What is clinical death - signs, maximum duration and consequences for human health. Statement of biological death

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

Signs of a dying person

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

Signs of clinical death

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

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

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

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

Definition of biological death

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

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

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

Stages of human dying

Biological death is preceded by the following stages:

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

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

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

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

Differences in biological death

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

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

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

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

Criteria for biological death

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

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

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

Signs of biological death

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

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

Diagnosis of death consists of orienting and reliable signs.

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

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

Early symptoms of biological death and late ones also differ.

early signs

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

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

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

late signs

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

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

brain death

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

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

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

Time of onset of biological death

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

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

The prescription of death is determined according to various indications in the study of tissues and organs of the corpse. The determination of the moment of death in the early period is carried out by studying the degree of development of cadaveric processes.

Statement of death

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

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

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

transplantology

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

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

Organs and tissues for transplantation should be removed before the 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 from 12 to 48 hours.

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

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

Reliable signs of biological death are cadaveric spots, rigor mortis and cadaveric decomposition.

Cadaverous spots are a kind of blue-violet or purple-violet staining of the skin due to draining and accumulation of blood in the lower parts of the body. They begin to form 2-4 hours after the cessation of cardiac activity. The initial stage (hypostasis) - up to 12-14 hours: the spots disappear with pressure, then reappear within a few seconds. Formed cadaveric spots do not disappear when pressed.

Rigor mortis is a compaction and shortening of skeletal muscles, creating an obstacle to passive movements in the joints. It manifests itself in 2-4 hours from the moment of cardiac arrest, reaches a maximum in a day, and resolves in 3-4 days.

Cadaveric decomposition - occurs at a later date, manifested by decomposition and decay of tissues. The terms of decomposition are largely determined by the conditions of the external environment.

Statement of biological death

The fact of the onset of biological death can be established by a doctor or paramedic by the presence of reliable signs, and before they form, by the combination of the following symptoms:

Lack of cardiac activity (no pulse on large arteries; heart sounds are not heard, there is no bioelectrical activity of the heart);

The time of the absence of cardiac activity is significantly more than 25 minutes (at normal ambient temperature);

Lack of spontaneous breathing;

The maximum expansion of the pupils and the absence of their reaction to light;

Lack of corneal reflex;

The presence of postmortem hypostasis in sloping parts of the body.

brain death

The diagnosis of brain death is very difficult to make. There are the following criteria:

Complete and permanent absence of consciousness;

Sustained lack of spontaneous breathing;

The disappearance of any reactions to external stimuli and any kind of reflexes;

Atony of all muscles;

The disappearance of thermoregulation;

Complete and persistent absence of spontaneous and induced electrical activity of the brain (according to electroencephalogram data). The diagnosis of brain death has implications for organ transplantation. After its ascertainment, it is possible to remove organs for transplantation to recipients.

In such cases, when making a diagnosis, it is additionally necessary:

Angiography of cerebral vessels, which indicates the absence of blood flow or its level is below critical;

Conclusions of specialists: neuropathologist, resuscitator, forensic medical expert, as well as an official representative of the hospital, confirming brain death.

According to the legislation existing in most countries, "brain death" is equated with biological.

Resuscitation measures

Resuscitation measures are the actions of a doctor in case of clinical death, aimed at maintaining the functions of blood circulation, respiration and revitalizing the body.

Reanimator one

The resuscitator produces 2 breaths, after which - 15 chest compressions. Then this cycle is repeated.

Two resuscitators

One resuscitator performs mechanical ventilation, the other - heart massage. In this case, the ratio of respiratory rate and chest compressions should be 1:5. During inspiration, the second rescuer should pause the compressions to prevent gastric regurgitation. However, during massage on the background of mechanical ventilation through an endotracheal tube, such pauses are not necessary; moreover, compression during inhalation is beneficial, as more blood from the lungs flows to the heart and cardiopulmonary bypass becomes more effective.

The effectiveness of resuscitation

A prerequisite for carrying out resuscitation measures is the constant monitoring of their effectiveness. Two concepts should be distinguished:

efficiency of resuscitation

Efficiency of artificial respiration and blood circulation.

Resuscitation efficiency

The effectiveness of resuscitation is understood as a positive result of resuscitation of the patient. Resuscitation measures are considered effective when a sinus rhythm of heart contractions appears, blood circulation is restored with registration of blood pressure not lower than 70 mm Hg. Art., constriction of the pupils and the appearance of a reaction to light, restoration of the color of the skin and the resumption of spontaneous breathing (the latter is not necessary).

Efficiency of artificial respiration and circulation

The effectiveness of artificial respiration and blood circulation is said when resuscitation measures have not yet led to the revival of the body (there are no independent blood circulation and respiration), but the ongoing measures artificially support metabolic processes in tissues and thereby lengthen the duration of clinical death.

The effectiveness of artificial respiration and blood circulation is evaluated by the following indicators.

Constriction of the pupils.

The appearance of transmission pulsation on the carotid (femoral) arteries (assessed by one resuscitator when another chest compressions are performed).

Change in the color of the skin (reduction of cyanosis and pallor).

With the effectiveness of artificial respiration and blood circulation, resuscitation continues for an arbitrarily long time until a positive effect is achieved or until the indicated signs disappear permanently, after which resuscitation can be stopped after 30 minutes.

Skull injuries. Concussion, bruise, compression. First aid, transportation. Principles of treatment.

Closed injuries of the skull and brain.

Injury to the soft tissues of the skull in its course almost does not differ from damage to other areas. Differences appear when the brain is damaged. Allocate concussion, contusion, compression of the brain, fractures of the vault and base of the skull.

A concussion develops when a significant force is applied to the skull as a result of hitting it with an object or bruising it during a fall. The essence of the changes occurring in this case is the concussion of the delicate brain tissue and the violation of the histological relationships of cells.

Symptoms and course.

Loss of consciousness that develops at the time of injury is the main symptom of a concussion. Depending on the severity, it can be short-term (within a few minutes) or last for several hours or even days. The second important symptom is the so-called retrograde amnesia, which is expressed in the fact that a person, having regained consciousness, does not remember what happened immediately before the injury.

First aid is to provide rest and carry out activities that reduce swelling and swelling of the brain. Locally - cold, sedatives, sleeping pills, diuretics.

All patients with concussion should be hospitalized with the appointment of bed rest. With a sharply increased intracranial pressure, manifested by severe headaches, vomiting, etc., a spinal puncture is shown to clarify the diagnosis, which allows you to determine the pressure of the cerebrospinal fluid and the blood content in it (which happens with brain bruises and subarachnoid hemorrhages). Removal of 5-8 ml of cerebrospinal fluid during puncture usually improves the patient's condition and is completely harmless.

Injury

A brain contusion is a violation of the integrity of the brain substance in a limited area. It usually occurs at the point of application of the traumatic force, but it can also be observed on the side opposite to the injury (bruise from counterblow).

In this case, the destruction of a part of the brain tissue of blood vessels, histological connections of cells with the subsequent development of traumatic edema occurs. The zone of such violations is different and is determined by the severity of the injury. Cerebral phenomena are observed, the so-called. contusion-concussion syndrome: dizziness, headaches, vomiting, slowing of the pulse, etc. Sometimes they are accompanied by fever. From a concussion, a bruise is distinguished by focal signs: loss of function of certain parts of the brain. So, sensitivity, movements, facial expressions, speech, etc. can be disturbed. Based on these symptoms, a neurological examination of the patient makes it possible to make an accurate topical diagnosis of the damaged area of ​​the brain.

Assistance for a brain injury is the same as for a concussion, but bed rest is observed for a longer time.

Brain compression, intracranial bleeding.

Brain compression is the result of blood pressure on the brain due to intracranial bleeding or bone fragments or fractures of the skull. Fragments of bone that compress the substance of the brain are diagnosed by x-ray of the skull, which is mandatory for traumatic brain injury. They are subject to surgical removal during trepanation of the skull.

It is much more difficult to recognize compression of the brain caused by an intracranial hematoma (blood tumor). Hemorrhage in the cranial cavity with a volume of 30-40 ml leads to increased pressure, compression of the brain and disruption of its functions. The collection of blood can be above the dura (epidural hematoma), under the dura (subdural hematoma), or inside the brain (intracerebral hematoma).

Symptoms and course.

A characteristic condition with intracranial bleeding does not develop immediately after the injury, but after a few hours, necessary for the accumulation of blood and compression of the brain tissue, and is called the "light" interval. Symptoms with increased intracranial pressure: headache, nausea and vomiting, confusion and loss of consciousness, hoarse, intermittent breathing, slow pulse, anisocoria (different pupil sizes, usually wider on the side of the injury and do not narrow in the light).

Disturbances of movement and sensitivity in the limbs are found on the side opposite to the injury.

In the clinic of brain compression, three phases are distinguished: initial, full development and paralytic. In phase 1, there are initial signs of increased intracranial pressure and focal lesions. Full, bright development of cerebral and focal symptoms is typical for the second phase. In the paralytic phase, a coma develops, paralysis of sphincters, limbs, frequent and small pulse, intermittent, hoarse breathing, ending in respiratory arrest.

At a prelum of a brain operation is shown. The exact localization in seriously ill patients is sometimes difficult to determine; this requires, in addition to a thorough neurological examination, additional methods (ultrasound echolocation, ventriculography, etc.).

Chest injury. Classification. Pneumothorax, its types. Principles of first aid. Hemothorax. Clinic. Diagnostics. First aid. Transportation of victims with chest trauma.

In addition to concussions, bruises, compression of the chest wall, lungs and heart, fractures of the ribs and other bones, there are closed ruptures of the organs of the chest cavity. Usually, after an injury, patients develop: a pronounced drop in cardiac activity, shortness of breath, pallor, cyanosis, cold sweat, shock, and sometimes loss of consciousness.

When providing assistance, it is necessary to ensure peace, prescribe bed rest, warming, carry out oxygen therapy and administer cardiac agents. Usually, after such treatment, all symptoms soon disappear (if there are no bone fractures or organ damage).

A bruised chest may be accompanied by a fracture of the ribs, rupture of the vessels of the chest wall, trauma to the pleura and lung. The heart, as an anatomically more hidden organ, is rarely damaged, and the esophagus is even less often damaged.

With fractures of the ribs and ruptures of the lung, pneumothorax or hemothorax may develop. The air accumulated in the pleural cavity compresses the lung and shifts the mediastinum to the healthy side. Violating the function of the heart and respiration, it also enters the subcutaneous tissue, resulting in the formation of subcutaneous emphysema. If the intercostal and other vessels of the chest are damaged or if the lung ruptures, bleeding occurs into the pleural cavity and a hemothorax is formed. Finally, a severe bruise can cause the development of shock.

Pneumothorax is the accumulation of air in the pleural cavity. There are open, closed and valvular pneumothorax. The accumulation of air in the pleura, which communicates with atmospheric air through a wound in the chest wall or through a large bronchus, is called an open pneumothorax. With a closed pneumothorax, the air in the pleural cavity does not communicate with the external environment.

When the lung ruptures in the form of a flap, valvular pneumothorax can develop, when air enters the pleura when inhaled, and when exhaled it cannot leave the pleural cavity through the bronchus, since the lung flap closes the damaged bronchus and does not let it through. Thus, with valvular pneumothorax, the amount of air in the pleura increases with each breath and its pressure rises, so it is also called a tension pneumothorax.

Symptoms and course.

The accumulation of air in the pleura in a small amount usually does not cause disturbances, and if its further supply stops, then it resolves. A significant accumulation of air, especially under pressure (valvular pneumothorax), leads to compression of the lung, displacement of the mediastinum, disrupting breathing and cardiac activity. The danger of open pneumothorax is that when breathing, air enters and exits the pleura, which infects the pleura and leads to balloting of the mediastinum, irritation of the nerve endings and a decrease in the respiratory surface of the lungs. At the same time, pronounced shortness of breath, cyanosis, increased heart rate, restriction of respiratory excursions of the diseased side of the chest, the appearance of subcutaneous emphysema, boxed sound during percussion and weakening of respiratory noises are manifested. X-ray reveals accumulation of air in the pleura and atelectasis of the lung. Open pneumothorax is complicated by shock in more than 60% of patients.

Help with open pneumothorax should be the imposition of a hermetic (occlusive) bandage. Treatment is operative. With valvular pneumothorax, a puncture of the chest wall with a thin trocar is indicated to remove air. If the simultaneous removal of air from the pleura is ineffective and it accumulates again, then the pleura is drained (underwater drainage or constant aspiration), if these methods are ineffective, an operation is indicated.

The general condition of such patients is usually severe, they need rest, to fight anemia and to restore the disturbed functions of vital organs.

Subcutaneous emphysema in chest trauma is an external expression of a closed lung injury. She herself does not require the use of special therapeutic measures, even with strong degrees of development. When a lung is ruptured, an operation is performed according to indications. From the subcutaneous tissue, the air usually soon resolves.

Hemothorax, i.e. accumulation of blood in the pleura, can be unilateral and bilateral. In the latter case, there is a threat of death from asphyxia. Unilateral small hemothorax does not cause severe disorders and after a few days the blood resolves. A significant accumulation of blood in the pleura is accompanied by the development of acute anemia due to blood loss, respiratory failure (compression of the lung) and cardiac activity due to displacement of the heart. In these cases, repeated pleural punctures are indicated for blood evacuation and subsequent administration of antibiotics.

When evacuating blood, air should not penetrate into the pleura, which is of great importance for the expansion of the lung. To do this, a rubber tube is put on the needle sleeve, which is pinched when the syringe is removed, or a cannula with a tap is used. In the absence of emergency indications, punctures begin 2-3 days after the injury. The frequency of punctures is determined by the accumulation of blood in the pleural cavity. There are small hemothorax (blood in the sinus), medium (blood up to the angle of the scapula), large (above the angle of the scapula). With a large hemothorax, surgical treatment is possible, reinfusion of blood is possible.

Abdominal trauma. Damage to the abdominal cavity and retroperitoneal space. clinical picture. Modern methods of diagnostics and treatment. Features of combined trauma.

Injuries to the abdominal organs.

The most common of closed injuries of the abdominal cavity and retroperitoneal space are ruptures of hollow and parenchymal organs.

A strong blow with an object on the stomach when the abdominal wall is relaxed or, conversely, when struck by the stomach, the lower part of the chest when falling on a solid body is a typical mechanism of injury when the abdominal organs are ruptured.

The force of the impact, the traumatic agent (a hit by a horse's hoof, a car wheel, a falling object, a part of a working machine, when falling from a height onto a stone, a log, etc.) and the anatomical and physiological state of the organ at the time of damage determines the severity of the damage. There are more extensive ruptures of hollow organs if they were filled at the moment of impact. Collapsed intestinal loops and the stomach are rarely torn. Ruptures of parenchymal organs altered by a pathological process (malarial spleen, liver in hepatitis, etc.) can occur even with minor trauma.

When a hollow organ (intestine, stomach, etc.) is ruptured, the main danger is infection of the abdominal cavity with its contents and the development of diffuse purulent peritonitis. Ruptures of parenchymal organs (liver, spleen, kidneys) are dangerous for the development of internal bleeding and acute anemia. These patients may rapidly develop purulent peritonitis due to the presence of infection (with rupture of the liver, kidneys, bladder) and the nutrient medium - blood.

Symptoms and course.

The clinic of closed injuries of the abdominal organs is characterized by the appearance of severe pain throughout the abdomen with the greatest severity in the area of ​​the damaged organ. A sharp tension in the muscles of the abdominal wall, a characteristic symptom of ruptures of intra-abdominal organs.

The general condition of the patient is severe: pallor, cold sweat, frequent and small pulse, tense immobility in the supine position, usually with the hips brought to the stomach, a picture of shock or acute anemia, depending on the damaged organ.

Damage to the parenchymal organ, accompanied by internal bleeding, quickly leads to the development of acute anemia: increasing pallor, frequent and small pulse, dizziness, vomiting, progressive decrease in blood pressure, etc. With percussion of the abdomen, dullness is noted in its lower lateral sections, moving with a change in body position. Sometimes with intra-abdominal bleeding before the development of infection, the abdominal wall may be mildly tense, but, as a rule, there is swelling and severe symptoms of peritoneal irritation (Shchetkin-Blumberg, Mendel). The rapid development of peritonitis is characteristic of the rupture of hollow organs.

X-ray of the abdominal cavity in case of suspected rupture of a hollow organ helps to clarify the diagnosis, tk. allows you to determine the presence of free gas in it.

Injuries to the abdominal organs require immediate surgery.

With an intraperitoneal rupture of the kidney, when blood and urine enter the abdominal cavity, an emergency abdominal surgery is indicated, which, depending on the severity of the destruction of the kidney, may result in its removal or suturing the wound with isolation of the kidney from the abdominal cavity and drainage through an additional lumbar incision.

Extraperitoneal ruptures of the kidneys are accompanied by the development of a large retroperitoneal hematoma, swelling of the lumbar region, urine with blood and the development of varying degrees of acute anemia. If there is no severe acute anemia, these patients are treated conservatively: rest, cold on the lower back, administration of hemostatic drugs, transfusion of hemostatic doses of blood. To prevent suppuration of the hematoma, it is evacuated after puncture under ultrasound control and antibiotics are administered.

If the anemia gets worse, surgery is needed. Exposing the damaged kidney (through a lumbar incision) and, depending on the severity of the injury, removing it or suturing the wound with subsequent drainage. If it is necessary to remove the kidney, the surgeon must make sure that the patient has a second functioning kidney.

Intraperitoneal rupture of the bladder is accompanied by cessation of urination and the rapid development of peritonitis, severe intoxication. Immediate surgery is indicated to suture the wound of the bladder and ensure the outflow of urine.

Extraperitoneal rupture of the bladder is manifested by the formation of a large infiltrate above the pubis, reaching the navel, the absence of urination and severe intoxication as a result of urine absorption.

An emergency operation consisting in exposing the bladder (without opening the peritoneum), suturing its damage and ensuring the outflow of urine. It is sometimes possible to provide urine diversion with an indwelling catheter inserted through the urethra.

In victims with injuries to the chest or abdomen, the possibility of so-called thoracoabdominal injuries (simultaneous chest and abdomen) should always be considered.

Injuries to the abdomen may be accompanied by a rupture of the diaphragm and entry of the abdominal organs into the chest cavity. In case of a fracture of the ribs on the right, it is always necessary to take into account the possibility of rupture of the liver and examine the victim in the direction of identifying this damage; damage to the ribs on the left is often accompanied by rupture of the spleen.

Dislocations. Clinical picture, classification, diagnosis. First aid, treatment of dislocations.

Dislocation- persistent non-physiological displacement of the articular surfaces of the bones in relation to each other.

Dislocations are usually named after the distal bone that enters the joint - for example, a dislocation in the shoulder joint is called a dislocation of the shoulder (exceptions are dislocations of the vertebrae and the acromial end of the clavicle).

Often, dislocations also damage the joint capsule and its ligaments.

50% of all dislocations are shoulder dislocations, followed by elbow, hip, knee and ankle dislocations. Dislocations of the clavicle in the acromial and sternal regions, patella, bones of the wrist, foot, and lower jaw can be observed. Dislocations of the vertebrae are very dangerous.

Causes of dislocations: violations of the development of the joint (usually the hip joint), trauma, sudden sudden movements, separation of the articular surfaces due to tumors, tuberculosis, osteomyelitis, etc.

Classification.

Complete dislocation - the articular surfaces of both bones cease to touch.

Incomplete dislocation (subluxation) - the articular surfaces retain partial contact.

congenital, acquired

According to the timing of occurrence: fresh (up to 2 days), stale (up to 3-4 weeks), old (more than 4 weeks).

Reducible, irreducible (with interposition of soft tissues, treatment only by surgery).

Habitual dislocations - constantly recurring after the primary dislocation in the joint (usually dislocation of the shoulder). The reason is gross damage to the joint capsule and ligamentous apparatus.

Congenital dislocation of the hip.

There are three forms of form:

1. Congenital hip dysplasia (pre-luxation) - the head of the femur is in the joint without centering.

2. Subluxation of the hip - the head of the femur remains in the joint, but its centering is disturbed - it is displaced outwards and upwards.

3. Dislocation of the hip - the head of the femur extends beyond the joint.

Diagnosis of congenital dislocation.

The child starts walking late.

With unilateral dislocation, lameness is noted, with bilateral dislocation - "duck gait".

Early symptoms:

Restriction of abduction in the hip joint - is determined when the child is positioned on the back by abducting the legs when bending at the knee and hip joints.

Normally, the possibility of abduction is 90 o, by 9 months it decreases to 50 o.

Click symptom (Marx-Ortolani) - when the legs are abducted, the dislocation is reduced, accompanied by a characteristic click (determined at the age of 1 to 3 months).

Asymmetry of skin folds is an indirect sign.

Limb deformity (shortening, external rotation, protrusion of the greater trochanter)

Conservative:

Therapeutic exercise, wide swaddling (in the position of abduction of the ribs). Continue for 4-5 months.

Use of special tyres.

Surgical treatment (with late diagnosis and ineffectiveness of conservative treatment).

Open reduction of dislocation, reconstructive surgery, joint arthroplasty.

Traumatic dislocations.

The most common shoulder dislocation (up to 50-60%)

Types of traumatic dislocations:

Open (in the presence of damage to the skin that communicates with the joint cavity);

Closed.

Mechanisms of injury:

Fall on an outstretched or bent limb;

Impact with a fixed limb;

Excessive muscle contraction.

Diagnostics.

history of trauma;

Pain syndrome;

Deformation in the joint area and change in the axis of the limb;

Forced position of the limb, change in length (more often - shortening);

Lack of active and severe limitation of passive movements in the joint;

- "spring fixation", when the limb, when trying to abduct, takes its original position.

Reduction of dislocation;

Immobilization;

Function restoration.

First aid:

Transport immobilization;

Anesthesia.

Dislocation reduction.

The reduction is performed by a traumatologist (usually together).

The reduction of dislocation of large joints is best done under anesthesia.

Shoulder dislocation reduction methods:

Hippocratic-Cooper method.

Kocher method.

Janelidze method.

Surgical treatment of dislocations. Indications for surgical treatment:

open dislocations;

Irreducible fresh dislocations (with interposition of soft tissues).

Old dislocations.

Habitual dislocations.

The task is to eliminate dislocation, strengthen the ligaments and joint capsule.

Immobilization and rehabilitation.

The duration of immobilization is 2-3 weeks. (first plaster bandages or splints, then a scarf bandage, etc.).

After 1-2 weeks. While maintaining soft immobilization, movements in the joint gradually begin, and a course of physiotherapy exercises is carried out. Complete cure occurs in 30-40 days, the possibility of full load in 2-3 months.

Fractures. Classification, clinical picture. Fracture diagnosis. First aid for fractures.

A fracture is a break in the integrity of a bone.

Classification.

1. By origin - congenital, acquired.

Congenital fractures are extremely rare (occur in the prenatal period). Fractures that occur during childbirth are acquired.

All acquired fractures are divided by origin into two groups - traumatic and pathological (causes: osteoporosis, malignant tumor metastases, tuberculosis, syringomyelia, osteomyelitis, syphilitic gumma, etc.).

2. According to the presence of damage to the skin - open (damaged skin and mucous membranes) and closed.

A separate group - gunshot fractures.

3. According to the place of application of force:

Direct - a fracture occurs at the place of application of force;

Indirect - a fracture occurs at a certain distance from the place of application of force.

4. Depending on the type of impact, fractures are divided into those caused by: flexion, twisting (rotation), compression (compression), impact (including gunshot), avulsion fractures.

5. According to the nature of bone damage, fractures can be complete and incomplete.

Incomplete fractures include fissures, a subperiosteal fracture in children of the "green branch" type, perforated, marginal, fractures of the base of the skull, fractures of the inner plate of the cranial vault.

6. In the direction of the fracture line, they are distinguished - transverse, oblique, longitudinal, comminuted, helical, compression, tear-off.

7. Depending on the presence of displacement of bone fragments, fractures can be without displacement and with displacement. There are displacements: in width, in length, at an angle, rotational.

8. Depending on the section of the damaged bone, fractures can be diaphyseal, metaphyseal and epiphyseal.

Metaphyseal fractures are often accompanied by adhesion of the peripheral and central fragments (compounded or impacted fractures). If the line of a bone fracture penetrates the joint, it is called intra-articular. In adolescents, sometimes there is a detachment of the epiphysis - epiphysiolysis.

9. By the number of fractures can be single and multiple.

10. According to the complexity of damage to the musculoskeletal system, simple and complex fractures are distinguished.

11. Depending on the development of complications, uncomplicated and complicated fractures are distinguished.

12. In the presence of a combination of fractures with injuries of a different nature, they speak of a combined injury or polytrauma.

Complications of fractures:

Traumatic shock;

Damage to internal organs;

vascular damage;

Fat embolism;

Interposition of soft tissues;

Wound infection, osteomyelitis, sepsis.

Types of displacement of fragments:

Length offset;

Lateral shift;

offset at an angle;

Rotational displacement.

Distinguish primary displacement - occurs at the time of injury;

Secondary - observed with incomplete comparison of fragments:

Mistakes in the tactics of fixing bone fragments;

Premature removal of skeletal traction;

Unreasonable premature changes of plaster casts;

The imposition of loose plaster bandages;

Premature loading on the injured limb;

Pathological changes in fractures can be divided into three stages:

1) damage caused by trauma;

2) formation of callus;

3) Restructuring of the bone structure.

Bone regeneration.

There are two types of regeneration:

Physiological (constant restructuring and renewal of bone tissue);

Reparative (aimed at restoring its anatomical integrity).

Phases of reparative regeneration.

1st phase - catabolism of tissue structures, proliferation of cellular elements.

2nd phase - formation and differentiation of tissue structures.

3rd - the formation of angiogenic bone structure (restructuring of bone tissue).

4th phase - complete restoration of the anatomical and physiological structure of the bone.

Types of callus.

There are 4 types of callus:

Periosteal (external);

Endostal (internal);

Intermediate;

Paraossal.

Types of union of fractures.

Union begins with the formation of periosteal and endosteal calluses, temporarily fixing fragments. Further fusion can be carried out in two ways.

Primary fusion. Conditions - the fragments are accurately compared and securely fixed, there is no need for the formation of a powerful bone callus.

Secondary fusion. Initially, the regenerate, represented by a pronounced callus, is replaced by cartilaginous tissue, and then by bone.

Fracture diagnosis.

Absolute symptoms of a fracture.

1. Characteristic deformation.

2. Pathological mobility.

3. Bone crepitus. (with the exception of impacted fractures, where these symptoms may not be present).

Relative symptoms of a fracture.

Pain syndrome, aggravated by movement, load along the axis;

Hematoma;

Shortening of the limb, its forced position (maybe with dislocation);

Function violation.

X-ray examination.

Fracture treatment. Conservative and operative methods of treatment. Compression-distraction method for the treatment of bone fractures. Principles of treatment of fractures with delayed consolidation of bone fragments. False joints.

Treatment methods:

1. Conservative treatment.

2. Skeletal traction.

3. Surgical treatment (osteosynthesis).

The main components of the treatment:

Reposition of bone fragments;

Immobilization;

Acceleration of the processes of formation of bone callus.

Reposition(reduction) of fragments - their installation in an anatomically correct position. Mixing discrepancy in width up to 1/3 of the diameter of the bone is allowed.

Reposition rules:

Anesthesia;

Comparison of the peripheral fragment in relation to the central one;

X-ray control after reposition.

Types of reposition:

Open, closed;

One-step, gradual;

Manual, hardware.

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

Despite the fact that in appearance a person who is in the clinical stage of dying already looks without obvious signs of life and at first glance he cannot be helped, in fact, emergency resuscitation can sometimes 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 reviving - you need to save him. This is where knowledge of how clinical death differs from irrevocable, biological death in terms of signs.

Dying stages

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

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

Remember! With a sudden death, the obligatoriness and sequence of the phases are erased, but the inherent signs are preserved.

Signs of the onset of clinical death

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

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

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

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

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

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

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

Signs of the onset of biological death

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

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

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

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

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

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

symptom of Beloglazov

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

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

Biological death alternately affects organs and systems, therefore it is also extended in time. The cells of the brain and its membranes are the first to die - it is this fact that makes further resuscitation inexpedient, since it will not be possible to return a person to a full life, although the rest of the tissues are still viable.

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

Resuscitation steps in observed clinical death

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

Competently carried out artificial respiration obeys the following algorithm.

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

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

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

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

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

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

biological death.

Early: " cat's eye", clouding and softening of the cornea, a symptom of "floating ice", soft eye.

Later: hypostatic spots, symmetrical face, marbling of the skin, rigor mortis 2-4 hours.

social death - death of the brain with preserved respiratory and cardiac activity (up to 6 hours of death of the cortex - brain death; true death - social).

Question Stages of Cardiopulmonary Resuscitation

Resuscitation is a set of measures aimed at temporarily replacing vital functions, restoring their management until complete recovery.

Indications for BSLR

clinical death.

Basic resuscitation.

Volume of BSLR:

1) We carry out the diagnosis of clinical death (loss of consciousness, dilated pupil, absence of Ps on the carotid artery, pale skin, no breathing)

2) Cardiac arrest can be different, it depends on the cause of clinical death. Distinguish between asystole and fibrillation (simultaneous contraction of individual muscle groups of the myocardium without a common systole)

3) Electromechanical dissociation. In which the impulse to contract the muscles penetrates into the heart, but the muscles do not respond (sinus node bundles of his, purkinje fibers)

Clinically, the type of cardiac arrest manifests itself in the same way. Heart massage during fibrillation is not very effective, so it is necessary to defebrel the heart. It can be mechanical - (precordial blow) a punch to the heart area. After diagnosing clinical death, the patient must be transferred to a hard surface, the clothes and belt should be unfastened with a jerk.

1) The blow is applied to the region of the lower third of the body of the sternum from a height of 20-30 cm double blow. We check the pulse. Precordial shock to children is not carried out!!

2) If there is no pulse, we proceed to a heart massage. Chest compression is performed with both hands. The bases of the palms are strictly on the lower third of the sternum. The arms are straightened. In adults, the chest is pressed 3-4 cm 80-100 compressions per minute. For 1 time, 30 compressions are performed.

If there are foreign bodies in the oral cavity, perform sonation of the oral cavity.

4) We start ventilation at the scene of the incident mouth to mouth. We close the nose, completely grasp the mouth and make a full long exhalation. 2 breaths.

Every 3-5 minutes check the pulse. When a pulse appears, IVL continues.

During resuscitation, the effectiveness of cardiac massage is checked. AND IVL

Massage: on the carotid artery, a pulsation synchronous with massage is determined. With mechanical ventilation, a clearly visible excursion of the chest.

Monitoring the effectiveness of resuscitation:

1) Independent pulse on the carotid artery

2) The pupil narrows

3) The skin turns pink

Effective resuscitation measures will be carried out until the restoration of cardiac activity or until the arrival of an ambulance. In case of ineffectiveness, the measures are held for 30 minutes.

Resuscitation is not carried out:

1. In persons with severe trauma incompatible with life

2. In persons with stage 4 malignant diseases

3. In persons with long-term chronic diseases in the stage of persistent decompensation

4. In persons with refusal of resuscitation

5. In persons in a state of biological death

Question Basic Rules for Performing Closed Heart Compression Precordial Strike First

The blow is applied to the region of the lower third sternum, 20-30 cm, the force is 70 kg, after the blow, we must watch the pulse (children are not done) if there is no pulse, heart massage is not done.

Compression of the chest is carried out with two hands of each other on the lower third of the sternum, the arms are straightened, the joint is not compressed. In adults, the chest is pressed 4-6 cm. Pressure 100-80 per minute

Massage is carried out 30 pressures

We throw back our heads

Safar triple reception, throw back the head and open the mouth and jaw protrusion, examine the oral cavity. We quickly carry out sanitation of the oral cavity. After sanitation proceeds to IVL.

At the scene of the accident

- mouth to mouth

-nose to mouth

Fully grasp the mouth tightly before these make an extended exhalation, 2 breaths away from the patient

Check heartbeat. The course of resuscitation is checked by the effectiveness of cardiac massage and the effectiveness of mechanical ventilation. On the carotid artery, synchronization with pulsation massage is determined

Question 6 Criteria for the effectiveness of cardiac massage

With proper ventilation on inspiration, chest excursion is visible

Monitoring the effectiveness of resuscitation

self pulsation

The pupil narrows, the skin of the face turns pink.

Question 7 Bleeding - the release of blood outside the vascular bed.

1) Injury to the vessel wall

2) Destruction of the vessel wall by the inflammatory process

3) Violation of the permeability of the vessel wall

4) Blood diseases

5) Violation of blood clotting

6) Congenital pathology of the vessel wall

7) Liver disease (ALD)

8) Drug bleeding (asperin)

Classification.

1) By the nature of the damaged vessel

Arterial

wine

capillary

Parenchymal

2) In connection with the external environment

outdoor

internal

3) By duration

Chronic

4) By the time of occurrence

Primary (after injury)

Secondary (early 2nd day, late)

5) By manifestations

Hidden

profuse

Distinguish

1) Single

2) Repeat

3) multiple

Signs of bleeding.

General: retardation, weakness, dizziness, noise in the ears, bears before the eyes, pale, cold, clammy sweat. Tachycardia, decrease in blood pressure, decrease in CVP (normal 100-120), shortness of breath, thirst, dry mouth, mouth, decrease in diuresis.

Local: hematoma, impaired consciousness, hemoptysis, DN hematemesis, tarry stools, peritonitis, hematuria, hemarthrosis.

Degrees of blood loss:

1) pulse 90-100 BP 100-120 HB 100-120

2) pulse110-120 Ad90-60 HB 80-100

3) pulse 140 BP 80 HB70-80

4) pulse 160 BP 60 HB less than 70

Question 8 Temporary stopping methods.

With arterial.

1) Finger pressure.

Temporal artery to the temporal bone above the tragus of the ear by 2 transverse fingers

Carotid artery to the transverse process of the 6th cervical vertebra at the lower edge of the wound between the anterior edge of the sternocleidomastoid muscle and the trachea.

Humerus to humerus at mid-shoulder.

The femur to the pubic bone of the pelvis at a point on the border between the inner and middle third of the inguinal fold.

2) Tourniquet for arterial bleeding above the wound, slaughter for 30 minutes. in the summer for an hour.

3) Maximum flexion of the limb in the joint

4) Tight tamponade of the wound

5) Clamping the vessel during transportation to the health facility

Venous bleeding.

1) pressing

2) Tight tomponade

3) Flexion at the joint

4) Clamp on vessel

5) Elevated position of the limb

6) Pressure bandage.

capillary

1) pressure bandage

2) Wound tomponade

3) Ice pack

internal bleeding

1) Rest of the sick

2) Bubble with forehead

3) Hemostatics (Vikasol 1% 1 ml dicenone 12.5% ​​1.2 ml i.v. m. Ca chloride copronic acid 20-40 ml)

Question 9 How to apply a tourniquet:

– a tourniquet is applied in case of damage to the large arteries of the limbs above the wound, so that it completely compresses the artery;

- a tourniquet is applied with a raised limb, placing a soft tissue under it (bandage, clothes, etc.), make several turns until the bleeding stops completely. The coils should lie close to each other so that folds of clothing do not fall between them. The ends of the tourniquet are securely fixed (tied or fastened with a chain and a hook). A properly tightened tourniquet should stop the bleeding and disappearance of the peripheral pulse;

- a note must be attached to the tourniquet indicating the time the tourniquet was applied;

- the tourniquet is applied for no more than 1.5–2 hours, and in the cold season, the duration of the tourniquet is reduced to 1 hour;

- if it is absolutely necessary for a longer stay of the tourniquet on the limb, it is loosened for 5-10 minutes (until the blood supply to the limb is restored), while finger pressing the damaged vessel during this time. Such a manipulation can be repeated several times, but at the same time, each time reducing the time between manipulations by 1.5-2 times compared to the previous one. The tourniquet must lie so that it is visible. The victim with a tourniquet applied is immediately sent to a medical facility for the final stop of bleeding.

Question 10

Types of terminal states:

1. predagonic state(dullness of consciousness, a sharp pallor of the skin with cyanosis, blood pressure is not determined, there is no pulse on the peripheral arteries, except for the carotid and femoral, breathing is frequent and shallow)

2. Agonic state(consciousness is absent, motor excitation is possible, pronounced cyanosis, the pulse is determined only on the carotid femoral arteries, severe respiratory disorders of the Cheyne-Stokes type)

3. clinical death from the moment of the last breath and cardiac arrest, it is manifested by a complete absence of signs of life: loss of consciousness, no pulse on the carotid and femoral arteries, heart sounds, respiratory movement of the chest, maximum pupil dilation with no reaction to light.

4. Period of clinical death last 5-7 minutes, followed by biological death, obvious signs of death are stiffness, a decrease in body temperature, the appearance of cadaveric spots

There is also social death(brain death) while maintaining cardiac and respiratory activity.

Biological or true death is an irreversible stop of physiological processes in tissues and cells. However, the possibilities of medical technology are constantly increasing, so this irreversible cessation of bodily functions implies the state of the art in medicine. Over time, the ability of doctors to resuscitate the dead increases, and the border of death is constantly moving into the future. There is also a large group of scientists, these are supporters of nanomedicine and cryonics, who argue that most of the people who are currently dying can be revived in the future if their brain structure is preserved in time.

Early symptoms of biological death include:

• to pressure, or other irritation,
• clouding of the cornea occurs
• drying triangles appear, called Larcher spots.

Even later, cadaveric spots can be found, which are located in sloping places of the body, after which rigor mortis begins, cadaveric relaxation and, finally, the highest stage of biological death - cadaveric decomposition. Rigor and decomposition most often begin in the upper extremities and muscles of the face. The time of appearance and duration of these symptoms are largely influenced by the initial background, humidity and temperature of the environment, as well as the causes that led to death or irreversible changes in the body.

Body and signs of biological death

However, the biological death of a particular person does not lead to the simultaneous biological death of all organs and tissues of the body. The lifetime of body tissues depends on their ability to survive hypoxia and anoxia, and this time and ability are different for different tissues. Worst of all tolerate anoxia brain tissue, which die first. The spinal cord and stem sections resist longer, they have a greater resistance to anoxia. The remaining tissues of the human body can resist deadly influences even more strongly. In particular, it persists for another one and a half to two hours after fixing biological death.

A number of organs, for example, the kidneys and liver, can “live” up to four hours, and the skin, muscle tissue and part of the tissues are quite viable up to five to six hours after biological death is declared. The most inert tissue is that which is viable for several more days. This property of organs and tissues of the body is used in organon transplantation. The sooner after the onset of biological death, organs are removed for transplantation, the more viable they are and the higher the probability of their successful engraftment in another organism.

clinical death

Biological death follows clinical death and there is the so-called "brain or social death", a similar diagnosis arose in medicine due to the successful development of resuscitation. In some cases, cases were recorded when, during resuscitation, it was possible to restore the function of the cardiovascular system in people who were in a state of clinical death for more than six minutes, but by this time irreversible changes in the brain had already occurred in these patients. Their breathing was supported by mechanical ventilation, but the death of the brain meant the death of the individual and the person turned into only a "cardiopulmonary" biological mechanism.