patient’s life.

The main signs of clinical death:

• absence of pulse in the carotid arteries;
• lack of spontaneous breathing;
• dilation of the pupils - they dilate 40-60 seconds after blood circulation stops.

Additional signs of clinical death:

• lack of consciousness;
• pallor or cyanosis of the skin;
• lack of independent movements (however, rare convulsive muscle contractions are possible when acute stop blood circulation);
• unnatural position of the patient.

The diagnosis of clinical death should be established within 7-10 seconds. For the success of resuscitation measures, the time factor and technically correct implementation are crucial. To speed up the diagnosis of clinical death, checking the presence of a pulse and the condition of the pupils is carried out simultaneously: the pulse is determined with one hand, and the eyelids are raised with the other.

Cardiopulmonary and cerebral resuscitation

The complex of cardiopulmonary and cerebral resuscitation (CPCR), according to P. Safar, consists of 3 stages:

Stage I - basic life support
Purpose: emergency oxygenation.
Stages: 1) restoration of patency respiratory tract; 2) artificial ventilation; 3) indirect cardiac massage. Stage II - further life support
Goal: restoration of independent blood circulation.
Stages: 1) drug therapy; 2) diagnosis of the type of circulatory arrest; 3) defibrillation. Stage III - long-term life support
Goal: cerebral resuscitation.
Stages: 1) assessment of the patient’s condition and prognosis for the immediate future; 2) restoration of higher brain functions; 3) treatment of complications, rehabilitation therapy.

The first stage of resuscitation should be started immediately at the scene of the incident without delay by any person familiar with the elements of cardiopulmonary resuscitation. Its goal is to support artificial circulation and mechanical ventilation using elementary methods that ensure an extension of the period of reversible changes in vital organs until adequate spontaneous circulation is restored.

The indication for SLCR is the presence of even two main signs of clinical death. It is unacceptable to begin resuscitation measures without checking the pulse in the carotid artery, since performing indirect cardiac massage during normal operation can cause circulatory arrest.

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 those who are next to the victim can help. The main thing is not to get confused and act quickly. This requires knowledge of the signs of clinical death, its symptoms and the rules of resuscitation.

Symptoms of clinical death

Clinical death is a reversible state of dying in which the heart stops working and breathing stops. All external signs vital functions disappear, it may seem that the person is dead. This 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 the organs, general condition. If more than 6 minutes have passed, the person will be deprived of many vital important functions due to the death of brain cells.

To recognize this condition in time, you need to know its symptoms. Signs of clinical death are:

• Coma - loss of consciousness, cardiac arrest with cessation of blood circulation, pupils do not react to light.
• Apnea – absence breathing movements chest, but metabolism remains at the same level.
• Asystole - the pulse in both carotid arteries cannot be heard for more than 10 seconds, which indicates the beginning of destruction of the cerebral cortex.

Duration

Under conditions of hypoxia, the cerebral cortex and subcortex are able to remain viable for a certain time. Based on this, the duration of clinical death is determined by two stages. The first of them 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 – death of all parts of the brain.

The second stage of the state of reversible dying lasts 10 minutes or more. 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 oxygen therapy– saturation of the body with oxygen under pressure in a special chamber;
• hemosorption - blood purification by a device;
• drugs that sharply reduce metabolism and cause suspended animation;
• transfusion of fresh donor 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;
• obstruction of the respiratory tract (lung disease, suffocation);
• anaphylactic shock– respiratory arrest due to the body’s rapid reaction to an allergen;
• large loss of blood due to injuries, wounds;
• electrical damage to tissues;
• extensive burns, wounds;
• toxic shock– poisoning toxic substances;
• vasospasm;
• the body's response to stress;
• excessive physical exercise;
• violent death.

Basic steps and first aid methods

Before taking first aid measures, you must be sure that a state of temporary death has occurred. If all of the following symptoms are present, it is necessary to proceed to treatment emergency assistance. You should make sure of the following:

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

If there are symptoms of clinical death, it is necessary to call an ambulance resuscitation team. Until the doctors arrive, it is necessary to maintain the victim’s vital functions as much as possible. To do this, apply a precordial blow to the chest with a fist in the area of ​​the heart. The procedure can be repeated 2-3 times. If the victim’s condition remains unchanged, then it is necessary to proceed to artificial pulmonary ventilation (ALV) 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. Second - trained medical workers on site or in a hospital. The algorithm for performing the first stage is as follows:

1. Lay the victim on a flat, hard surface.
2. Place your hand on his forehead, tilting his head back slightly. At the same time, the chin will move forward.
3. With one hand, pinch the victim’s nose, with the other, stretch out your tongue and try to blow air into your mouth. Frequency – about 12 breaths per minute.
4. Go to indirect massage hearts.

To do this, use the palm of one hand to press on the area of ​​the lower third of the sternum, and place the second hand on top of the first. Indentation chest wall is performed to a depth of 3-5 cm, and the frequency should not exceed 100 contractions per minute. Pressure is performed without bending the elbows, i.e. straight position of the shoulders over the palms. You cannot inflate and compress the chest at the same time. It is necessary to ensure that the nose is tightly pinched, otherwise the lungs will not receive the required amount of oxygen. If insufflation is done quickly, air will enter the stomach, causing vomiting.

Resuscitation of a patient in a clinical setting

Resuscitation of the victim in a hospital setting is carried out according to specific system. It consists of the 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 by administering Gecodez through a central venous catheter.
4. Correction acid-base balance intravenously (Sorbilact, Xylate).
5. Restoration of capillary circulation by drip(Reosorbilact).

When successful implementation resuscitation measures, the patient is transferred to the ward intensive care, where it is carried out further treatment and condition monitoring. Resuscitation stops at following cases:

• Ineffective resuscitation measures 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 clinical death if resuscitation measures are ineffective. Tissues and cells of the body do not die immediately; it all depends on the organ’s ability to survive hypoxia. Death is diagnosed based on certain signs. They are divided into reliable (early and late), and orienting - immobility of the body, absence of breathing, heartbeat, pulse.

Biological death can be distinguished from clinical death using early signs. They occur 60 minutes after death. These include:

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

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

• the appearance of cadaveric spots - localized mainly on the arms and legs. The spots have marble color.
• rigor mortis is a condition of the body due to ongoing biochemical processes that disappears after 3 days.
• cadaveric cooling - states the completion of biological death when the body temperature drops to a minimum level (below 30 degrees).

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

Signs of a Dying Person

Clinical and biological (true) death are two stages of one process. Biological death is declared if resuscitation measures during clinical death were unable to “start” the body.

Signs of clinical death

The main sign of clinical cardiac arrest is the absence of pulsation in the carotid artery, indicating cessation of blood circulation.

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

Lack of reaction 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 the listed symptoms is present, resuscitation measures 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 - biological death.

Definition of biological death

The death of an organism is determined 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 death occurs at the moment of cessation brain activity, approximately 5-15 minutes after clinical death.

Accurate signs of biological death are indications medical devices, which recorded the cessation of electrical signals from the cerebral cortex.

Stages of human dying

Biological death is preceded by the following stages:

1. Preagonal state - characterized by sharply depressed or absent consciousness. Skin pale, arterial pressure can drop to zero, the pulse is palpable only in the carotid and femoral arteries. Increasing oxygen starvation quickly worsens the patient's condition.
2. Terminal pause is 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 stops controlling vital processes.

All three stages may be absent if the body has been exposed to powerful destructive processes (sudden death). The duration of the agonal and preagonal periods can vary from several days and weeks to several minutes.

The agony ends with clinical death, which is characterized by the complete cessation of all life 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 carried out to help bring the person back to life.

The last stage of dying is considered irreversible biological death. Determination of the occurrence of true death occurs if all measures to remove a person from a state of clinical death have not led to results.

Differences in biological death

Biological death is distinguished between natural (physiological), premature (pathological) and violent.

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

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

Violent death occurs as a result of murder, suicide, or is a consequence 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 vital activity are cardiac and respiratory arrest, absence of pulse and reaction to external stimuli and pungent odors (ammonia).
2. Based on brain death - an irreversible process of cessation of vital activity of the brain and its stem sections.

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

Signs of biological death

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

The central one dies first nervous system- spinal cord and brain, this occurs approximately 5-6 minutes after the onset of true death. The death of other organs can last for 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 the ability to grow for a long time.

Diagnosis of death consists of guiding and reliable signs.

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

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

Also vary early symptoms biological death and later.

Early signs

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

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

Early signs of biological death indicate that resuscitation measures are already pointless.

Late signs

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

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

Brain death

The diagnosis of “brain death” is made when there is complete necrosis of brain cells.

The diagnosis of cessation of brain activity is made on the basis of the obtained electroencephalography, showing complete electrical silence in the cerebral cortex. An angiography will reveal a cessation of cerebral blood supply. Artificial ventilation lungs and drug support can keep the heart pumping for some time - 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 the organism in this case is inevitable.

Time of biological death

Determining the time of onset of biological death has great importance to establish the circumstances of the death of a person who died in non-obvious conditions.

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

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

Ascertainment of death

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

In case of death from an accident or violent death, it is fundamentally impossible to declare brain death. Breathing and heartbeat may not be audible, 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, his organs can be used as transplants. The development of modern transplantology allows us to save thousands of human lives every year.

The moral and legal issues that arise appear to be quite complex and are resolved in each case individually. The consent of the relatives of the deceased for the removal of organs is required.

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 a special solution for 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 the drawing up of a protocol. The conditions and procedure for removing organs and tissues from a deceased person are regulated by the law of the Russian Federation.

The death of a person is a socially significant phenomenon, including a complex context of personal, religious and social relationships. However, dying is an integral part of the existence of any living organism.

The main personal and intellectual characteristics that determine a person’s personality are associated with the functions of his brain. Therefore, brain death must be considered as the death of a person, and a violation of the regulatory functions of the brain quickly leads to disruptions in the functioning of other organs and the death of a person. Cases of primary brain damage leading to death are relatively rare. In other cases, brain death occurs due to circulatory disorders and hypoxia.

Large neurons of the cerebral cortex are very sensitive to hypoxia. Irreversible changes in them occur within 5-6 minutes from the moment blood circulation ceases. This period of acute hypoxia, when blood circulation and (or) breathing has already stopped, but the cerebral cortex has not yet died, is called clinical death. This condition is potentially reversible because if cerebral perfusion with oxygenated blood is restored, brain viability is maintained. If oxygenation of the brain is not restored, then the cortical neurons will die, which will mark the onset of biological death, an irreversible condition in which a person’s salvation is no longer possible.

The duration of the period of clinical death is influenced by various external and internal factors. This time period increases significantly during hypothermia, since as the temperature drops, the need for oxygen by brain cells decreases. Reliable cases of successful resuscitation have been described within up to 1 hour after respiratory arrest due to hypothermia. Some medications that inhibit metabolism in nerve cells also increase their resistance to hypoxia. These drugs include barbiturates, benzodiazepines and other antipsychotics. With fever, endogenous purulent intoxication, and jaundice, on the contrary, the period of clinical death is reduced.

At the same time, in practice it is impossible to reliably predict how much the duration of the period of clinical death has increased or decreased and one has to focus on the average of 5-6 minutes.

Signs of clinical and biological death

Signs of clinical death are :

Respiratory arrest, ascertained by the absence of respiratory movements of the chest . Other methods for diagnosing apnea (vibration of a thread brought to the nose by a current of air, fogging of a mirror brought to the mouth, etc.) are unreliable, since they give positive result even with very shallow breathing that does not provide effective gas exchange.

Circulatory arrest, ascertained by the absence of pulse in the carotid and (or) femoral arteries . Other methods (listening to heart sounds, determining the pulse in the radial arteries) are unreliable, since heart sounds can be heard even with ineffective, discoordinated contractions, and the pulse in the peripheral arteries may not be determined due to their spasm.

Loss of consciousness (coma) with dilated pupils and lack of reaction to light talk about deep hypoxia of the brain stem and inhibition of the functions of stem structures.

The list of signs of clinical death could be continued, including suppression of other reflexes, ECG data, etc., however, from a practical point of view, the definition of these symptoms should be considered sufficient to establish this state, since identifying a large number of symptoms will take longer and delay the start of resuscitation measures.

Numerous clinical observations have established that after breathing stops, circulatory arrest develops on average after 8-10 minutes; loss of consciousness after circulatory arrest - after 10-15 seconds; dilation of the pupil after stopping blood circulation - after 1-1.5 minutes. Thus, each of the listed signs must be considered a reliable symptom of clinical death, which inevitably entails the development of other symptoms.

Signs of biological death or reliable signs of death appear 2-3 hours after its actual onset and are associated with the onset of necrobiotic processes in tissues. The most characteristic of them are:

Rigor mortis lies in the fact that the muscles of the corpse become more dense, due to which a slight bending of the limbs may even be observed. The onset of rigor mortis depends on the ambient temperature. At room temperature, it becomes noticeable after 2-3 hours, is expressed after 6-8 hours from the moment of death, and after a day it begins to resolve, and completely disappears by the end of the second day. With more high temperature this process goes faster, and at low temperatures it goes slower. In the corpses of emaciated, weakened patients, rigor mortis is poorly expressed.

Cadaveric spots are bluish-purple bruises that appear at the points of contact of the corpse with a solid support. In the first 8-12 hours, when the position of the corpse changes, cadaveric spots can move under the influence of gravity, then they are fixed in the tissues.

Symptom of "cat pupil" lies in the fact that when the eyeball of a corpse is compressed from the sides, the pupil takes on an oval and then a slit-like shape, like a cat’s, which is not observed in living people and in a state of clinical death.

The list of signs of biological death could also be continued, however, these signs are the most reliable and sufficient for practical activities.

An extremely important fact is that quite a significant amount of time passes between the moment of development of biological death and the appearance of its reliable signs - at least 2 hours. During this period, if the time of circulatory arrest is unknown, the patient’s condition should be regarded as clinical death, since there are no reliable signs of biological death.