home Endocrinology The concept of clinical and biological death. Distinctive signs of clinical and biological death in humans

The concept of clinical and biological death. Distinctive signs of clinical and biological death in humans

Biological death (or true death) is the irreversible cessation physiological processes in cells and tissues. Irreversible cessation is usually understood as “irreversible within the framework of modern medical technologies"cessation of processes. Over time, the ability of medicine to resuscitate dead patients changes, as a result of which the border of death is pushed into the future. From the point of view of scientists - supporters of cryonics and nanomedicine, the majority of people who are dying now can be revived in the future if the structure of their brain is now preserved.

To early signs biological death relate:

1. Lack of eye reaction to irritation (pressure)

2. Clouding of the cornea, formation of drying triangles (Larche spots).

3. Symptom appearance " cat eye": with lateral compression eyeball the pupil transforms into a vertical fusiform slit.

Subsequently, cadaveric spots are found localized in sloping areas of the body, then rigor mortis occurs, then cadaveric relaxation, cadaveric decomposition. Rigor mortis and cadaveric decomposition usually begin in the muscles of the face and upper extremities. The time of appearance and duration of these signs depend on the initial background, temperature and humidity environment, the reasons for the development of irreversible changes in the body.

The biological death of a subject does not mean the immediate biological death of the tissues and organs that make up his body. The time before death of the tissues that make up the human body is mainly determined by their ability to survive under conditions of hypoxia and anoxia. This ability is different for different tissues and organs. The shortest life time under anoxic conditions is observed in brain tissue, to be more precise, in the cerebral cortex and subcortical structures. Stem sections and spinal cord have greater resistance, or rather resistance to anoxia. Other tissues of the human body have this property to a more pronounced extent. Thus, the heart retains its viability for 1.5-2 hours after the onset of, according to modern concepts, biological death. Kidneys, liver and some other organs remain viable for up to 3-4 hours. Muscle tissue, skin and some other tissues may well be viable up to 5-6 hours after the onset of biological death. Bone, being the most inert tissue of the human body, retains its vitality for up to several days. Associated with the phenomenon of survivability of organs and tissues of the human body is the possibility of transplanting them, and the more early dates after the onset of biological death, organs are removed for transplantation; the more viable they are, the greater the likelihood of their successful further functioning in a new organism.

Clinical death is the last stage of dying. According to the definition of Academician V.A. Negovsky, “clinical death is no longer life, but is not yet death. This is the emergence of a new quality - a break in continuity. In a biological sense, this state resembles suspended animation, although it is not identical to this concept.” Clinical death is a reversible condition and the mere fact of cessation of breathing or blood circulation is not proof of death.

Signs of clinical death include:

1. Lack of breathing.

2. Absence of heartbeat.

3. Generalized pallor or generalized cyanosis.

4. Lack of pupil reaction to light

Definition of clinical death

The duration of clinical death is determined by the period during which the higher parts of the brain (subcortex and especially the cortex) are able to maintain viability under conditions of anoxia. Characterizing clinical death, V.A. Negovsky talks about two terms.

· The first period of clinical death lasts only 5-6 minutes. This is the time during which the higher parts of the brain retain their viability during anoxia under conditions of normothermia. All world practice indicates that if this period is exceeded, the revival of people is possible, but as a result, decortication or even decerebration occurs.

· But there may be a second term of clinical death that doctors have to deal with when providing care or in special conditions. The second period of clinical death can last tens of minutes, and resuscitation measures will be very effective. The second period of clinical death is observed when special conditions are created to slow down the processes of degeneration of the higher parts of the brain during hypoxia or anoxia.

The duration of clinical death is prolonged under conditions of hypothermia, with lesions electric shock, in case of drowning. In conditions clinical practice this can be achieved by physical influences(head hypothermia, hyperbaric oxygen therapy), application pharmacological substances, creating states similar to suspended animation, hemosorption, transfusion of fresh (not canned) donated blood and some others.

If resuscitation measures were not carried out or were unsuccessful, biological or true death occurs, which is an irreversible cessation of physiological processes in cells and tissues.

Immediate use modern methods cardiopulmonary resuscitation(revival) can prevent the onset of biological death.

Resuscitation. It is necessary to distinguish between 2 stages of resuscitation. The first stage is immediate, carried out at the scene of the incident (for example, at the scene of a traffic accident) by a person who is in close proximity to the victims. The second stage (specialized) requires the use medications and corresponding equipment and can be carried out in a specialized ambulance, a helicopter specialized for these purposes, in a medical institution adapted for such purposes as anti-shock measures and resuscitation (introduction medications, infusion of blood and blood substitutes, electrocardiography, defibrillation, etc.).

The first stage can be carried out by almost anyone medical worker or a person well trained in resuscitation techniques. The second stage can only be carried out by a specialist, usually an anesthesiologist-resuscitator.

Here it is appropriate to present the techniques and rules of only the first stage, since the manipulations of the second stage are not directly related to traumatology.

The first stage of resuscitation includes: a) restoration of patency respiratory tract; b) artificial respiration; c) restoration of blood circulation by external cardiac massage. Resuscitation efforts should begin as quickly as possible. The artificial circulation and ventilation created provide only minimal blood flow and minimal oxygenation, so everything possible must be done to connect as quickly as possible specialized assistance for the second stage of resuscitation and intensive care, to consolidate the initial results of revitalization.

Restoration of airway patency. Airway closure may be caused by for the most part vomit, blood, mucus, which the patient, being unconscious, cannot get rid of by expectoration or swallowing. In addition, in the absence of consciousness, when the muscles are relaxed, with the neck bent anteriorly, the root of the tongue may rest against the back wall of the pharynx. Therefore, the first thing you should do is bend your head back. In this case, the lower jaw should be pushed forward, the mouth should be opened, which leads to the movement of the root of the tongue from back wall throats. If the tongue still sinks, and there are no extra hands to hold the jaw in an advanced position, you can pierce the tongue with a pin or stitch it with a needle, pull it out of the mouth and secure a thread or pin behind the victim’s ear. If there is foreign content, you need to clean the mouth and throat with a finger wrapped in a bandage, handkerchief, etc. To do this, turn the patient's head and shoulders (if the patient is lying on his back) slightly to one side, open the patient's mouth, clean the oral cavity with a finger (or suction, if he is). If damage is suspected cervical region spine, bending the head back is not necessary due to the risk of worsening spinal cord damage. In this case, we are limited to fixing extended tongue or an airway is inserted.

Artificial respiration. Ventilation of the respiratory tract should begin by forcing air through the mouth. If it is not possible to blow air into the lungs through the mouth due to the closure of the nasopharynx, then they try to blow air into the nose. When blowing air into the mouth, as mentioned above, it is necessary to move the victim’s jaw forward and tilt his head back. To prevent the howling spirit from leaking through the nose, you need to pinch it with one hand or cover the nasal passages with your cheek. Direct ventilation with exhaled air through the mouth-to-mouth or mouth-to-nose system can be carried out more hygienically if blowing is done through a scarf or gauze placed over the patient’s nose and mouth. You should take a deep breath, place your lips tightly around the patient’s mouth and exhale sharply. When pumping air, it is necessary to monitor whether the chest rises from the air blown into the lungs. Next, conditions are created for passive exhalation: the chest, collapsing, will lead to pushing out a portion of air from the lungs. After energetically carrying out 3-5 deep blows of air into the victim’s lungs, the pulse in the carotid artery is felt. If the pulse is detected, continue to inflate the lungs at a rhythm of 12 breaths per 1 minute (one breath per 5 seconds).

To carry out artificial respiration through the nose, the patient’s mouth must be closed at the time of insufflation; when exhaling, the mouth must be opened to facilitate the release of air from the respiratory tract.

Sometimes when air is blown in, it enters not only the lungs, but also the stomach, which can be determined by swelling of the epigastric region. To remove air, press the stomach area with your hand. In this case, along with the air from the stomach, its contents may enter the pharynx and oral cavity; in this case, turn the victim’s head and shoulders to the side and clean the mouth (see above),

Artificial circulation (heart massage). The diagnosis of cardiac arrest is made on the basis of the following signs: loss of consciousness, respiratory arrest, dilated pupils, absence of pulse;) in large vessels - carotid, femoral. The last sign most reliably indicates cardiac arrest. The pulse should be determined from the side closest to the person providing assistance. To determine the pulse on the carotid artery, you must use next step: index and middle finger laid on thyroid cartilage the patient, and then move it to the side of the neck, trying to palpate the vessel flat and not with the tailbones of the fingers.

Blood circulation can be restored during cardiac arrest using external cardiac massage, that is, rhythmic compression of the heart between the sternum and the spinal column. When compressed, blood from the left ventricle flows through the vessels to the brain and heart. After the pressure on the sternum ceases, it fills the cavities of the heart again.

External cardiac massage technique. The palm of one hand is placed on bottom part sternum, the palm of the other hand is placed on top of the first. The sternum is pressed towards spinal column, leaning on your hands and body weight (in children, compression of the sternum is carried out only with your hands). Having pressed the sternum as much as possible, you need to hold the compression for 1/2 second, after which the pressure is quickly released. It is necessary to repeat compression of the sternum at least once every 1 second, because less frequent pressure does not create sufficient blood flow. In children, the frequency of sternum compressions should be higher - up to 100 compressions per minute. In the intervals between pressures, there is no need to remove your hands from the sternum. The effectiveness of the massage is judged by: a) pulse impulses on the carotid artery in time with the massage; b) constriction of the pupils; c) the emergence of independent breathing movements. Changes in skin color are also taken into account.

A combination of cardiac massage and ventilation. External massage by itself, without simultaneously blowing air into the lungs, cannot lead to resuscitation. Therefore, both of these methods of revival must be combined. If the revival is carried out by 1 person, it is necessary to perform 15 compressions of the sternum for 15 seconds every 2 quick blows of air into the lungs (using the mouth-to-mouth or mouth-to-nose system). The patient’s head must be thrown back. If resuscitation measures are carried out by 2 people, then one of them performs one deep inflation of the lungs after every fifth compression chest.

Cardiopulmonary resuscitation continues until a spontaneous pulse occurs; after this, artificial respiration should be continued until spontaneous breathing occurs.

When moving the victim to vehicle, transfer on a stretcher, transportation, resuscitation measures, if necessary, must be continued in the same mode: for 2 deep intense air injections, perform 15 compressions of the sternum.

Following clinical death comes biological death, characterized by a complete stop of all physiological functions and processes in tissues and cells. With the improvement of medical technology, the death of man is moving further and further. 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:

Preagonal state - characterized by sharply depressed or absent consciousness. The skin is pale, blood pressure can drop to zero, the pulse can be felt only in the carotid and femoral arteries. Increasing oxygen starvation quickly worsens the patient's condition.
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.
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:

Traditional signs of cessation of vital activity are cardiac and respiratory arrest, absence of pulse and reaction to external stimuli and pungent odors (ammonia).
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 of human dying, replacing the 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 first to die is the central nervous system - the spinal cord and brain, this happens approximately 5-6 minutes after true death occurs. 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:

Lack of reaction of the pupils to light stimulation or pressure.
The appearance of Larche spots - triangles of dried skin.
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.
Drying of the eye cornea - the iris loses its original color, as if becoming covered with a white film, and the pupil becomes cloudy.
Drying of the lips - the lips become dense and wrinkled, and acquire a brown color.

Early signs biological death indicate that it is already pointless to carry out resuscitation measures.

Late signs

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

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.
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.
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 and drug support can keep the heart pumping for some time - from a few minutes to several days or 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, in the shortest possible 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 death of a person is the complete cessation of biological and physiological processes in his body. The fear of making a mistake in recognizing it forced doctors and researchers to develop precise methods its diagnosis and determine the main signs indicating the onset of death of the human body.

In modern medicine, clinical and biological (final) death are distinguished. Brain death is considered separately.

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

What is clinical death of a person

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

Later in the article, the comparative signs of biological and clinical death will be discussed in more detail. By the way, the human condition between these two types of death of the body is called terminal. And clinical death may well move into the next, irreversible stage - biological, an 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 may go through several phases, characterized as preagonal and agonal.

The first of them manifests itself in inhibition of consciousness while it is preserved, as well as in dysfunction of the central nervous system, expressed by stupor or coma. The pressure, as a rule, is low (maximum 60 mm Hg), and the pulse is rapid, weak, shortness of breath appears, and the breathing rhythm is disturbed. This condition can last for several minutes or several days.

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

Manifestation of agony

The onset of agony is marked by a short series of breaths, and sometimes by a single breath. Due to the fact that a dying person has simultaneous excitation of the muscles that carry out both inhalation and exhalation, ventilation of the lungs almost completely stops. Higher departments The central nervous system turns off, and the role of the regulator of vital functions, as proven by researchers, at this moment 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 agony that a person’s body loses that notorious 60-80 g of weight, which is attributed to the soul leaving it. True, scientists prove that in fact weight loss occurs due to the complete combustion of ATP in the cells (enzymes that supply energy to the cells of a living organism).

The agonal phase is usually accompanied by a lack of consciousness. A person's pupils dilate and do not respond to light. Blood pressure cannot be determined; the pulse is practically not palpable. In this case, the heart sounds are muffled, and breathing is rare and shallow. These signs of clinical death, which is approaching, can last several minutes or several hours.

How does the state of clinical death manifest?

When clinical death occurs, breathing, pulse, blood circulation and reflexes disappear, and cellular metabolism passes anaerobically. But this does not last long, because the amount of energy in the dying person’s brain is depleted, and his nervous tissue dies.

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

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

Three main signs of clinical death

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

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

Apnea - cessation of breathing. It is manifested by a lack of movement of the chest, which indicates a cessation of respiratory activity.

Asystole - main feature clinical death, expressed by cardiac arrest together with the absence of bioelectrical activity.

What is sudden death

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

This type of death includes those that occurred without apparent reason cases of cardiac arrest, which are caused by the occurrence of ventricular fibrillation (disjointed and uncoordinated contraction of some groups muscle fibers) or (less often) acute weakening of heart contractions.

Signs of sudden clinical death are manifested by loss of consciousness, pale skin, cessation of breathing and pulsation in the carotid artery (by the way, it can be determined by placing 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 other reasons that can cause sudden death. These are electrical injuries, lightning injuries, 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 efficiency and correctness of resuscitation measures.

How is cardiac 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.), unfasten the belts, remove restrictive clothing and begin indirect massage hearts.

The sequence of resuscitation actions looks like this:

the person providing assistance takes a place to the left of the victim;
places hands one on top of the other on the lower third of the sternum;
pushes (15 times) at a rate of 60 times per minute, using your body weight to achieve a flexion of the chest of approximately 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 pushes in the form of two exhalations into the mouth or nose of the dying person for 2 seconds each (you need to make sure that the victim’s chest rises).

Indirect massage helps compress the heart muscle between the chest and spine. Thus, the blood is pushed into large vessels, and during the pause between beats the heart is filled with blood again. In this way, cardiac activity is resumed, which after some time 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?

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

As is known, the cerebral cortex dies first, then the subcortical centers, and finally the spinal cord. Four hours after the heart stops working, it dies Bone marrow, and after a day the destruction of human skin, tendons and muscles begins.

How does brain death manifest?

From the above, it is clear that accurately determining the signs of a person’s clinical death is very important, because from the moment the heart stops until the onset of brain death, leading to irreparable consequences, there are only 5 minutes.

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

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

What does biological death look like?

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

Biological or, in other words, the final death of the body is the last stage of dying, which is characterized by irreversible changes developing in all organs and tissues. In this case, 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 Larche spots);
if the eyeball is gently squeezed from the sides, the pupil turns into a vertical slit (the so-called “cat’s eye” symptom).

By the way, the signs listed above also indicate that 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 of biological death. The latter appear:

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

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

Rigor mortis usually begins in the facial muscles and hands of a person. And the time of its appearance and the duration of the process strongly depend on the cause of death, as well as on the temperature and humidity at the location of the dying person. Typically, 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 necessary help dying.

It must be taken into account that the duration of clinical death directly depends on what caused it, what age the person is, as well as 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. Exchange processes throughout the body and in the brain in such a situation are greatly slowed down. And when artificial hypothermia the duration of clinical death is increased to 2 hours.

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

According to the instructions of the Russian Ministry of Health (2003), resuscitation measures are stopped only when a person’s brain death is determined or if they are ineffective medical care provided within 30 minutes.

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

Signs of 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 of signs clinical death:

1. Absence of pulse in the carotid artery is the main sign of 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 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 resuscitation must be started immediately. 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

Definition of signs 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. The thumb and forefinger squeeze the eyeball; if the 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. Purple cadaveric spots 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 the back of the shoulders and hips, on the back and buttocks.

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

Full development of signs occurs within 24 hours after death. Before you begin to revive the victim, you must first establish the presence of clinical death.

! They begin resuscitation only if there is no pulse (in the carotid artery) or breathing.

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

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

TO events cardiopulmonary resuscitation relate: precordial stroke , indirect cardiac massage And artificial ventilation (ventilation) using the mouth-to-mouth method.

Cardiopulmonary resuscitation consists of sequential stages: precordial stroke; artificial maintenance of blood circulation (external cardiac massage); restoration of airway patency; artificial pulmonary ventilation (ALV);

Preparing the victim for resuscitation

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

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

For ensuring airway patency it is necessary: 1) clean the oral cavity of mucus and vomit with a cloth wrapped around the index finger. 2) eliminate tongue retraction in two ways: by throwing back the head or extending it lower jaw.

throw back your head the victim needs to ensure that the back wall of the pharynx moves away from the root of the sunken tongue, and air can freely pass into the lungs. This can be done by placing a cushion of clothing either under the neck or under the shoulder blades. (Attention! ), but not to the back of the head!

Forbidden! Place hard objects under your neck or back: a backpack, a brick, a board, a stone. In this case, during chest compressions, the spine can be broken.

If there is a suspicion of a fracture of the cervical vertebrae, you can, without bending your neck, extend only the lower jaw. To do this, place your index fingers on the corners of the lower jaw under the left and right earlobes, push the jaw forward and secure it in this position with your thumb right hand. The left hand is freed, so it is necessary to pinch the victim’s nose with it (thumb and forefinger). So the victim is prepared to carry out artificial ventilation lungs (ventilator).

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

Despite the fact that by appearance a person staying in clinical stage dying, looks already without obvious signs life and at first glance he cannot be helped, in fact, emergency resuscitation is sometimes able to snatch 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 the slightest chance of revival, you need to save him. This is where knowledge of the differences between clinical death and irreversible, biological death comes in handy.

Stages of Dying

If this is not an instant death, but a 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 pre-agony phase, the agony itself, and then the subsequent phases - clinical and biological death.

Remember! In case of sudden death, the obligatory nature and order of the phases are erased, but the inherent signs are preserved.

Signs of clinical death

The stage of clinical death, defined unambiguously 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 minutes are counting.

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

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

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

The cessation of heartbeat also has the definition of “asystole,” which means the absence of cardiac activity and activity, as shown on the bioelectrical 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 up and down movement of the chest, as well as the absence of visible traces of fogging on a mirror brought to the mouth and nose, which inevitably appear when breathing is present.
The cessation of brain activity, which has medical term"coma", typical complete absence consciousness and reaction to light from the pupils, as well as reflexes to any irritants.

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

Remember! The less time has passed since the cessation of heartbeat and breathing, the greater the chance of bringing the deceased back to life - the rescuer has only 3 to 5 minutes on average! Sometimes in conditions low temperatures this period increases to a maximum of 8 minutes.

Signs of impending 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 the prolonged absence of biological processes within the body.

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

Early, initial signs characterizing biological death that overtakes a person no later than 1 hour include:

on the side of the eye cornea, clouding first occurs for 15 to 20 minutes, and then dries out;
from the side of the pupil - the “cat's eye” effect.

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

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

Beloglazov's symptom

TO late signs, by which biological death has overtaken a person is recognized, include the following:

complete dryness of the outer mucous membranes and skin;
cooling of the deceased body and its cooling to the temperature of the surrounding atmosphere;
the appearance of cadaveric spots in sloping areas;
rigor of a deceased body;
cadaveric decomposition.

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

The heart, as an organ, loses its vitality completely within an hour or two from the moment biological death is declared, 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 of successful transplantation or restoration of integrity in case of injury.

Resuscitation steps in case of observed clinical death

The presence of three main signs accompanying clinical death - absence of pulse, breathing and consciousness - is already sufficient to begin emergency resuscitation measures. They boil down to immediately calling an ambulance, in parallel - artificial respiration and heart massage.

Properly performed artificial respiration follows the following algorithm.

When preparing for artificial respiration, it is necessary to free the nasal and oral cavity from any contents, tilt your head back so that there is an acute angle between the neck and the back of the head, and a blunt angle between the neck and chin, only in this position will the airways open.
Having closed the dying man's nostrils with his hand, with his own mouth, after take a deep breath, tightly cover his mouth through a napkin or handkerchief and exhale into it. After exhaling, remove the hand from the nose of the dying person.
Repeat these steps every 4 to 5 seconds until chest movement appears.

Remember! You should not throw your head back too much - make sure that there is not a straight line between the chin and the neck, but an obtuse angle, otherwise the stomach will overflow with air!

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

The massage is done exclusively in a horizontal position of the body on a hard surface.
Arms are straight, without bending at the elbows.
The rescuer's shoulders are located exactly above the dying person's chest, and his outstretched straight arms are perpendicular to it.
When pressed, the palms are either placed on top of each other or in a lock.
The pressure is applied in the middle of the sternum, just below the nipples and just above the xiphoid process, where the ribs meet, using the heel of the palm with raised fingers, without lifting the hands from the chest.
The massage must be carried out rhythmically, with a break to exhale into the mouth, at a rate of 100 compressions per minute and to a depth of about 5 cm.

Remember! The proportionality of correct resuscitation actions is 1 inhalation-exhalation for 30 compressions.

The result of reviving a person should be his return to such mandatory initial indicators - the reaction of the pupil to light, palpation of the pulse. But the resumption of independent breathing is not always achievable - sometimes a person remains in temporary need of artificial ventilation, but this does not prevent him from reviving.