Clinical and biological death definition signs. Biological death: its main features and difference from clinical death

Man, like every living organism on Earth, begins his journey with birth and inevitably ends with death. This is a normal biological process. This is the law of nature. You can extend life, but it is impossible to make it eternal. People dream, create a lot of theories, propose different ideas O eternal life. Unfortunately, so far they are unjustified. And it’s especially offensive when life is cut short not because of old age, but because of illness (see) or an accident. Clinical and biological death: what do they look like? And why doesn’t life always win?

The concept of clinical and biological death

When all the vital functions of the body cease to function, death occurs. But a person, as a rule, does not die immediately. He goes through several stages before completely saying goodbye to life. The dying process itself consists of 2 phases - clinical and biological death (see).

Signs of clinical and biological death give us the opportunity to consider how a person dies and, possibly, save him. Knowing the features and first symptoms clinical death, and early signs biological death, it is possible to accurately determine the person’s condition and begin resuscitation.

Clinical death is considered a reversible process. This is the intermediate moment between a living organism and an already dead one. It is characterized by cessation of breathing and cardiac arrest and ends physiological processes in the cerebral cortex, which are considered irreversible. The maximum duration of this period is 4-6 minutes. At low temperature environment the time for reversible changes doubles.

Important! Having discovered that carotid artery there is no pulse, immediately begin resuscitation without wasting a minute. You need to remember how it is carried out. Sometimes situations arise when someone's life is in your hands.

Biological death is an irreversible process. Without access to oxygen and nutrients cells die various organs, and it is not possible to revive the body. He will no longer be able to function, the person can no longer be revived. This is the difference between clinical death and biological death. They are separated by a period of only 5 minutes.

Signs of clinical and biological death

When clinical death occurs, all manifestations of life are absent:

• no pulse;
• no breathing;
• the central nervous system is “disabled”;
• there is no muscle tone;
• skin color changes (pallor).

But unbeknownst to us, at a very low level, metabolic processes are still ongoing, the tissues are viable and can still be fully restored. The time period is determined by the work of the cerebral cortex. As soon as nerve cells die off, there is no way to completely restore a person.

Not all organs die immediately; some retain the ability to live for some time. After a few hours, you can revive the heart and respiratory center. Blood retains its properties for several hours.

Biological death happens:

• physiological or natural, which occurs during the aging of the body;
• pathological or premature, associated with serious illness or non-life-threatening injuries.

In both cases, it is impossible to bring a person back to life. Signs of biological death in humans are expressed as follows:

• termination heart rate up to 30 min;
• lack of breathing;
• dilated pupil that does not respond to light;
• the appearance of dark blue spots on the surface of the skin.

An early symptom of biological death is the “cat pupil sign.” When you press on the side of the eyeball, the pupil becomes narrow and oblong, like a cat's.

Since organs do not die immediately, they are used in transplantology for organ transplantation. Patients whose kidneys, hearts, and other organs are failing are waiting for their donor. In European countries, people obtain paperwork to allow their organs to be used if they die in an accident.

How to make sure a person is dead?

Diagnosis of clinical and biological death is important; it is carried out by doctors. But everyone should know how to determine it. Irreversible death of a person can be determined by the following signs:

1. "Symptom of a cat's pupil."
2. The cornea of ​​the eye dries out and becomes cloudy.
3. Formation of cadaveric spots due to depression vascular tone. They usually occur several hours later, when a person has died.
4. Decreased body temperature.
5. Rigor mortis also sets in after a few hours. The muscles become hard and the body becomes inactive.

Doctors diagnose a reliable sign of biological death based on data medical equipment, which determines that electrical signals are no longer being received from the cerebral cortex.

In what cases can a person be saved?

Clinical death differs from biological death in that a person can still be saved. An accurate signal of clinical death is considered if the pulse in the carotid artery is not heard and there is no breathing (see). Then resuscitation actions are carried out: indirect cardiac massage, injection of adrenaline. IN medical institutions With modern equipment such activities are more effective.

If the person shows minimal signs of life, immediate revival is performed. If there is any doubt about biological death, resuscitation measures are taken to prevent the person’s death.

It is also worth paying attention to the harbingers of clinical death:

• reduction in blood pressure to critical levels (below 60 mm Hg);
• bradycardia (pulse below 40 beats per minute);
• increased heart rate and extrasystole.

Important! Establishing a diagnosis of clinical death should take no more than 10 seconds for the person providing assistance! Revival measures taken no later than two minutes after the first signs of clinical death appear are successful in 92% of cases.

Will the person be saved or not? At some stage, the body loses strength and stops fighting for life. Then the heart stops, breathing stops and death occurs.

Signs of biological death do not appear immediately after the end of the clinical death stage, but some time later. Moreover, each of the signs manifests itself 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” (Beloglazov's symptom). Appears 25-30 minutes after death. Where does this name come from? A person's pupil round shape, and in a cat it is elongated. After death, human tissues lose their elasticity and firmness, and if squeezed on both sides of the eyes dead person, it becomes deformed, and along with the eyeball, the pupil also becomes deformed, taking on an elongated shape, like a cat’s. In a living person, deforming the eyeball is, if not impossible, then very difficult. In various accidents, when the victim has no breathing and no signs of heart contraction, it is necessary to begin artificial ventilation of the lungs as soon as possible and private massage hearts.

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

Cadaveric spots. They arise due to post-mortem redistribution of blood in a corpse under the influence of gravity. After the heart stops, 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 visible through the skin in the form of bluish-purple spots, which are called cadaveric spots. The coloring of cadaveric spots is not uniform, but spotty, with a so-called “marble” pattern. They appear approximately 1.5-3 hours (sometimes 20-30 minutes) after death. Cadaveric spots are located in the underlying parts of the body. When the corpse is positioned on its back, cadaveric spots are located on the back and rear - lateral surfaces of the body, on the stomach - on the front surface of the body, face, vertical position corpse (hanging) - on lower limbs and lower abdomen. In some poisonings, cadaveric spots have an unusual color: 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 with changes in environmental conditions. For example, when removing the corpse of a drowned person to the shore, the cadaveric spots on his body that are bluish-purple in color, due to the penetration of air oxygen through the loosened skin, can change color to pink-red. If death occurred as a result of large blood loss, then the cadaveric spots will have a much paler shade or be completely absent. When a corpse is in conditions low temperatures cadaveric spots will form later, up to 5-6 hours. The formation of cadaveric spots occurs in two stages. As is known, cadaveric blood does not clot during the first 24 hours after death. Thus, in 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, the cadaveric spots will not change their position. Determining the presence or absence of blood clotting is very simple - you need to press on the stain with your finger. If the blood has not coagulated, when pressure is applied, the cadaveric spot at the point of pressure will turn white. Knowing the properties of cadaveric stains, it is possible to determine at the scene of the incident the approximate age of death, as well as find out whether the corpse was turned over after death or not.

Rigor mortis. After death occurs, 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 completely clear. Some researchers believe that the basis is biochemical changes in the muscles, others - in the nervous system. In this state, the muscles of the corpse create an obstacle to passive movements in the joints, therefore, to straighten the limbs that are in a state of severe rigor mortis, it is necessary to use physical strength. Full development of rigor mortis in all muscle groups is achieved on average by the end of the day. Rigor mortis does not develop 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, and limbs undergo rigor). After 1.5-3 days, rigor disappears (resolves), which is expressed in muscle relaxation. Rigor mortis resolves in the reverse order of development. The development of rigor mortis is accelerated in conditions of high temperature; at low temperatures it is delayed. If death occurs as a result of a cerebellar injury, rigor mortis develops very quickly (0.5-2 seconds) and fixes the position of the corpse at the time of death. Rigor mortis is resolved ahead of schedule in the event of a violent muscle strain.

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

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. The skin is 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 is a reliable sign of biological death, occurring 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. The rate at which the body cools depends on the ambient temperature, 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 early signs of biological death appear, 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.

Signs of biological death do not appear immediately after the end of the clinical death stage, but some time later.

Biological death can be ascertained on the basis of reliable signs and a combination of signs. Reliable signs of biological death. Signs of biological death. One of the first main signs is clouding of the cornea and drying out.

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

Definition 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.

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.

Definition signs of clinical death:

1. Absence of pulse in the carotid artery - main sign circulatory arrest;

2. Lack of breathing can be checked by visible movements of the chest when inhaling and exhaling, or by placing your ear to the chest, hearing the sound of breathing, feeling (the movement of air during exhalation is felt by the cheek), and also by bringing a mirror, glass or watch glass, as well as cotton wool or thread, holding them with tweezers. But precisely to determine this sign you should not waste time, since the methods are not perfect and unreliable, and most importantly, they require a lot of precious time to determine;

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 out of 4 signs of clinical death one of the first two 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. They do not perform resuscitation only in case of biological(irreversible) of death, when irreversible changes occur in the tissues of the brain and many organs.

Stages of Dying

The pregonal state is characterized by severe circulatory and respiratory disorders leading to the development of tissue hypoxia and acidosis (lasting from several hours to several days).
. Terminal pause - cessation of breathing, sharp depression of heart activity, cessation of bioelectrical activity of the brain, extinction of corneal and other reflexes (from a few seconds to 3-4 minutes).
. Agony (from several minutes to several days; can be prolonged by resuscitation to weeks and months) is an outbreak of the body’s struggle for life. It usually begins with a short breath hold. Then a weakening of cardiac activity occurs and functional disorders various systems of the body. Externally: the bluish skin turns pale, the eyeballs sink, the nose becomes pointed, lower jaw sags.
. Clinical death (5-6 min) Deep depression of the central nervous system, spreading to the medulla oblongata, cessation of circulatory and respiratory activity, reversible condition. Agony and wedge death can be reversible.
. Biological death is an irreversible condition. First of all, irreversible changes occur in the brain cortex - “brain death”.

Resistance to oxygen starvation in different organs and tissues their death is not the same; it occurs in different terms after cardiac arrest:
1) GM bark
2) subcortical centers and spinal cord
3) Bone marrow- up to 4 hours
4) skin, tendons, muscles, bones - up to 20 - 24 hours.
- it is possible to establish the duration of death.
Supravital reactions are the ability of individual tissues after death to respond to external stimuli (chemical, mechanical, electrical). From the moment of biological death to the final death of individual organs and tissues, about 20 hours pass. They determine the time from the moment of death. To establish the duration of death, I use chemical, mechanical and electrical stimulation of the smooth muscles of the iris, facial muscles and skeletal muscles. Electromechanical muscle responses are the ability of skeletal muscles to respond by changing tone or contracting in response to mechanical or electrical stress. These reactions disappear by 8-12 hours post-mortem. When mechanical impact (impact with a metal rod) is applied to the biceps brachii muscle in the early postmortem period, a so-called idiomuscular tumor (ridge) is formed. In the first 2 hours after death it is high, appears and disappears quickly; in the period from 2 to 6 hours it is low, appears and disappears slowly; when the onset of death is 6-8 hours ago, it is determined only by palpation in the form of a local compaction at the site of impact.
Contractile activity muscle fibers in response to their irritation electric shock. The threshold of electrical excitability of muscles gradually increases, therefore, in the first 2-3 hours after death, a contraction of the entire facial muscles is observed, in the period from 3 to 5 hours - compression of only the orbicularis oris muscle into which the electrodes are inserted, and after 5-8 hours only fibrillar twitching is noticeable orbicularis oris muscle.

The pupillary reaction to the introduction of vegetotropic drugs into the anterior chamber of the eye (constriction of the pupil upon administration of pilocarpine and dilation due to the action of atropine) persists up to 1.5 days after death, but the reaction time becomes increasingly slower.
Reaction sweat glands manifested by postmortem secretion in response to subcutaneous injection of adrenaline after treating the skin with iodine, as well as blue staining of the mouths of the sweat glands after applying a developing mixture of starch and castor oil. The reaction can be detected within 20 hours after death.

Diagnosis of death

WMD - it is necessary to establish that in front of us is a human body without signs of life or it is a corpse.
Diagnostic methods are based on:
1. life safety test
Concentrated around the so-called. “vital tripod” (heart, lungs and brain)
Based on evidence of the presence of the most important vital functions:
- integrity of the nervous system
- presence of breathing
- presence of blood circulation
2. identifying signs of death

Signs indicating death:

Lack of breathing (pulse, heartbeat, various traditional methods- for example, a glass of water is placed on the chest)
. Lack of sensitivity to painful, thermal and olfactory (ammonia) stimuli
. Lack of reflexes from the cornea and pupils, etc.

Life safety tests:

a. Feeling the heartbeat and the presence of a pulse in the area of ​​the radial brachial carotid temporal femoral arteries (panadoscope - device). Aloscutation is a method of listening to the heart.
b. listening to the heart (1 beat for 2 minutes)
c. when examining the hand of a living person -
Beloglazov's sign (cat's eye phenomenon)
. Already 10 and 15 minutes after death
. When the eyeball is compressed, the pupil of the deceased takes on the appearance of a vertically running slit or oval.
Absolute, reliable signs of death are early and late changes in the corpse.
Early changes in the corpse:
1. Cooling (reducing the temperature to 23 degrees in the rectum, the first hour - by 1-2 degrees, the next 2-3 hours by 1, then by 0.8 degrees, etc.) It is necessary to measure at least 2 times (in at the beginning of the medical examination and at the end.
2. Muscle rigor (onset 1-3 hours, all muscles by 8 hours)
3. Drying of the corpse (parchment spots) - post-mortem abrasions, spots in the corners of the eyes.
4. Cadaveric spots. Location in the lower part of the body depending on the position of the human body.
Stages of their appearance
1) hypostasis 1-2 hours after death (drip - stagnation of blood in the veins and capillaries of the underlying parts of the body as a result of blood flowing after death under the influence of gravity, but the possibility of its flow due to movement of the body remains, during its movement it cannot be noted in what way the state of the body
2) stasis 10 - 24 hours of stagnation of blood, which when moving the body has the property of swelling, then the previous spots remain noticeable.
3) imbibition: after 24-36 hours, blood stagnates to such an extent that blood cannot flow when the person’s body moves.
5. Autolysis - tissue decomposition
Late changes in the corpse
. Rotting (starts from the front wall of the abdomen - 1-2 days in the abdominal area), formation of blisters, emphysema.
(They are also forms of conservation)
. mummification (the process of dehydration of tissues and organs of a corpse and their drying out.
. Fat wax (saponification)
. peat tanning— late preservation of a corpse under the influence of humic acids in peat bogs.

Establishing the cause of death

1. identifying signs of the action of a damaging factor on the body
2. establishing the lifetime effect of this factor, the duration of the injury
3. establishment of thanatogenesis - a sequence of structural and functional disorders caused by the interaction of the body with a damaging factor leading to death
4. exclusion of other damage that could lead to fatal outcome.

Primary causes of death:

1. damage incompatible with life (damage to vital organs - heart, g.m. - due to transport trauma).
2. blood loss - rapid loss of one-third to one-half of the amount of available blood usually leads to death. (profuse and acute blood loss). A sign of acute blood loss - Mnakov spots - striped pale red hemorrhages under inner shell left ventricle of the heart.
3. compression of organs important for life by escaping blood or absorbed air
4. concussion of vital organs
5. asphyxia with aspirated blood - blood entering the respiratory organs
6. Embolism - blockage blood vessel, disrupting the blood supply to the organ (air - when large veins are damaged,
adipose - with fractures of long tubular bones, extensive crushing of subcutaneous adipose tissue, when drops of fat enter the bloodstream and then into the internal organs - g.m. and lungs; thromboembolism - in case of vascular disease - thrombophlebitis, tissue - when particles of tissues and organs enter the bloodstream when they are crushed; solids - foreign objects- bullet fragments)
7. Shock - acutely developing pathological process caused by exposure to an extremely strong psychological phenomenon on the body

Secondary causes of death

1. infections (brain abscess, purulent peritonitis, pleurisy, meningitis, sepsis)
2. intoxication (for example, with crush syndrome or compression syndrome) traumatic toxicosis, characterized by local and general pathological changes in response to long-term and extensive soft tissue damage.
3. other non-infectious diseases (hypostatic pneumonia (congestion and pneumonia), etc.)

Topic No. 2 First aid for exposure to high and low temperatures, electric shock, fainting, heat and sunstroke, functional damage. Resuscitation.

Lesson No. 3 Methods of resuscitation

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

Literature:

1. On approval of the list of conditions for which first aid is provided and the list of measures to provide first aid: Order of the Ministry of Social Health of the Russian Federation dated May 4, 2012 No. 477n. // SPS “Consultant Plus”.

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

3. Tuzov A.I. Providing first aid to victims by internal affairs officers: Memo. – M.: DGSK Ministry of Internal Affairs of Russia, 2011. – 112 p.

4. Bogoyavlensky I. F. Providing first aid at the scene of an incident and in outbreaks emergency situations: reference book. – St. Petersburg: OJSC Medius, 2014. – 306 p.

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

Concept, signs of clinical and biological death

Clinical death– a short period of time (no more than 5 minutes) after stopping breathing and circulation, during which recovery is still possible important functions body.

Main signs of clinical death:

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

Lack of breathing

Absence of pulse in the carotid arteries;

The skin is pale with an earthy tint;

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

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

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

Body cold below 200 C after 1-2 hours;

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

The appearance of cadaveric spots on the skin. Cadaveric stains are formed as a result of post-mortem redistribution of blood in the corpse to the underlying parts of the body. They appear 2–3 hours after death. IN forensic medicine cadaveric spots are an indisputable reliable sign of death. Based on the severity of the cadaveric spot, one judges how long ago the death occurred (by the location of the cadaveric spots one can determine the position of the corpse and its movement);

Rigor mortis develops after 2–4 hours in a descending manner from top to bottom. It occurs completely within 8–14 hours. After 2–3 days, rigor mortis disappears. The main importance in resolving rigor mortis is the ambient temperature, at high temperature it disappears faster.

Determination of signs of life:

Demonstrated by a teacher using the Maxim dummy simulator

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

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

Presence of pupil reaction to light. If you illuminate your eye with a beam of light (for example, a flashlight), you will notice a constriction of the pupil ( positive reaction pupil to the light) or in daylight, this reaction can be checked as follows: cover the eye with your hand for a while, then quickly move your hand to the side, while a noticeable constriction of the pupil.

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

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

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

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

2. Subsequence. The following sequence of events is determined:

Clearing and maintaining airway patency;

External massage hearts;

Artificial respiration;

Stop bleeding;

Fighting shock;

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

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

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

Resuscitation assistance need to provide at sudden death in cases of electric shock and lightning, in case of blows to the heart area or solar plexus, in cases of drowning or hanging, with a heart attack complicated epileptic seizure, hit foreign body V Airways, general freezing and a number of other cases when death occurs suddenly.

Contraindications to resuscitation:

Clear signs of death;

Injuries incompatible with life;

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

Violation of the integrity of the chest.

Resuscitation can be stopped:

· if an independent pulse is felt in the carotid artery, and rib cage rises and falls, that is, the victim breathes on his own, the previously dilated pupils narrow, and the natural (pale pink) color is restored skin;

· if resuscitation measures are taken over by the arriving ambulance team medical care;

· if the doctor gives an order to stop it due to ineffectiveness (death has been declared);

· if resuscitation measures aimed at restoring vital functions are ineffective, within 30 minutes.