Agony presupposes the presence of a number of phases. How long does a person's agony last? Characteristic clinical picture

What is agony? In Russian, this word was borrowed from French in the early 19th century. It was previously used in the 16th century. What is the meaning of the word "agony"? It means "struggle", "final moments of life", "a state preceding death". The medical definition of agony as a state of the body was described in his writings by Hippocrates, who lived in 360 BC.

This article details how this condition comes and what its symptoms are.

medical interpretation

What is agony medical point vision? The last moment of life before irreversible death. There is such a thing as terminal state a person who can still be resuscitated. If it fails, agony ensues. In this case, clinical death turns into biological. Another name for agony is death.

In this state, a person's blood circulation is disturbed and breathing becomes very difficult, as a result, oxygen starvation, hypoxia occurs. The deterioration of blood flow leads to a slow work of the heart, in the future to its complete stop. The duration of the agony is determined by the factors that caused this process. They are different. Let's look at them now. Agony caused by some trauma acute illnesses, lasts a very short period of time, up to a few seconds.

In some cases, it can last up to several hours, even more rarely days, delivering terrible torment to a person.

signs

Depending on what caused this condition, the signs of agony can be very different. But there are also general indicators of what is happening in the body at these moments.

The main sign of an atonal state is the appearance of arrhythmia. A person's breathing becomes frequent, intermittent and superficial. Another manifestation of arrhythmia during agony is rare breathing, with prolonged wheezing. At the same time, the head of the dying person leans back, the mouth opens wide. He seems to be gasping for air. But in this state, he does not receive the required amount of air, as pulmonary edema appears.

There is a suppression of cardiac activity. This is the final moment in agony. In some cases, the heart rate accelerates, there is an increase blood pressure, a person regains consciousness for a very short period. In these few last seconds he can say more. This condition is an indicator that resuscitation will be useless.

Another sign of an agonal state is the failure of brain functions. The subcortex of the brain becomes the regulator of all systems. At these moments, the body works at a primitive level, this determines the state of breathing and heart function during the agony.

Other signs

Other signs of agony, depending on the causes that caused it:

Mechanical asphyxia, in simple terms, suffocation. In this case, there is a sharp jump in blood pressure with a simultaneous slowing of the heartbeat (bradycardia). In this case, the skin of the upper body becomes cyanotic, involuntary convulsions occur, the tongue falls out, involuntary emptying Bladder and rectum.
An agonal state in heart failure: blood pressure drops sharply, heart rhythm (tachycardia) is disturbed, the pulse weakens, the body becomes completely cyanotic, the face swells, death cramps occur.

State of agony

This state of a person lasts from a few seconds. In some cases, its duration reaches three or more hours. The predagonal state of a person can last up to several days. During this period, a person may fall into a coma. The transition from the preagonal state to agony is called the terminal pause. Its duration ranges from a few seconds to two to four minutes.

Sometimes during the agony, a person, fighting for life, regains consciousness. As described above, the control of body functions passes from the higher parts of the central nervous system to the secondary ones. At this point, the body is actively trying to maintain life by mobilizing the remaining forces. But this happens very short term followed by death.

First symptoms

How does the agony begin? The person's breathing changes. Becomes intermittent. As the brain shuts down, breathing becomes faster and the breaths become deeper. The agony doesn't last long. This is a short term process. At the end of the agony, breathing stops, then the turn of the heart, then the brain. The agony ends with a complete stop of the activity of the brain, breathing and heart.

clinical death

After the agony comes clinical death. So to speak, a "bridge" between life and death. Metabolic processes in the body are still functioning at a primitive level. Clinical death can be reversible. With timely medical intervention there is a chance to bring a person back to life. Resuscitation, carried out over the next 5-7 minutes, makes it possible to start the heart, thereby ensuring blood flow to the brain tissues. Brain tissues that do not receive oxygen from the bloodstream die within two to three minutes. If resuscitation fails, biological death occurs and the person dies. The pathologist fixes the time of death.

In some cases, death occurs instantly, without agony. This happens when receiving severe and extensive injuries of the skull, with instantaneous dismemberment of the body in disasters, with anaphylactic shock, for some cardiovascular diseases. A thrombus detached from the vessel wall can block a vein or artery. In this case, death occurs instantly. Also, a rupture of a vessel of the brain or heart can lead to rapid death.

medical term " imaginary death”- this is when a person has all the processes expressed so weakly that he is mistaken for dead. Respiration and heartbeat are not particularly pronounced. This happens with some types of diseases. At some points, it can be difficult to determine whether a person is dead or still alive. Only medical worker acknowledges death. A person in this condition needs to be given first aid as soon as possible. medical care to avoid clinical death.

So what is agony? This short-term process can be characterized as a struggle for life.

How to ease a person's agony

Modern medicine is able to alleviate human suffering with the help of medicines. Many patients, in order to avoid the death agony, agree to euthanasia. This issue is quite controversial and sensitive. Someone cannot give up moral principles; religion does not allow someone to do this. Such a choice is extremely difficult to make.

During agony, a person completely loses control over his own body. It is the fear of death throes that pushes people to such a decision. Taking it, a person must be in full consciousness.

Life after death

Many facts are known when people returned "from the next world." That is, they returned to life, suffering a clinical death.

Quite often, after such a life, people's lives change dramatically. Sometimes they acquire unusual abilities. For example, it can be clairvoyance. Also, sometimes there is an ability to treat various ailments.

The opinions of scientists differ in many respects, but some still believe that this is possible.

Conclusion

Now you know what agony is, what are its signs. We hope that this information was interesting and helpful.

Death cramps are almost always the last movements of a person.

Of course, knowing the causes of a phenomenon or the mechanism of its development will not help a person who is dying, but it can save others from misdiagnosing similar manifestations.

Human death cramps

We can safely say that the death throes of a person are one of the symptoms of agony. They are very short. Quite rarely, death cramps last more than five minutes. Most often, they disturb the dying for no more than 30 seconds.

During the course of convulsions, a sharp spasm of both smooth and skeletal muscles person. Therefore, he may have involuntary urination, defecation and other processes.

It is noticed that the death cramps of a person are not pronounced. Not everyone can notice them, since they are mostly internal in nature.

Thermal state, death cramps, agony

Almost every person goes through the following stages before death: thermal state, death cramps, agony. During the period of the thermal state, a person has confusion of consciousness and general lethargy. The pressure drops sharply. The pulse is almost imperceptible. The exception is the carotid artery, which can only be felt by a specialist. The skin is very pale. Sometimes it seems that a person is breathing very deeply and often. But this is a mistake. The number of breaths often does not exceed 10 times per minute. No matter how deep they may seem, the lungs have practically stopped working and the air simply stops circulating through the arteries.

In the period preceding the agony, there may be intense activity. It seems that a person is fighting with all his might for life. The remaining forces in it are activated. But this period is not long, as they quickly dry up and then there is a thermal pause. It is very different from the period of increased excitability, as it seems that breathing has completely stopped. The pupils are incredibly dilated and the reaction to light is completely absent. Heart activity also slows down.

The period of agony begins with short sighs. The main brain centers are switched off. Gradually, the main functions are transferred to duplicating ones. The heart rate can fully recover, and blood flow returns to normal. On the this moment all reserves are mobilized, so a person can regain consciousness. But, this is the last thing he does in life, since all the reserves of the currently available universal energy carrier have been completely cleaned up. Thermal state, death cramps, agony do not last long. The last stage is especially short, not exceeding one minute. After this, there is a complete shutdown of respiratory, brain and cardiac activity.

Cause of death cramps

We can say that the main cause of death cramps is not yet fully understood. But, due to the fact that the consciousness of a person is practically turned off, he ceases to control his body and reflexes. Paralysis of the sphincters occurs much earlier, therefore, under the influence of various spasms, death cramps appear. They are most characteristic of internal organs person. External manifestations not so characteristic and noticeable.

Death cramps are a vivid confirmation that life in a person is fading away and there are completely no opportunities to save him. After the agony, he will pass into a different state and will no longer feel the pain that accompanied recent times.

How does a person die

From a medical point of view, death is the cessation of biological and physiological processes of life. In medicine, thanatology deals with the study of this phenomenon. As a rule, death does not occur on its own, it is caused by some phenomena - illness, aging, murder and accident. After death, the body of a living being begins to decompose, irreversible processes occur.

For many centuries human death carried the imprint of something mystical. Death sometimes was and is beyond human perception, because it has the principle of unpredictability, unexpectedness and inevitability.

How people die

The answer to the question of how a person dies is not unambiguous. A person can die either in the course of processes occurring in the body, or by the will of an accident. In general, there are several types of death.

clinical death. It involves respiratory and cardiac arrest, however, with such a death, the biological body of a person can be restored within an hour.
biological death. Represents brain death, after this death a certificate is issued. In the course of this phenomenon, some cells of the body have died, and some are still living. The structure of connections between brain cells is also preserved, and it acts as the basis of a person's long-term memory. There is an assumption that in the future medicine will be able to bring a person out of biological death for several hours.
Information death. Assumes final death when information for resuscitation is completely lost.

We looked at the process of how people die. In addition, when a person dies, certain processes take place in his body. They are divided into several states.

Before the agony This condition is characterized by the performance of a reflex function by the body, which is aimed at “reducing torment”. This is because the biological body is damaged. This condition entails loss of consciousness and loss of sensitivity to pain. The preagonal state is characterized by a violation of the main functions of the central nervous system, this state is called coma. Breathing is disturbed, sometimes it becomes frequent and irregular. The duration of this condition can be very different, and in some diseases it is completely absent.
Agony. This condition is characterized by an attempt by the body to use the last possibilities for survival. At the beginning of this state, the heart rhythm is restored, breathing quickens, consciousness is restored to a short time. Due to the lack of oxygen in the tissues, incompletely oxidized products can accumulate. This condition lasts for 5 minutes, sometimes 30 minutes, then the blood pressure decreases, the heart stops beating, and breathing stops.
clinical death. This state begins from the moment the cardiac activity stops. If oxygen is completely absent in the tissues, the death of the cerebral cortex occurs, after which it is impossible to restore the body. The duration of this death starts from the time of cardiac arrest until the start of the resuscitation process. Duration under normal conditions - 5 minutes. However, duration is affected numerous factors in the form of age, state of health of the deceased, conditions of dying, and so on.
Diagnosis. When diagnosing, a number of checks are carried out aimed at the safety of breathing, heart functions, and the central nervous system.

So, why people die, there is no definite answer to the question, but any effect has its own reason.

Signs of approaching death

Of course, no one can predict the moment of death, but doctors who have dealt with seriously ill people indicate signs that characterize the approach of death. First of all, there is a loss of appetite, because the need for energy decreases. First of all, there is a rejection of meat, since a weakened body hardly digests this product. And subsequently, even the most beloved products do not cause former pleasure. You can also highlight the signs of approaching death:

Drowsiness and fatigue. A person begins to get tired even from walking around the house, he wants to sleep a lot, and it is very difficult to wake him up.
Weakness. A person feels weak very often, he simply does not have enough energy to perform even the most simple and familiar actions.
Disorientation. A person begins to orientate poorly, this is due to the fact that his brain suffers.
Hard breath. It becomes uneven.
The person will seem isolated, he may lose interest in what is happening around.
Excretory dysfunction.
Edema, venous spots.

If a person dies from an illness, it is not difficult for an experienced specialist to predict the onset of death. And even relatives and friends can notice that this moment is approaching.

How do people die of old age?

A very common question is how people die of old age. But it is worth noting that a person dies not from old age as such, but from diseases caused by it. After all, even a person with good health who dies of old age in his sleep is actually dying from some kind of illness. The fact is that our body is a kind of mechanism. Its cogs are the cells of our body, which are renewed quickly in youth, and slowly in old age. Every year there is a greater risk of certain diseases, because like any mechanism, the human body is subject to wear and tear, and the only question is when exactly the disease comes. And it depends on a number of factors such as the way of life of a person, the climate and environment in which he lives, and so on. Therefore, if in youth the body easily copes with even more serious diseases, then in old age this may not happen, and certain systems fail to work, leading to death. In addition, there is a list of deadly diseases that happen to a person only in old age.

What does a person feel before death?

This question is relevant, and no one can give an exact answer to it. Someone sees the light at the end of the tunnel and leaves their biological body with a smile, someone does not understand at all what is happening to him, and someone experiences panic fear before death. This is a purely individual question, so there is no definite answer.

Many scientists suggest that a person's feelings before death differ depending on how prepared he was for such an outcome. If a person dies from an accident, and this happens instantly, most likely, the person simply does not understand what happened to him. If he dies from a serious illness, which he learned about a year before his death, then he had time to “finish things” on earth and prepare for death. What a person feels before death is personal, and it is impossible to give an exact answer.

Facts about how a person dies

A person's feelings before death can be very different, and in this case, much depends on the cause of death. However, doctors have tried to describe the general complaints of a person before death, in a state of agony.

Chest pain. It becomes difficult for a person to breathe, so he experiences unbearable pain in the chest.
Dizziness. A person partially or completely loses consciousness, he cannot be responsible for his actions.
Fear. Fear appears in the brain, and despite the fact that the work of the brain at this moment seems to be passive, the feeling of fear is present.
Heat. Some people get hot, they feel like their whole body is on fire.

This is interesting: body functions that do not stop working after death

What do people die from most?

There is a general world statistics on the causes of human deaths. So more than 60% deaths falls on noncommunicable diseases. These are diseases such as cancer, ischemic disease heart and other heart diseases, diabetes, lung disease. The leaders of fatal diseases are numerous heart diseases, and recently not only the elderly, but also young people suffer from them.

23% of deaths are in infectious diseases, maternal, foodborne diseases. Only 9% of deaths are due to accidents.

So, we answered the question of what people die from, and there are many reasons for this.

More statistics

The statistics of deaths in the world and in individual countries has an indicator, the so-called mortality rate. It represents the number of deaths per certain period divided by the number of person-years. The highest mortality rate is observed in Third World countries, namely in Africa - Mozambique, Zambia, Zimbabwe, it ranges from 21-22. Moreover, most of the deaths are due to infectious diseases. Countries such as Jordan, the United Arab Emirates, Qatar have the lowest mortality rate, here the coefficient has a value of 2-3. The rate is calculated per 1000 people.

In Russia, about a million people die every year, according to statistics, 60% of them suffer from heart disease, cancer and respiratory diseases. The rest die from other diseases. Recently, mortality from cirrhosis of the liver has increased. The number of deaths in the northern regions of Russia is slightly higher than in the rest.

About 0 people die in the world every year, most of them have cancer, 18% die from smoking and alcohol abuse. Every day a person dies on the planet, in countries with high level economies, people over the age of 70 are dying, and younger age groups are dying in poorer countries. Only 10% of the dead die an unnatural death.

Conclusion

So, we can conclude how many people die every day and even every hour, and the causes of death are very different. In the future, some of the diseases can be prevented, but if a person himself does not monitor the quality of his life, then medicine is powerless.

Agony - what is it? Signs of agony

This article details how this condition comes and what its symptoms are.

medical interpretation

What is agony medically? The last moment of life before irreversible death. There is such a thing as a terminal state of a person, in which resuscitation is still possible. If it fails, agony ensues. In this case, clinical death turns into biological. Another name for agony is death.

In this state, a person's blood circulation is disturbed and breathing becomes very difficult, as a result, oxygen starvation, hypoxia occurs. The deterioration of blood flow leads to a slow work of the heart, in the future to its complete stop. The duration of the agony is determined by the factors that caused this process. They are different. Let's look at them now. The agony caused by some injuries, acute diseases, lasts a very short period of time, up to a few seconds.

In some cases, it can last up to several hours, even more rarely days, delivering terrible torment to a person.

signs

Depending on what caused this condition, the signs of agony can be very different. But there are also general indicators of what is happening in the body at these moments.

There is a suppression of cardiac activity. This is the final moment in agony. In some cases, the heart rate accelerates, blood pressure rises, the person regains consciousness for a very short period. In those last few seconds, he might say something else. This condition is an indicator that resuscitation will be useless.

Other signs

Other signs of agony, depending on the causes that caused it:

Mechanical asphyxia, in simple terms, suffocation. In this case, there is a sharp jump in blood pressure with a simultaneous slowing of the heartbeat (bradycardia). In this case, the skin of the upper body becomes cyanotic, involuntary convulsions occur, the tongue falls out, involuntary emptying of the bladder and rectum.
An agonal state in heart failure: blood pressure drops sharply, heart rhythm (tachycardia) is disturbed, the pulse weakens, the body becomes completely cyanotic, the face swells, death cramps occur.

State of agony

First symptoms

clinical death

After the agony comes clinical death. So to speak, a "bridge" between life and death. Metabolic processes in the body are still functioning at a primitive level. Clinical death can be reversible. With timely medical intervention, there is a chance to bring a person back to life. Resuscitation, carried out over the next 5-7 minutes, makes it possible to start the heart, thereby ensuring blood flow to the brain tissues. Brain tissues that do not receive oxygen from the bloodstream die within two to three minutes. If resuscitation fails, biological death occurs and the person dies. The pathologist fixes the time of death.

In some cases, death occurs instantly, without agony. This happens when severe and extensive injuries of the skull are received, with instantaneous dismemberment of the body in catastrophes, with anaphylactic shock, and with certain cardiovascular diseases. A thrombus detached from the vessel wall can block a vein or artery. In this case, death occurs instantly. Also, a rupture of a vessel of the brain or heart can lead to rapid death.

The medical term "imaginary death" is when a person's processes are so weakly expressed that he is mistaken for dead. Respiration and heartbeat are not particularly pronounced. This happens with some types of diseases. At some points, it can be difficult to determine whether a person is dead or still alive. Only a medical officer certifies death. A person in this condition needs first aid as soon as possible in order to avoid clinical death.

So what is agony? This short-term process can be characterized as a struggle for life.

How to ease a person's agony

Modern medicine is able to alleviate human suffering with the help of medicines. Many patients, in order to avoid the death agony, agree to euthanasia. This issue is quite controversial and sensitive. Someone can't give up moral principles, someone does not allow religion. Such a choice is extremely difficult to make.

During agony, a person completely loses control over his own body. It is the fear of death throes that pushes people to such a decision. Taking it, a person must be in full consciousness.

Life after death

Many facts are known when people returned "from the next world." That is, they returned to life, suffering a clinical death.

The opinions of scientists differ in many respects, but some still believe that this is possible.

Conclusion

Now you know what agony is, what are its signs. We hope that this information was interesting and useful to you.

Signs of approaching death

If you are dying or caring for a dying person, you may have questions about how the process of dying will be physically and emotionally. The following information will help you answer some questions.

Signs of approaching death

The process of dying is as diverse (individual) as the process of birth. Impossible to predict exact time death, and how the person will die. But people who are on the verge of death experience a lot similar symptoms regardless of the type of disease.

As death approaches, a person may experience some physical and emotional changes, such as:

A dying person may experience other symptoms, depending on the disease. Talk to your doctor about what to expect. You can also contact the Terminally Ill Assistance Program, where they will answer all your questions regarding the process of dying. The more you and your loved ones know, the more prepared you will be for this moment.

As death approaches, a person sleeps more, and it becomes more and more difficult to wake up. The periods of wakefulness become shorter and shorter.

As death approaches, the people who care for you will notice that you are unresponsive and that you are in a very deep sleep. This state is called a coma. If you are in a coma, then you will be tied to the bed, and all your physiological needs(bathing, turning, eating and urinating) will need to be controlled by someone else.

General weakness is a very common phenomenon with the approach of death. It is normal for a person to need help with walking, bathing, and going to the toilet. Over time, you may need help to roll over in bed. medical equipment such as wheelchairs, walkers or hospital bed can be very helpful during this period. This equipment can be rented from a hospital or terminally ill center.

With the approach of death periods rapid breathing may be interspersed with periods of restlessness.

Your breath may become wet and stagnant. This is called "death rattle". Changes in breathing usually happen when you are weak, and normal discharge from your respiratory tract and the lungs cannot come out.

Although noisy breathing may be a signal to your loved ones, you will most likely not feel pain and notice congestion. Since the fluid is deep in the lungs, it is difficult to remove it from there. Your doctor may prescribe oral tablets(atropines) or patches (scopolamine) to relieve congestion.

Your loved ones may turn you on the other side so that the discharge comes out of the mouth. They can also wipe these secretions with a damp cloth or special swabs (you can ask at the help center for the terminally ill or buy them at pharmacies).

Your doctor may prescribe oxygen therapy to help relieve your shortness of breath. Oxygen therapy will make you feel better, but will not prolong your life.

Visual impairment is very common in the last weeks of life. You may notice that you have trouble seeing. You may see or hear things that no one else notices (hallucinations). visual hallucinations- a common occurrence before death.

If you are caring for a dying person who is hallucinating, you need to cheer him up. Recognize what the person sees. Denial of hallucinations can upset the dying person. Talk to the person, even if he or she is in a coma. It is known that dying people can hear even when they are in a deep coma. People who came out of a coma said that they could hear all the time while they were in a coma.

Hallucinations are the perception of something that is not really there. Hallucinations can involve all of the senses: hearing, sight, smell, taste, or touch.

The most common hallucinations are visual and auditory. For example, a person may hear voices or see objects that the other person cannot see.

Other types of hallucinations include gustatory, olfactory, and tactile hallucinations.

Treatment for hallucinations depends on their cause.

As death approaches, you are likely to eat and drink less. This is due to a general feeling of weakness and a slower metabolism.

Since nutrition is so important in society, it will be difficult for your family and friends to watch you not eat anything. However, metabolic changes mean you don't need the same amount of food and fluids as you used to.

You can eat small meals and liquids while you are active and able to swallow. If swallowing is a problem for you, thirst can be prevented by moistening your mouth with a damp cloth or a special swab (available at a pharmacy) dipped in water.

Often the kidneys gradually stop producing urine as death approaches. As a result, your urine turns dark brown or dark red. This is due to the inability of the kidneys to properly filter urine. As a result, urine becomes very concentrated. Also, its number is decreasing.

As appetite decreases, some changes also occur in the intestines. The stool becomes harder and more difficult to pass (constipation) as the person takes in less fluid and becomes weaker.

You should tell your doctor if you have bowel movements less than once every three days, or if bowel movements are uncomfortable. Stool softeners may be recommended to prevent constipation. You can also use an enema to cleanse the colon.

As you become more and more weak, it is natural that you find it difficult to control your bladder and bowels. Your bladder may be placed urinary catheter as a means of prolonged drainage of urine. The terminally ill program can also provide toilet paper or underwear (these can also be purchased at a pharmacy).

As death approaches, the part of the brain responsible for regulating body temperature begins to malfunction. You may have heat and in a minute you will be cold. Your hands and feet may feel very cold to the touch and may even turn pale and blotchy. Changes in skin color are called patchy skin lesions and are very common in last days or hours of life.

Your caregiver can control your temperature by wiping your skin with a damp, slightly warm washcloth or by giving you medications such as:

Many of these medicines are available in the form rectal suppository if you have difficulty swallowing.

Just as your body prepares physically for death, you must also prepare emotionally and mentally for it.

With the approach of death, you may lose interest in the world around you and individual details. Everyday life, such as date or time. You can close in on yourself and communicate less with people. You may want to communicate with only a few people. This introspection can be a way of saying goodbye to everything you knew.

In the days leading up to death, you may enter a state of unique conscious awareness and communication that may be misinterpreted by your loved ones. You can say that you need to go somewhere - "go home" or "go somewhere". The meaning of such conversations is unknown, but some people think that such conversations help prepare for death.

Events from your recent past can mix with distant events. You can remember very old events in great detail, but not remember what happened an hour ago.

You can think of people who have already died. You may say that you have heard or seen someone who has already died. Your loved ones can hear you talking to the deceased person.

If you are caring for a dying person, you may be upset or frightened by this. strange behavior. You may want to bring your loved one back to reality. If this kind of communication is bothering you, talk to your doctor to better understand what's going on. Your close person may fall into a state of psychosis, and it may be scary for you to watch it. Psychosis occurs in many people before death. It may have a single cause or be the result of several factors. Reasons may include:

Symptoms may include:

Sometimes delirium tremens can be prevented with alternative medicine, such as relaxation and breathing techniques, and other methods that reduce the need for sedatives.

Palliative care can help you relieve the physical symptoms associated with your condition, such as nausea or difficulty breathing. Control of pain and other symptoms is important part your treatment and improve your quality of life.

How often a person feels pain depends on their condition. Some deadly diseases, such as bone cancer or pancreatic cancer, can be accompanied by severe physical pain.

A person can be so afraid of pain and others physical symptoms that he may be thinking of committing suicide with the assistance of a doctor. But death pain can be effectively dealt with. You should tell your doctor and loved ones about any pain. There are many medications and alternative methods (such as massage) that can help you deal with the pain of death. Be sure to ask for help. Ask a loved one to report your pain to the doctor if you are unable to do so yourself.

You may want your family not to see you suffer. But it is very important to tell them about your pain, if you cannot stand it, so that they immediately consult a doctor.

Spirituality means a person's awareness of the purpose and meaning of his life. It also denotes the relationship of a person with higher powers or the energy that gives meaning to life.

Some people don't often think about spirituality. For others, it's part of everyday life. As you approach the end of your life, you may be faced with your own spiritual questions and challenges. Being associated with religion often helps some people achieve comfort before death. Other people find solace in nature, in social work, strengthening relationships with loved ones or in creating new relationships. Think of things that can give you peace and support. What questions concern you? Seek support from friends, family, relevant programs, and spiritual guides.

Caring for a dying relative

Physician-assisted suicide refers to the practice of medical assistance to a person who voluntarily wishes to die. This is usually done by prescribing a lethal dose of medication. Although the doctor is indirectly involved in the death of a person, he is not a direct cause of it. Oregon is currently the only state to legalize physician-assisted suicide.

A person with a terminal illness may consider suicide with the assistance of a doctor. Among the factors that can cause such a decision are severe pain, depression and fear of dependence on other people. A dying person may consider himself a burden for his loved ones and not understand that his relatives want to provide him with their help, as an expression of love and sympathy.

Often a person with a terminal illness contemplates physician-assisted suicide when their physical or emotional symptoms don't get effective treatment. Symptoms associated with the dying process (such as pain, depression, or nausea) can be controlled. Talk to your doctor and family about your symptoms, especially if these symptoms bother you so much that you think about death.

Pain and symptom control at the end of life

At the end of life, pain and other symptoms can be effectively managed. Talk to your doctor and loved ones about the symptoms you are experiencing. The family is an important link between you and your doctor. If you yourself cannot communicate with the doctor, your loved one can do this for you. There is always something you can do to ease your pain and symptoms so that you feel comfortable.

There are many pain relievers available. Your doctor will choose the easiest and most non-traumatic drug for pain relief. Usually applied first oral preparations because they are easier to take and less expensive. If you don't have sharp pain Painkillers can be bought without a doctor's prescription. These are drugs such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. It is important to stay ahead of your pain and take your medications on schedule. Irregular use of medications is often the cause of ineffective treatment.

Sometimes pain cannot be controlled with over-the-counter medications. In this case, more effective forms treatment. The doctor may prescribe pain medications such as codeine, morphine, or fentanyl. These drugs can be combined with others, such as antidepressants, to help you get rid of the pain.

If you cannot take pills, there are other forms of treatment. If you have trouble swallowing, you can use liquid medicines. Also, drugs can be in the form of:

Many people who suffer from severe pain fear that they will become addicted to pain medications. However, addiction rarely occurs in terminally ill people. If your condition improves, you can slowly stop taking the medicine so that dependence does not develop.

Painkillers can be used to manage the pain and help keep it tolerable. But sometimes painkillers cause drowsiness. You can only accept a small amount of medicines and, accordingly, endure a little pain to stay active. On the other hand, maybe weakness doesn't matter to you of great importance and you are not disturbed by drowsiness caused by certain medications.

The main thing is to take medicines on a certain schedule, and not just when the need arises. But even if you take medication regularly, sometimes you may feel severe pain. This is called "pain breakouts". Talk to your doctor about what medications should be on hand to help manage breakouts. And always tell your doctor if you stop taking a medicine. Sudden termination may cause serious side effects and severe pain. Talk to your doctor about ways to manage pain without medication. Alternative medical therapy may help some people relax and relieve pain. You can combine traditional treatment With alternative methods, such as:

For more information, see the Chronic Pain section.

During the period when you are learning to cope with your illness, short-term emotional stress is normal. Non-depression that lasts more than 2 weeks is no longer normal and should be reported to your doctor. Depression can be cured even if you have fatal disease. Antidepressants combined with psychological counseling will help you cope with emotional distress.

Talk to your doctor and family about your emotional stress. Although grief is a natural part of the process of dying, it does not mean that you have to endure serious emotional pain. Emotional suffering can intensify physical pain. They can also reflect badly on your relationships with loved ones and prevent you from saying goodbye to them properly.

As death approaches, you may experience other symptoms as well. Talk to your doctor about any symptoms you may have. Symptoms such as nausea, fatigue, constipation or shortness of breath can be managed with medication, special diets and oxygen therapy. Have a friend or family member describe all of your symptoms to a doctor or terminally ill worker. It is helpful to keep a journal and write down all your symptoms there.

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This article details how this condition comes and what its symptoms are.

medical interpretation

In this state, a person's blood circulation is disturbed and breathing becomes very difficult, as a result, oxygen starvation, hypoxia occurs. The deterioration of blood flow leads to a slow work of the heart, in the future to its complete stop. The duration of the agony is determined by the factors that caused this process. They are different. Let's look at them now. The agony caused by some injuries, acute diseases, lasts a very short period of time, up to a few seconds.

In some cases, it can last up to several hours, even more rarely days, delivering terrible torment to a person.

signs

Depending on what caused this condition, the signs of agony can be very different. But there are also general indicators of what is happening in the body at these moments.

Other signs

Other signs of agony, depending on the causes that caused it:

Mechanical asphyxia, in simple terms, suffocation. In this case, there is a sharp jump in blood pressure with a simultaneous slowing of the heartbeat (bradycardia). In this case, the skin of the upper body becomes cyanotic, involuntary convulsions occur, the tongue falls out, involuntary emptying of the bladder and rectum.
An agonal state in heart failure: blood pressure drops sharply, heart rhythm (tachycardia) is disturbed, the pulse weakens, the body becomes completely cyanotic, the face swells, death cramps occur.

State of agony

First symptoms

clinical death

After the agony comes clinical death. So to speak, a "bridge" between life and death. Metabolic processes in the body are still functioning at a primitive level. Clinical death can be reversible. With timely medical intervention, there is a chance to bring a person back to life. Resuscitation, carried out over the next 5-7 minutes, makes it possible to start the heart, thereby ensuring blood flow to the brain tissues. Brain tissues that do not receive oxygen from the bloodstream die within two to three minutes. If resuscitation fails, biological death occurs and the person dies. The pathologist fixes the time of death.

So what is agony? This short-term process can be characterized as a struggle for life.

How to ease a person's agony

During agony, a person completely loses control over his own body. It is the fear of death throes that pushes people to such a decision. Taking it, a person must be in full consciousness.

Life after death

Many facts are known when people returned "from the next world." That is, they returned to life, suffering a clinical death.

The opinions of scientists differ in many respects, but some still believe that this is possible.

Conclusion

Now you know what agony is, what are its signs. We hope that this information was interesting and useful to you.

The last stage of dying is called agony. The agonal state is characterized by the fact that compensatory mechanisms begin to work actively. This is a struggle with the extinction of the last vitality of the body.

Irreversible changes in brain tissues that begin due to hypoxia and changes acid-base balance are called terminal states. They are characterized by the fact that the functions of the body fade away, but this does not happen all at once, but gradually. Therefore, in some cases, doctors can restore them with the help of resuscitation.

The terminal states include the following:

severe shock (we are talking about a state of shock of the IV degree);
coma of the IV degree (it is also called transcendental);
collapse;
preagony;
termination respiratory movements– terminal pause;
agony;
clinical death.

Agony as a stage of the terminal state is characterized by the fact that the patient's vital functions are inhibited, although he can still be helped. But this can be done in cases where the body has not yet exhausted its capabilities. For example, it is possible to restore vitality if death occurs as a result of blood loss, shock or asphyxia.

All diseases are classified according to the ICD. The agonal state is referred to as R57. This is a shock that is not defined in other rubrics. Under this code, the ICD defines a number of thermal states, including preagony, agony, and clinical death.

Problems begin with disruption of the central nervous system. The patient falls into an unconscious state. In some cases, consciousness is preserved, but it is confused. At the same time, blood pressure drops significantly - it can drop below 60 mm Hg. Art. In parallel with this, the pulse quickens, it becomes threadlike. You can feel it only on the femoral and carotid arteries, on peripheral it is absent.

Breathing in a state of preagony is superficial, it is difficult. The skin of the patient turns pale. The agonal state can begin immediately after the end of this period or after the so-called thermal pause.

The duration of this period directly depends on the reasons that caused the onset of the specified period. pathological process. If the patient had a sudden cardiac arrest, then this period is practically absent. But blood loss, respiratory failure, traumatic shock can cause the development of a pre-agonal state, which will last for several hours.

The preagonal and agonal states are not always inseparable. For example, with blood loss, in most cases there is a so-called transitional period - a terminal pause. It can last from 5 seconds to 4 minutes. It is characterized by a sudden cessation of breathing. Bradycardia begins. This is a condition in which the heart rate decreases markedly, in some cases asystole occurs. It's called cardiac arrest. Pupils stop responding to light, they dilate, reflexes disappear.

In this condition, the electroencephalogram disappears bio electrical activity, ectopic impulses appear on it. During the terminal pause, glycolytic processes are intensified, and oxidative processes are inhibited.

Due to a sharp lack of oxygen, which occurs during a state of pre-agony and terminal pause, all body functions are inhibited. Its main symptom is respiratory failure.

The agonal state is characterized by the absence pain sensitivity, extinction of the main reflexes (pupillary, skin, tendon, corneal). Ultimately, the activity of the heart also stops. This process may differ depending on what caused the death.

With different types of death, the duration of the agony can vary significantly. For example, traumatic shock or blood loss leads to the fact that the last stage of dying can last from 2 to 20 minutes. With mechanical asphyxia (suffocation), it will be no more than 10 minutes. In cardiac arrest, agonal breathing can persist for up to 10 minutes even after circulation has stopped.

The longest agony is observed at death resulting from prolonged intoxication. It can be with peritonitis, sepsis, cancer cachexia. As a rule, in these cases there is no terminal pause. And the agony itself can last for several hours. In some cases, it lasts up to three days.

At the initial pores, many brain structures are activated. The patient's pupils dilate, the pulse may increase, motor excitation may appear. Vasospasm can lead to an increase in blood pressure. If this state lasts for a long time, then hypoxia intensifies. As a result, the subcortical structures of the brain are activated - and this leads to an increase in the excitation of the dying. This is manifested by convulsions, involuntary emptying of the intestines and bladder.

In parallel, the agonal state of the patient is characterized by the fact that the volume of blood in the veins decreases, which returns to the heart muscle. This situation arises due to the fact that the total volume of blood is distributed through the peripheral vessels. This interferes with normal pressure measurements. The pulse can be felt in the carotid arteries, heart sounds are not audible.

It can become weak with small amplitude movements. But sometimes patients sharply inhale and exhale. They can make from 2 to 6 such respiratory movements per minute. Before dying, the muscles of the entire torso and neck are involved in the process. Outwardly, it seems that such breathing is very effective. After all, the patient inhales full chest and completely releases all the air. But in fact, such breathing in an agonal state allows very little ventilation of the lungs. The air volume does not exceed 15% of normal.

Unconsciously, with each breath, the patient throws his head back, his mouth opens wide. From the side it looks like he is trying to swallow maximum amount air.

But the agonal state is accompanied by terminal pulmonary edema. This is due to the fact that the patient is in a state of acute hypoxia, in which the permeability of the capillary walls is increased. In addition, the rate of blood circulation in the lungs significantly decreases, and microcirculation processes are disturbed.

Knowing that all diseases are determined by international classification diseases (ICD), many people are interested in the code of agonal states. They are listed under section R00-R99. Here are collected all the symptoms and signs, as well as deviations from the norm, which are not included in other headings. In the subgroup R50-R69 are common features and symptoms.

R57 includes all types of shocks not classified elsewhere. Among them are thermal states. But it is worth noting separately, if death occurs from any other causes, then there are separate types of classification for this. R57 includes sudden stop blood circulation and respiration, which occurred under the influence of external or internal factors. In this case, clinical death will also apply to this section.

Therefore, it is necessary to understand the reasons due to which the agonal state developed. ICD 10 suggests that it is important to determine blood pressure to determine thermal signs. If it is above 70 mm Hg. Art., then the vital organs are in relative safety. But when it falls below the level of 50 mm Hg. Art. the processes of dying off begin, the heart muscle and brain suffer first of all.

Medical classification allows you to accurately determine the signs by which a thermal and agonal state is diagnosed. The ICD 10 R57 code indicates that the following symptoms are observed:

general lethargy;
disturbance of consciousness;
pressure drop below 50 mm Hg. Art.;
the appearance of severe shortness of breath;
absence of a pulse in the peripheral arteries.

Other clinical signs of agony are also noted. They are followed by signs of clinical death. It belongs to the same section as the agonal state. The ICD R57 code defines all the symptoms that a doctor needs to know in order to determine the extinction of life.

Primary symptoms occur within 10 seconds from the moment of circulatory arrest. The patient loses consciousness, his pulse disappears even on the main arteries, convulsions begin.

Secondary signs may begin in the period of 20-60 seconds:

pupils stop responding to light;
breathing stops;
the skin of the face is painted in an earthy gray color;
muscles relax, including sphincters.

As a result, involuntary processes of defecation and urination may begin.

You should know that thermal states, which include agony and the final stage - clinical death, are considered reversible. The body can be helped to overcome this state if it has not yet exhausted all its functionality. For example, this can be done when dying from asphyxia, blood loss or traumatic shock.

Resuscitation methods include chest compressions and artificial respiration. The person who provides such assistance can be misled by the patient's independent respiratory movements and signs of irregular heart activity. It is necessary to continue to do resuscitation measures until the person is removed from the state of agony until the condition is completely stabilized.

If these measures are not enough, then muscle relaxants can be used and tracheal intubation can be performed. If this is not possible, then do artificial ventilation lungs from mouth to nose or mouth. In cases where thermal pulmonary edema has already begun, intubation is indispensable.

In some cases, against the background of an indirect heart massage, the agonal state continues. Its signs are ventricular fibrillation of this organ. In this case, an electric defibrillator must be used. It is also important to carry out intra-arterial transfusion of blood and the necessary plasma-replacing fluids if dying occurs as a result of blood loss, traumatic shock.

Thanks to timely and complete measures taken to restore the patient's life, it is often possible to eliminate the agonal state. After that, the patient needs long-term observation and intensive care. The need for these measures remains even if the cause that caused the indicated thermal state was quickly eliminated. After all, the body of such a patient is prone to repeating the development of agony.

It is important to fully eliminate hypoxia, circulatory disorders and metabolic disorders. Need to be prevented possible development septic and purulent complications. Ventilation and transfusion therapy should continue until all signs are resolved. respiratory failure, and the volume of circulating blood will not return to normal.

Our smaller brothers also have situations when they are on the border between life and death. The agonal state of the animal clinical signs does not differ much from what happens in a similar situation with a person.

Experiments conducted on rats showed that after their heart stopped, brain activity increased by 30 seconds. At the same time, high-frequency waves emanating from it became more frequent, neurotransmitters were released. This was established by evaluating brain activity using an electroencephalograph and an electrocardiograph. Death in rats occurred as a result of suffocation.

By the way, scientists explain the visions that people who have experienced clinical death love to talk about with such brain activity. They explain this as just a feverish activity of this organ.

Predagonal state

The predagonal state is the stage of the dying of the organism, which is characterized by the development of disturbances in the activity of the central nervous system, blood circulation, and respiratory disorders. The patient is inhibited or is in a coma, the electrical activity of the brain and reflexes are depressed. Arterial pressure is sharply reduced (70-60 mm Hg. Art.) or is not determined. At the beginning, the pulse is weak and frequent, then bradycardia develops. Disorders of the peripheral circulation are manifested by the appearance of cyanosis, pallor or spotting of the skin. Respiration in the initial period is frequent and superficial, then bradypnea is noted. As a result of impaired breathing and hemodynamics, oxygen starvation increases. The duration of the preagonal state may be different and depends on the cause of death. So, with the sudden onset of ventricular fibrillation, the pre-agonal state is absent, and when dying from blood loss, due to the inclusion compensatory mechanisms, it can take several hours.

agonal state

The agonal state is the stage of dying preceding death, which is the last outbreak of the body's vital activity. The transitional period from the preagonal to the agonal state is the terminal pause. It is characterized by the appearance of a pause in breathing and a sharp slowdown in the pulse, up to a temporary stop of cardiac activity. The duration of the terminal pause is 2-4 minutes. After it develops clinical picture agony.

In the agonal stage, the higher parts of the central nervous system are switched off. Regulation vital functions begins to be carried out by the bulbar and some spinal centers, whose activity is aimed at mobilizing the last possibilities of the organism to survive. However, the fight against death is no longer effective, since the above centers cannot provide normal functioning vital organs. Dysfunction of the central nervous system and cause the development of the clinical picture of agony.

After the end of the terminal pause, a series of short and shallow breaths appears. Gradually, the depth of respiratory movements increases. Breathing is provided by muscle contraction chest, neck and has a pathological character (respiration of Kussmaul, Biott, Cheyne-Stokes). As a result of the simultaneous contraction of the muscles that provide both inhalation and exhalation, the respiratory act is disturbed, and ventilation of the lungs almost completely stops.

Against the background of the appearance of respiratory movements after the terminal pause, the sinus rhythm, a pulse appears on large arteries, blood pressure rises.

Thanks to these changes in breathing and cardiac activity, conditioned reflex activity and even consciousness can be restored in the agonal stage. However, the outbreak of vital activity is short-lived and ends with complete suppression of vital functions. Breathing and cardiac activity cease, clinical death occurs.

The concept of the terminal state, its stages and characteristics

The terminal state is the final state of the extinction of the functions of organs and tissues, which precedes clinical and biological death. It includes a peredagonal state, agony and clinical death. According to experts, the term "terminal state" includes severe forms of shock, collapse, transagonal state, terminal pause, agony and clinical death. characteristic feature that combines these processes into a terminal state is a rapidly growing hypoxia (oxygen starvation of all tissues and organs) with the development of acidosis (blood souring) due to the accumulation of non-oxidized metabolic products.

In the peredagonal state, various pronounced disorders of hemodynamics () and respiration occur, which lead to the development of tissue hypoxia and acidosis. The duration of the peredagonal state can be different, it basically leads to the duration of the entire period of dying.

The main symptoms of the peredagonal state: lethargy, dizziness, pallor of the skin, cyanosis of the face, the corneal reflex is preserved, breathing is weakened, there is no pulse on the peripheral arteries, but it can be felt on the carotid arteries (filamentous), blood pressure is not determined. After the peredagonal state, a terminal pause occurs, which is most clearly expressed when dying from bleeding. The latter is characterized by the absence of reflexes, short-term cessation of breathing, cardiac activity and bioelectrical activity of the brain. In this state, the patient may look like a corpse. The duration of the pause ranges from 5–10 s to 3–4 min. A characteristic feature is the deep inhibition of the cerebral cortex, the reaction of the pupils to light disappears in the victim, they expand. The agony (struggle) begins - the last outbreak of the body's struggle for life, which lasts from several minutes to half an hour or more (sometimes for hours and even for several days).

In the atonal period, the higher functions of the brain are excluded, consciousness is lost and can only be restored for a short time. At the same time, the activity of the centers of the medulla oblongata is noted, which is accompanied by a short-term increase in the function of respiration and blood circulation.

A sign of agony after the terminal pause is the appearance of the first breath. Agonal breathing differs sharply from the usual one - all respiratory, including auxiliary muscles (muscles of the neck and mouth) participate in the act of inhalation.

The heartbeat during the period of agony accelerates somewhat , the level of blood pressure can rise to 30-40 mm Hg. , and naturally does not provide normal functioning of the brain. There are peculiar changes in blood circulation: the arteries of the heart and the arteries that carry blood to the brain expand, and peripheral vessels and the vessels of the internal organs are sharply narrowed. So, the fading forces of the heart are directed mainly to maintaining the vital activity of the heart itself.

Usually, at the end of the agony, the breathing stops first, and the heart activity continues for a while. Primary cardiac arrest is less common. With the cessation of heart contractions and breathing, a state of so-called clinical death sets in, which is a kind of transitional state between life and death. At this stage, the organism as a whole no longer lives, but the vital activity individual bodies and tissues are preserved, irreversible changes in them have not yet occurred. Therefore, if immediately to a person who is in state of clinical death, provide medical assistance, sometimes it is possible to bring her back to life. The period of clinical death is characterized by deep oppression, which extends to medulla, stopping blood circulation and respiration and maintaining a minimum level of metabolic processes in the tissues of the body. The duration of clinical death is determined by the survival time of the cerebral cortex in the absence of blood circulation and respiration. On average, this time is 5-6 minutes. It increases if death occurs at a low temperature in young, physically healthy people. Many factors influence the duration of clinical death: the period of dying, the presence of a severe debilitating disease, age, etc.

The main symptoms of clinical death are as follows: lack of breathing, heartbeat, pulse on the carotid arteries, the pupils are dilated and do not react to light.

It is often difficult even for a doctor to determine the fact of death in the first moments, minutes, and sometimes even hours. In some cases, vital processes, in particular respiration and blood circulation, can occur within such insignificant limits that it is difficult to determine with the help of our senses whether a person is breathing or not, whether there are heartbeats or they are absent. Such a deep extinction of respiration and circulation occurs in diseases and certain types of diseases. external influence, such as electric shock, sunlight and thermal shock, drowning, poisoning with drugs and sleeping pills, with diseases of the central nervous system (epilepsy, encephalitis), in premature babies. This phenomenon is called imaginary, apparent death.

Imaginary death - this is a state of a person when the main functions of the body are expressed so weakly that they are not noticeable to the observer, therefore a living person gives the impression of a dead one. Only a careful examination allows you to establish signs of life. At the slightest suspicion of apparent death, first aid measures should be taken immediately and, if necessary, referred to the nearest hospital. In order to avoid erroneous ascertainment of death, the bodies of persons who died in the hospital are sent to the pathoanatomical department no earlier than two hours after the ascertainment of death, i.e. after the appearance of early cadaveric changes.

If breathing is absent for 5-6 minutes, then first in the cells of the cortex, and then in less sensitive to oxygen starvation brain regions and cells of other organs, processes of disintegration of the protoplasm of cell nuclei begin, which leads to irreversible phenomena, i.e. biological death — the final stage of the individual existence of any living system. In different tissues and organs, irreversible changes develop simultaneously. Most often they occur in the cerebral cortex. This moment, when the integrating activity of the central nervous system is disturbed, should be considered the beginning of biological death. The vital activity of other organs and tissues, including the brain stem, can still be restored.

Given the above, we can conclude that from the moment when it is not possible to establish a heartbeat, until at least one of the absolute signs of death appears, a person can be in a state of sharp depression of vital functions. It is impossible to exclude the possibility of such a state in such cases, and therefore during this period, which is called imaginary, relative or clinical death(It would be more correct to say - minimum life), regardless of its duration, measures must necessarily be taken to return given organism vital functions. To ascertain death, the so-called indicative (probable) and reliable (absolute) signs of death are used. Indicative signs include: immovable, passive position of the body, pallor of the skin, lack of consciousness, respiration, pulse and heartbeat, lack of sensitivity to pain, thermal irritations, lack of a corneal reflex, pupillary reaction to light.

It is not always easy to recognize real death by probable signs, if a little time has passed since death. Therefore, in doubtful cases in the presence of only indicative signs of death (immovable, passive position of the body, pallor of the skin, lack of consciousness, breathing, pulse on the carotid arteries and heartbeat, lack of sensitivity to pain, thermal irritations, lack of corneal reflex, pupillary reaction to light) and the absence of clearly not life-compatible injuries, first aid should be provided (artificial ventilation of the lungs, indirect heart massage, the introduction of cardiac drugs, etc.) until you are sure of the onset of early cadaveric changes. Only after the appearance of cadaveric spots, attempts to revive can be stopped and death is ascertained.