Signs of biological and clinical death. Clinical and biological death

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

Signs of clinical death:

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

Therefore, first of all, it is necessary to determine the presence of blood circulation and respiration in a sick or injured person.

Feature definition clinical death:

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

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

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

4. The upper eyelid of the victim rises 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 repeated eyelid lift, then it can be considered that there is no reaction to light.

If one of the first two of the 4 signs of clinical death is determined, then you need to immediately start resuscitation. Since only timely resuscitation (within 3-4 minutes after cardiac arrest) can bring the victim back to life. Do not do resuscitation only in 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 phenomenon of "cat's pupil"; 3) decrease in temperature; 4) body cadaveric spots; 5) rigor mortis

Feature definition biological death:

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

2. The eyeball is squeezed with the thumb and forefinger, if the person is dead, then his pupil will change shape and turn into a narrow slit - the “cat pupil”. It is impossible for a living person to do this. If these 2 signs appear, then this means that the person died at least an hour ago.

3. Body temperature drops gradually, by about 1 degree Celsius every hour after death. Therefore, according to these signs, death can be certified only after 2-4 hours and later.

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

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

Full development of signs occurs within a day after death. Before proceeding with the resuscitation of the victim, it is necessary first of all determine the presence of clinical death.

! Proceed to resuscitation only in the absence of a pulse (on the carotid artery) or breathing.

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

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

To activities cardiopulmonary resuscitation relate: precordial beat , indirect heart massage and artificial lung ventilation (IVL) method "mouth-to-mouth".

Cardiopulmonary resuscitation consists of sequential stages: precordial beat; artificial maintenance of blood circulation (external heart massage); restoration of airway patency; artificial lung ventilation (ALV);

Preparing the victim for resuscitation

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

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

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

Tilt your head back the victim is necessary so 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 roll of clothing or under the neck or under the shoulder blades. (Attention! ), but not in the back!

Forbidden! Place hard objects under the neck or back: a satchel, a brick, a board, a stone. In this case, during an indirect heart massage, you can break the spine.

If there is a suspicion of a fracture of the cervical vertebrae, without bending the neck, protrude only the lower jaw. To do this, put the index fingers on the corners of the lower jaw under the left and right earlobe, push the jaw forward and fix it in this position with the thumb of the right hand. The left hand is released, so with it (thumb and forefinger) it is necessary to pinch the nose of the victim. So the victim is prepared for artificial lung ventilation (ALV).

Principles of first aid. Signs of life and death. Clinical and biological death. The reaction of the body to injury - fainting, collapse, shock.

The concept and principles of first aid

First medical and pre-medical aid- this is a complex of emergency measures carried out to the injured or sick person at the scene of the incident and during the period of delivery to a medical institution.

In military medicine - a set of urgent simple measures aimed at saving the life of the injured, preventing serious consequences or complications, as well as reducing or completely stopping the impact of damaging factors on him; carried out by the affected person (self-help), his comrade (mutual help), an orderly or a sanitary instructor.

First medical and pre-medical aid includes the following activities:

• Immediate cessation of exposure to external damaging factors (electric current, high or low temperature, compression by weights) and removal of the victim from the adverse conditions in which he fell (extraction from water, removal from a burning or gassed room).
• Providing first medical or first aid to the victim, depending on the nature and type of injury, accident or sudden illness (stopping bleeding, bandaging a wound, artificial respiration, heart massage, etc.).
• Organization of the speedy delivery (transportation) of the victim to a medical institution.

When providing first aid, the following principles should be followed:

1. All actions of the assisting person must be expedient, deliberate, resolute, quick and calm.
2. First of all, it is necessary to assess the situation and take measures to stop the impact of factors harmful to the body.
3. Quickly and correctly assess the condition of the victim. This is facilitated by finding out the circumstances under which the injury or sudden illness occurred, the time and place of the injury. This is especially important if the victim is unconscious. When examining the victim, they establish whether he is alive or dead, determine the type and severity of the injury, whether there was and whether bleeding continues.
4. Based on the examination of the victim, the method and sequence of first aid is determined.
5. Find out what means are necessary for first aid, based on specific conditions, circumstances and opportunities.
6. Provide first aid and prepare the victim for transportation.

Signs of life and death. Clinical and biological death

In case of severe injury, electric shock, drowning, suffocation, poisoning, as well as a number of diseases, loss of consciousness may develop, i.e. a state when the victim lies motionless, does not answer questions, does not respond to others. This is the result of a violation of the activity of the central nervous system, mainly the brain.
The caregiver must clearly and quickly distinguish loss of consciousness from death.

The onset of death is manifested in the irreversible violation of the basic vital functions of the body, followed by the cessation of the vital activity of individual tissues and organs. Death from old age is rare. Most often, the cause of death is a disease or exposure to various factors on the body.

With massive injuries (aircraft, railway injuries, craniocerebral injuries with brain damage), death occurs very quickly. In other cases, death is preceded by agony which can last from minutes to hours or even days. During this period, cardiac activity is weakened, respiratory function is weakened, the skin of the dying person becomes pale, facial features are sharpened, sticky cold sweat appears. The agonal period passes into a state of clinical death.

Clinical death is characterized by:
- cessation of breathing;
- cardiac arrest.
During this period, irreversible changes in the body have not yet developed. Different organs die at different rates. The higher the level of tissue organization, the more sensitive it is to a lack of oxygen and the faster this tissue dies. The most highly organized tissue of the human body - the cerebral cortex dies as quickly as possible, after 4-6 minutes. The period while the cerebral cortex is alive is called clinical death. During this period of time, it is possible to restore the function of nerve cells and the central nervous system.

biological death characterized by the onset of irreversible processes in tissues and organs.

If signs of clinical death are found, it is necessary to immediately begin resuscitation measures.

Signs of life

Palpitation. It is determined by ear, putting the ear to the left half of the chest.

Pulse. It is most convenient to determine the pulse on the radial, carotid and femoral arteries. To determine the pulse on the carotid artery, you need to put your fingers on the front surface of the neck in the area of ​​\u200b\u200bthe cartilage of the larynx and move your fingers to the right or left. The femoral artery passes through the inguinal fold. The pulse is measured with the index and middle fingers. You should not determine the pulse with your thumb. The fact is that on the inside of the thumb there is an artery that supplies it with blood, of a fairly large caliber, and in some cases it is possible to determine one's own pulse. In critical situations, when the victim is unconscious, it is necessary to determine the pulse only on the carotid arteries. The radial artery has a relatively small caliber, and if the victim has low blood pressure, it may not be possible to determine the pulse on it. The carotid artery is one of the largest in the human body and it is possible to determine the pulse on it even at the lowest pressure. The femoral artery is also one of the largest, however, determining the pulse on it may not always be convenient and correct.

Breath. Breathing is determined by the movement of the chest and abdomen. In the case when it is impossible to determine the movement of the chest, with very weak shallow breathing, the presence of breathing is determined by bringing a mirror to the mouth or nose of the victim, which fogs up from breathing. In the absence of a mirror, you can use any shiny cold object (watch, glasses, knife blade, glass shard, etc.). In the absence of these items, you can use a thread or cotton wool, which will oscillate in time with the breath.

The reaction of the cornea of ​​the eye to irritation. The cornea of ​​​​the eye is a very sensitive formation, rich in nerve endings, and with minimal irritation of it, a reaction of the eyelids occurs - a blinking reflex (remember what sensations arise when a speck enters the eye). The reaction of the cornea of ​​​​the eye is checked as follows: the eye is gently touched with the tip of a handkerchief (not a finger!), If the person is alive, the eyelids will blink.

Pupillary reaction to light. The pupils of a living person react to light - they narrow, and expand in the dark. In the daytime, the reaction of the pupils to light is determined as follows: if a person lies with his eyes closed, then his eyelids are raised - the pupils will narrow; if a person lies with his eyes open, then close his eyes with his palm for 5-10 seconds, and then remove the palm - the pupils will narrow. In the dark, it is necessary to illuminate the eye with a light source, for example, a flashlight. Pupillary response to light should be checked in both eyes, as one eye may be artificial.

Signs of clinical death

• No signs of life.
• Agony breathing. Death in most cases is preceded by agony. After the onset of death, the so-called agonal breathing continues for a short time (15-20 seconds), that is, breathing is frequent, shallow, hoarse, foam may appear at the mouth.
• Seizures. They are also manifestations of agony and last a short time (several seconds). There is a spasm of both skeletal and smooth muscles. For this reason, death is almost always accompanied by involuntary urination, defecation and ejaculation. Unlike some diseases accompanied by convulsions, when death occurs, convulsions are mild and not pronounced.
• Pupillary reaction to light. As mentioned above, there will be no signs of life, but the reaction of the pupils to light in a state of clinical death remains. This reaction is the highest reflex, closing on the cortex of the cerebral hemispheres. Thus, while the cerebral cortex is alive, the reaction of the pupils to light will also be preserved. It should be noted that the first seconds after death, as a result of convulsions, the pupils will be maximally expanded.

Given that agonal breathing and convulsions will occur only in the first seconds after death, the main sign of clinical death will be the presence of a pupillary reaction to light.

Signs of biological death

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

"Cat's eye" (symptom of Beloglazov). Appears 25-30 minutes after death. Where does this name come from? A human has a round pupil, while a cat has an elongated one. After death, human tissues lose their elasticity and resilience, and if you squeeze the eyes of a dead person from both sides, it deforms, and the pupil deforms together with the eyeball, taking an elongated shape, like a cat's. In a living person, it is very difficult to deform the eyeball, if not impossible.

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

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

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

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

The body's response to injury

Fainting

Sudden loss of consciousness for a short time. It usually occurs as a result of acute circulatory failure, which leads to a decrease in blood supply to the brain. The lack of oxygen supply to the brain occurs most often with a decrease in blood pressure, vascular attacks, and heart rhythm disturbances. Fainting is sometimes observed with a long stay on the legs in a standing position, with a sharp rise from a prone position (the so-called orthostatic syncope), especially in people who are weakened or suffering from hypotension, as well as in patients taking medications that reduce blood pressure. Fainting is more common in women.

Factors provoking the onset of fainting are a violation of the diet, overwork, heat or sunstroke, alcohol abuse, infection, intoxication, recent serious illness, traumatic brain injury, being in a stuffy room. Fainting can occur as a result of excitement, fright, at the sight of blood, from severe pain during blows and injuries.

Signs of fainting: dizziness with ringing in the ears, a feeling of emptiness in the head, severe weakness, yawning, darkening of the eyes, cold sweat, dizziness, nausea, numbness of the extremities, increased bowel activity appear. The skin becomes pale, the pulse is weak, thready, blood pressure decreases. The eyes first wander, then close, there is a short-term loss of consciousness (up to 10 s), the patient falls. Then the consciousness is gradually restored, the eyes open, breathing and cardiac activity normalize. For some time after fainting, headache, weakness, and malaise remain.

First aid. If the patient has not lost consciousness, he should be asked to sit down, bend over and lower his head low to improve blood flow and oxygen supply to the brain.

If the patient has lost consciousness, he is laid on his back with his head down and his legs up. It is necessary to unfasten the collar and belt, sprinkle the face with water and rub it with a towel dipped in cold water, let the vapors of ammonia, cologne, and vinegar inhale. In a stuffy room, it is good to open a window to provide fresh air.

If the fainting state does not go away, the patient is put to bed, covered with heating pads, provided with peace, given cardiac and sedative medicines.

Shock

Severe general reaction of the body, acutely developing as a result of exposure to extreme factors (severe mechanical or mental trauma, burns, infection, intoxication, etc.). The shock is based on sharp disorders of the vital functions of the circulatory and respiratory systems, the nervous and endocrine systems, and metabolism.

The most common traumatic shock that develops with extensive trauma to the head, chest, abdomen, pelvis, limbs. A variety of traumatic shock is burn shock that occurs with deep and extensive burns.

In the initial phase, immediately after the injury, short-term excitation is usually noted. The victim is conscious, restless, does not feel the severity of his condition, rushes about, sometimes screams, jumps up, tries to run. His face is pale, the pupils are dilated, his eyes are restless, his breathing and pulse are quickened. In the future, indifference quickly sets in, complete indifference to the environment, the reaction to pain is reduced or absent. The victim's skin is pale, with an earthy tint, covered with cold sticky sweat, hands and feet are cold, body temperature is low. Rapid, shallow breathing is noted, the pulse is frequent, thready, sometimes not palpable, thirst appears, sometimes vomiting occurs.

Cardiogenic shock- a special severe form of heart failure, complicating the course of myocardial infarction. Cardiogenic shock is manifested by a drop in blood pressure, increased heart rate and circulatory disorders (pale, cyanotic skin, sticky cold sweat), often loss of consciousness. Requires treatment in a cardiac intensive care unit.

Septic (infectious-toxic) shock develops with severe infectious processes. The clinical picture of shock in this case is supplemented by an increase in body temperature, chills, and the presence of a local purulent-septic focus. In this condition, the patient needs specialized help.

emotional shock arises under the influence of a strong, sudden mental trauma. It can be manifested by a state of complete immobility, indifference - the victim "froze with horror." This condition can last from several minutes to several hours. In other cases, on the contrary, there is a sharp excitement, which is manifested by screams, senseless throwing, flight, often in the direction of danger. Pronounced vegetative reactions are noted: palpitations, sharp blanching or redness of the skin, sweating, diarrhea. A patient in a state of emotional shock must be hospitalized.

First aid is to stop the impact on the injured traumatic factor. To do this, you need to free him from the rubble, extinguish burning clothes, etc. In case of external bleeding, it is necessary to take measures to stop it - apply a sterile pressure bandage to the wound or (in case of arterial bleeding) apply a hemostatic tourniquet or twist from improvised materials above the wound (see Bleeding). If a fracture or dislocation is suspected, temporary immobilization of the limb should be provided. The oral cavity and nasopharynx of the victim are freed from vomit, blood, foreign bodies; if necessary, carry out artificial respiration. If the victim is unconscious, but breathing and cardiac activity are preserved, to prevent the flow of vomit into the respiratory tract, he is placed on his stomach, and his head is turned to the side. The victim, who is conscious, can be given inside painkillers (analgin, pentalgin, sedalgin). It is important to deliver the victim to a medical facility without delay.

Collapse

A severe, life-threatening condition characterized by a sharp decrease in blood pressure, depression of the central nervous system, and metabolic disorders. Vascular insufficiency and a decrease in blood pressure are the result of a drop in vascular tone caused by inhibition of the vasomotor center in the brain. With collapse, the vessels of the abdominal organs are filled with blood, while the blood supply to the vessels of the brain, muscles and skin is sharply reduced. Vascular insufficiency is accompanied by a decrease in the oxygen content in the blood surrounding tissues and organs.

Collapse can occur with sudden blood loss, lack of oxygen, malnutrition, trauma, sudden changes in posture (orthostatic collapse), excessive physical exertion, as well as poisoning and certain diseases (typhoid and typhus, pneumonia, pancreatitis, etc.).

With collapse, the skin turns pale, covered with a cold sticky sweat, the limbs become marbled blue, the veins collapse and become indistinguishable under the skin. Eyes sunken, facial features sharpened. Blood pressure drops sharply, the pulse is barely palpable or even absent. Breathing is rapid, shallow, sometimes intermittent. Involuntary urination and bowel movements may occur. Body temperature drops to 35 ° and below. The patient is lethargic, consciousness is darkened, and sometimes completely absent.

First aid. With a collapse, the patient needs emergency treatment: you need to urgently call an ambulance. Before the arrival of the doctor, the patient is laid down without a pillow, the lower part of the torso and legs are slightly raised, they are allowed to smell the vapors of ammonia. Heating pads are applied to the limbs, hot strong tea or coffee is given to the patient, and the room is ventilated.

Death- an inevitable stage of life, it represents the cessation of the existence of an organism as a single complex biological structure capable of interacting with the external environment, responding to its various influences. It is important to note that death almost never occurs immediately. It is always preceded by a transitional stage of dying, i.e. the gradual extinction of vital functions in a certain sequence.

The period of dying is called the terminal (final) state, which, in turn, is divided into stages:

predagonia;

clinical death.

The duration of the terminal phase can vary from a few minutes to many hours. Its development is based on increasing hypoxia and impaired brain function. The cerebral cortex is most sensitive to oxygen starvation, so the first sign is loss of consciousness. If the duration of hypoxia exceeds 3–5 minutes, then the restoration of cortical functions becomes impossible. Further, changes occur in the subcortical regions of the brain, then the medulla oblongata, in which the centers of respiration and blood circulation are located, dies. This, in turn, disrupts the activity of the cardiovascular, respiratory, endocrine systems, as well as the liver, kidneys, and metabolism.

clinical death- a short period of time (no more than 5 minutes) after stopping breathing and blood circulation, in which it is still possible to restore the vital functions of the body.

The main signs of clinical death:

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

Lack of breath

Absence of a 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 can lead to a complete restoration of body functions, including consciousness. On the contrary, after this period, medical care can contribute to the appearance of cardiac activity, respiration, but does not lead to the restoration of the function of the cells of the cerebral cortex and consciousness. In these cases, "brain death" occurs, i.e. social death. With a 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:

Cooling of the body below 200 C after 1-2 hours;

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

The appearance of cadaveric spots on the skin. Cadaveric spots are formed as a result of the 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. According to the degree of severity of the cadaveric spot, they judge the prescription of the onset of death (by the location of the cadaveric spots, you can determine the position of the corpse, its movement);

Rigor mortis develops after 2-4 hours in a descending type from top to bottom. Fully it comes in 8-14 hours. After 2-3 days, rigor mortis disappears. The main value in the resolution of rigor mortis is the ambient temperature, at high temperatures it disappears faster.

Determination of signs of life:

The presence of a heartbeat (determined by hand or ear on the chest in the area of ​​the left nipple);

The presence of a pulse in the arteries. The pulse is determined on the neck (carotid artery);

The presence of breathing (determined by the movement of the chest and abdomen, by moistening the mirror attached to the nose and mouth of the victim, by the movement of a piece of cotton wool or a bandage brought to the nasal openings);

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

10.2 Basic principles and procedure for resuscitation

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

Resuscitation needs to be provided in sudden death in cases of electric shock and lightning, in case of blows to the heart or solar plexus, in cases of drowning or hanging, in case of a heart attack, a complicated epileptic seizure, a foreign body entering the respiratory tract, general freezing and a number of other cases when death occurs suddenly.

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

1. Timeliness. If a person suddenly died literally in front of your eyes, then you should immediately start resuscitation. Resuscitation is most effective if started no later than 1-2 minutes after cardiac arrest and breathing. If you were not an eyewitness to 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. Determine the following sequence of events:

Releasing and maintaining airway patency;

External heart massage;

Artificial respiration;

Stop bleeding;

Dealing with shock;

Giving the victim a sparing position, the 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 the lower limit, and a break in their implementation may have adverse consequences for the patient.

Contraindications for resuscitation:

Obvious signs of death;

Injuries incompatible with life;

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

Violation of the integrity of the chest.

The procedure for resuscitation:

1. Lay the victim on a hard, flat surface. The supine position is most favorable for passive breathing movements.

2. Unfasten clothes, loosen the belt, cut ribbons, ties - everything that interferes with normal blood circulation and breathing. For the convenience of monitoring breathing and cardiac activity, the face and chest of the patient should be visible.

3. Restore airway patency:

3.1 Clean the mouth - turn the head of the victim on its side and in a circular motion of the index finger wrapped in a cloth (bandage, handkerchief) clean the mouth, remove removable dentures. If a fracture of the spine in the cervical region is suspected, the head cannot be turned due to the risk of damage to the spinal cord.

3.2 To eliminate the retraction of the tongue, the victim's head must be thrown back, while the rescuer puts one hand on the victim's forehead, and brings the other under his neck, near the back of the head. In this position, the passage that communicates the mouth, the nasopharynx with the trachea is straightened, which is important for artificial ventilation, and the tissues between the larynx and lower jaw are stretched, and the root of the tongue moves away from the posterior pharyngeal wall. In 80% of cases, this is enough to restore breathing.

3.3. Push the lower jaw forward - for this, the branches of the lower jaw are pushed forward with the fingers of both hands so that the lower incisors are in front of the upper ones.

Lower jaw extension techniques:

- Having fixed the head of the victim with the palms, his chin is pushed forward with the fingers of both hands behind the corners of the lower jaw, and the mouth is slightly opened with the thumbs.

- one hand fixes the head by the forehead, the index and middle fingers of the second hand are inserted into the mouth so that the hand grabs the lower jaw and pushes the jaw forward.

4. Check for signs of life (breathing, pulse)

5. If breathing is not restored and there is no pulse, then start external cardiac massage, alternating it with artificial respiration.

Biological death is an irreversible stop of all biological processes in the body. Please note that today timely cardiopulmonary resuscitation helps to start the heart and restore breathing. In medicine, natural (physiological) death is distinguished, as well as premature (pathological). As a rule, the second death is sudden, occurs after a violent murder or an accident.

Causes of biological death

The primary reasons are :

• Damage that is incompatible with life.
• Profuse bleeding.
• Concussion, squeezing of vital organs.
• State of shock.

Secondary reasons include:

• Various .
• The strongest intoxication of the body.
• non-communicable diseases.

Symptoms of death

It is on the basis of some signs that death is ascertained. First, the heart stops, the person stops breathing, and after 4 hours a large number of cadaveric spots appear. Rigor numbness occurs due to circulatory arrest.

How to recognize biological death?

• There is no respiratory and cardiac activity - there is no pulse on the carotid artery, the beat of the heart is inaudible.
• Absence of cardiac activity for more than half an hour.
• The pupils are maximally dilated, while there is no corneal reflex, there is no reaction to light.
• Hypostasis (the appearance of dark blue spots on the body).

Please note that the listed signs do not always indicate the death of a person. The same symptomatology appears in case of severe hypothermia of the body, which depresses the effect of drugs on the nervous system.

It is important to understand that biological death does not mean that all organs and tissues immediately die. It all depends on the individual characteristics of the organism. First of all, the tissue dies (subcortical structure, cerebral cortex), but the dorsal, stem sections die later.

The heart after death can be viable for two hours, and the liver and kidneys live for about four hours. The longest viable tissue is muscle, skin. Bone tissue can retain its functions for several days.

Early and late signs of death

Within an hour, the following symptoms appear:

• The appearance on the body of Larcher spots (triangles of dried skin).
• Cat's eye syndrome (elongated pupil shape during squeezing of the eyes).
• Cloudy pupil with white film.
• The lips become brown, thick and wrinkled.

Attention! If all of the above symptoms are present, resuscitation is not carried out. It is meaningless in this case.

Late symptoms include:

• Spots on the body of a marble color.
• Cooling of the body, because the temperature drops.

When does the doctor declare death?

The doctor reports the death of the patient in the absence of:

• motor response to pain.
• Consciousness.
• Corneal reflex.
• Cough, gag reflex.

To confirm brain death, the doctor uses instrumental diagnostic methods:

• Electroencephalography.
• Angiography.
• Ultrasonography.
• Magnetic resonance angiography.

The main stages of biological death

• Predagony- sharply suppressed or completely absent. In this case, the skin turns pale, it is poorly palpable on the carotid, femoral artery, the pressure decreases to zero. The patient's condition deteriorates sharply.
• Terminal pause is an intermediate stage between life and death. If resuscitation is not carried out in a timely manner, the person will die.
• Agony- the brain ceases to control all physiological processes.

In the case of the negative impact of destructive processes, the above stages are absent. As a rule, the first and last stages last several minutes or days.

Medical diagnosis of biological death

In order not to be mistaken in death, many experts use different tests and methods:

• Winslow test- a vessel filled with water is placed on the chest of a dying person, with the help of vibration they learn about respiratory activity.
• Auscultation , palpation of the central, peripheral vessels.
• Magnus test - tightly pull the finger, if it is gray-white, then the person has died.

Previously, more stringent samples were used. For example, the José test involved pinching the skin fold with special forceps. During the Desgrange test, boiling oil was injected into the nipple. But during the Raze test, red-hot iron was used, heels and other parts of the body were burned with it.

Assistance to the victim

Timely resuscitation makes it possible to return the functions of vital system organs. We draw attention to the following algorithm of assistance:

• Immediately eliminate the damaging factor - squeezing the body, electricity, low or high temperature.
• To save the victim from adverse conditions - take it out of the burning room, pull it out of the water.
• First aid will depend on the type of disease, injury.
• Urgent transport of the victim to the hospital.

Attention! It is important to properly transport the patient. If he is unconscious, it is best to carry him on his side.

If you are providing first aid, be sure to adhere to the following principles:

• Actions should be quick, expedient, calm, deliberate.
• Realistically evaluate the environment.
• Don't panic, you need to assess what state the person is in. To do this, you need to learn about the nature of the injury, disease.
• Call an ambulance or transport the victim yourself.

Thus, biological death is the end of human life. It is very important to distinguish it from, in the latter case, the victim can be helped. If, nevertheless, it was not possible to avoid a tragic situation, you should not take action on your own, you should immediately call an ambulance. The sooner resuscitation methods are used, the greater the chance that the person will survive.

Biochemical death (or true death) is an irreversible cessation of physiological processes in cells and tissues. Irreversible termination is usually understood as "irreversible within the framework of modern medical technologies" termination of processes. Over time, the possibilities of medicine for resuscitation of deceased patients change, as a result of which, the border of death is pushed into the future. From the point of view of scientists - supporters of cryonics and nanomedicine, most of the people who are dying now can be revived in the future if their brain structure is preserved now.

Early signs of biological death include:

1. Lack of reaction of the eye to irritation (pressure)

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

3. The appearance of the symptom of "cat's eye": with lateral compression of the eyeball, the pupil transforms into a vertical spindle-shaped slit.

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

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

Signs of clinical death include:

1. Lack of breath.

2. Lack of heartbeat.

3. Generalized pallor or generalized cyanosis.

4. Lack of pupillary response 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 in anoxic conditions. Describing clinical death, V.A. Negovsky speaks of two terms.

The first term 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 normothermic conditions. All world practice shows that if this period is exceeded, people can be revived, but as a result, decortication or even decerebration occurs.

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

The duration of clinical death is prolonged under conditions of hypothermia, electric shock, and drowning. In clinical practice, this can be achieved through physical effects (hypothermia of the head, hyperbaric oxygenation), the use of pharmacological substances that create states similar to suspended animation, hemosorption, transfusion of fresh (not canned) donor 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 of modern methods of cardiopulmonary resuscitation (revival) can prevent the onset of biological death.

Resuscitation. Two stages of resuscitation should be distinguished. 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 of medications and appropriate 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 (administration of medications, infusion of blood and blood substitutes, electrocardiography, defibrillation, etc.).

The first stage can be carried out by almost any medical professional or person well trained in resuscitation techniques. The second stage and the ability to carry out only a specialist, as a rule, is an anesthesiologist-resuscitator.

Here it is appropriate to give the techniques and rules of only the first stage, since the manipulations of the second stage do not directly relate to traumatology.

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

Restoration of airway patency. The closure of the respiratory tract may be due mainly to vomit, blood, mucus, from which the patient, being in an unconscious state, cannot get rid of coughing or swallowing. In addition, in the absence of consciousness, when the muscles are relaxed, with the neck bent forward, the root of the tongue can rest against the back wall of the pharynx. Therefore, the first step is to 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 the back of the pharynx. If the tongue still sinks, and there are no extra hands to hold the jaw in an advanced anterior position, you can pierce the tongue with a pin or flash it with a needle, pull it out of the mouth and fasten the thread or pin behind the victim's ear. In the presence of foreign contents, it is necessary to clean the mouth and throat with a finger wrapped in a bandage, a handkerchief, etc. To do this, turn the patient's head and shoulders (if the patient is lying on his back) somewhat to one side, open the patient's mouth, clean the oral cavity with a finger (or suction, if he is). If a cervical spine injury is suspected, it is not necessary to bend the head backwards because of the risk of aggravating damage to the spinal cord. In this case, they are limited to fixing an elongated tongue or an air duct is introduced.

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. Blowing air into the mouth, as mentioned above, it is necessary to push 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 carried out through a handkerchief or gauze placed on the nose and mouth of the patient. You should take a deep breath, place your lips tightly around the patient's mouth and exhale sharply. When air is injected, it is necessary to monitor whether the chest rises from the air blown into the lungs. Further, conditions are created for passive exhalation: the chest, subsiding, will lead to the expulsion of a portion of air from the lungs. After vigorously carried out 3-5 deep breaths of air into the lungs of the victim, a pulse is felt on the carotid artery. If the pulse is determined, continue to inflate the lungs with a rhythm of 12 breaths in 1 min (one breath in 5 s).

For artificial respiration through the nose, the patient's mouth must be closed at the time of inhalation, while exhaling, the mouth must be opened to facilitate the release of air from the respiratory tract.

Sometimes, when blowing air, 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 can enter the pharynx and oral cavity, in which case the head and shoulders of the victim are turned to the side and the mouth is cleaned (see above),

Cardiopulmonary bypass (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 a pulse;) on large vessels - carotid, femoral. The last sign is the most reliable evidence of cardiac arrest. The pulse should be determined from the side closest to the caregiver. To determine the pulse on the carotid artery, the following technique should be used: the index and middle fingers are placed on the patient's thyroid cartilage, and then advanced to the side of the neck, trying to palpate the vessel flat, and not with the tailbones of the fingers.

To restore blood circulation during cardiac arrest, you can use an external heart massage, that is, rhythmic compression of the heart between the sternum and spinal column. When compressed, blood from the left ventricle flows through the vessels to the brain and heart. After the cessation of pressure on the sternum, it again fills the cavity of the heart.

Technique of external heart massage. The palm of one hand is placed on the lower part of the sternum, the palm of the other hand is placed on top of the first. The sternum is pressed towards the spinal column, leaning on the hands and body weight (in children, squeezing the sternum is carried out only with the hands). Having pressed the sternum as much as possible, it is necessary to delay the compression for 1/2 s, after which the pressure is quickly removed. It is necessary to repeat the compression of the sternum at least 1 time in 1 s, because a rarer pressure does not create sufficient blood flow. In children, the frequency of compressions of the sternum should be higher - up to 100 compressions per 1 minute. In the intervals between pressures, the hands do not need to be removed from the sternum. The effectiveness of the massage is judged by: a) pulse shocks on the carotid artery in time with the massage; b) narrowing of the pupils; c) the appearance of independent respiratory movements. Changes in the color of the skin are also taken into account.

Combination of cardiac massage with lung ventilation. External massage alone, without simultaneous blowing of air into the lungs, cannot lead to resuscitation. Therefore, both of these methods of revitalization must be combined. In the event that revival is carried out by 1 person, it is necessary to produce 15 compressions of the sternum for 15 seconds every 2 quick blows of air into the lungs (according to the mouth-to-mouth or mouth-to-nose system). The head of the patient must be thrown back. If resuscitation is carried out by 2 people, then one of them produces one deep inflation of the lungs after every fifth chest compression.

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

When moving the victim to a vehicle, transferring on a stretcher, transporting, resuscitation measures, if necessary, must be continued in the same mode: for 2 deep intensive air injections, 15 compressions of the sternum should be performed.