Early and late signs of biological death. Biological death: definition

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

To the number early symptoms biological death includes:

to pressure or other irritation,
clouding of the cornea occurs,
Drying triangles appear, called Larchet spots.

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

The body and signs of biological death

However, biological death specific person does not lead to simultaneous biological death of all organs and tissues of the body. The lifespan of body tissues depends on their ability to survive hypoxia and anoxia, and this time and ability differ for different tissues. The worst tissues that tolerate anoxia are the brain tissues that die first. The spinal cord and stem sections resist longer and have greater resistance to anoxia. Other fabrics human body can resist lethal influences even more strongly. In particular, it persists for another one and a half to two hours after recording biological death.

A number of organs, for example, kidneys and liver, can “live” up to four hours, and skin, muscle tissue and some tissues are quite viable up to five to six hours after biological death is declared. The most inert tissue is one that is viable for several more days. This property of organs and tissues of the body is used in organ transplantation. The sooner after the onset of biological death organs are removed for transplantation, the more viable they are and the higher the likelihood 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 thanks 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 in these patients irreversible changes in the brain they had already managed to set in. Their breathing was maintained mechanical ventilation method, but the death of the brain meant the death of the individual and the person turned into only a “cardiopulmonary” biological mechanism.

Visual function is one of the most important for humans. With the help of vision, a person from birth learns about the world and establishes contact with people around him. Any pathologies of the visual organs, and especially congenital ones, bring inconvenience and affect not only his physical, but also his psycho-emotional state. One of these pathologies is the cat's pupil in humans.

The photo clearly shows the appearance of the syndrome " cat pupil»

Cat pupil syndrome belongs to a group of genetic congenital pathologies. This disease is caused by the presence in the karyoptosis of an additional chromosome consisting of particles of the 22nd chromosome. The disease received this name due to its main symptom – vertical coloboma of the eye. Therefore, it has an elongated shape, and such an eye resembles the eye of a cat.

Cat pupil syndrome is inherited. If at least one of the parents had this disease, the risk of its development in the intrauterine fetus is within 80%. Therefore, when carrying such a fetus, screening for chromosomal abnormalities is mandatory.

Symptoms of cat pupil in humans

The first signs of this pathology appear from the moment the child is born. These include: narrow elongated pupil, absence anus and the presence of dimples or protrusions near the auricle.

In the first years of life, they may also appear additional symptoms cat's pupil in humans. They appear as:

Presence of hernias: inguinal, umbilical.
Cryptorchidism.
Abnormal development of female reproductive organs.
Drooping corners of the eyes.
Slantness and squint.
Heart defects.
Pathological development of the urinary system.
Stunted growth.
Changes in the structure and curvature of the spinal column.
Dehiscence of palate and cleft lip.

Sometimes availability of this disease accompanied by mental retardation.

Diagnostic methods

Despite the fact that the pupil resembles a cat's, this does not improve night vision, nor does it improve the clarity of perception of distant objects

Most doctors can determine the presence of cat pupil syndrome by appearance newborn To establish accurate diagnosis It is recommended to carry out cytogenetic analysis and study of the child’s karyotype. These procedures are prescribed when planning pregnancy. These are the main methods for diagnosing cat pupil syndrome.

If necessary, the diagnostic complex is supplemented with:
Amniocentesis: specific analysis of amniotic fluid.
Chorionic villus biopsy: biomaterial is taken from the placenta.
Cordocentesis: examination of umbilical cord blood.

The presence of an extra chromosome confirms the development of pathology. It consists of two identical sections of chromosome 22. Normally, such a region in the genome is present in four copies. In cat pupil syndrome, three copies are detected.

Correct diagnosis is the key to successful treatment. Therefore, when identifying cat pupil syndrome, differential diagnosis is mandatory. Retinoblastoma has such a visual symptom as cat's eyes. This is a malignant neoplasm that affects inner part eyeball. This pathology It is inherited and most often develops in children.

The disease is also differentiated from Rieger's syndrome. This pathology has a very similar symptoms. But this disease occurs due to mutations of the 4th and 13th genes.

Treatment options

On this moment Treatment methods for this pathology have not yet been developed

IN modern medicine doesn't exist yet therapeutic methods for the treatment of genetic diseases. Therefore, there is no treatment for cat pupil syndrome. But there are medical recommendations on preventing the development of pathology and ways to help sick children. To do this you need:

Take a test to determine the genetic compatibility of partners before conceiving a child.
Consult a geneticist if there is a family history of this disease.
Must pass perinatal diagnosis in the 1st, 2nd, 3rd trimester: ultrasound and blood tests.
At the birth of a sick child, medical actions can only help improve his quality of life.
A newborn with cat pupil syndrome must undergo proctoplasty in the first days.

In addition, such children must be examined narrow specialists: surgeon, nephrologist, cardiologist, endocrinologist, orthopedist.

If cat pupil syndrome is present, doctors cannot give any prognosis. No one knows how a child with genetic disease and how long he will live. This depends on the severity of the pathology and the extent of damage to internal organs.

At timely detection illness, provision of adequate medical care, counseling and rehabilitation, the quality of life of such people increases significantly.

Complications of the disease

It is possible to bring the condition of a child with cat pupil syndrome closer to satisfactory only through systematic drug treatment. The lack of maintenance therapy leads to the development of severe diseases of all body systems. This condition often leads to death.

Genetic pathologies, including syndrome cat eye impossible to cure. Therefore, it is recommended to undergo a full examination and consult with a geneticist before pregnancy.

The cat's pupil is undoubtedly a very unusual pathology. Find out what else amazing facts hide our eyes:

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

TO early signs biological death include:

1. Lack of eye reaction to irritation (pressure)

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

3. The appearance of the “cat's eye” symptom: with lateral compression of the eyeball, the pupil transforms into a vertical fusiform slit.

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

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

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

Signs of clinical death include:

1. Lack of breathing.

2. Absence of heartbeat.

3. Generalized pallor or generalized cyanosis.

4. Lack of pupil reaction to light

Definition of clinical death

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

When moving the victim onto a vehicle, carrying him on a stretcher, or transporting resuscitation measures, if necessary, it is necessary to continue in the same mode: perform 15 sternum compressions for 2 deep intense air injections.

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

Despite the fact that by appearance a person staying in clinical stage dying, looks already without obvious signs life and at first glance he cannot be helped, in fact, emergency resuscitation is sometimes able to snatch him from the clutches of death.

Therefore, when you see a practically dead person, you should not rush to give up - you need to find out the stage of dying, and if there is the slightest chance of revival, you need to save him. This is where knowledge of the differences between clinical death and irreversible, biological death comes in handy.

Stages of Dying

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

Predagonal phase. It is characterized by inhibition of function nervous system, drop in blood pressure, circulatory disorders; on the part of the skin - pallor, spotting or cyanosis; from the side of consciousness - confusion, retardation, hallucinations, collapse. The duration of the preagonal phase is extended over time and depends on numerous factors; it can be extended with medication.
Agony phase. The pre-death stage, when breathing, blood circulation, and cardiac function are still observed, albeit weakly and briefly, is characterized by a complete imbalance of organs and systems, as well as a lack of regulation by the central nervous system of life processes. This leads to the cessation of oxygen supply to the cells and tissues, the pressure in the vessels drops sharply, the heart freezes, breathing stops - the person enters the phase of clinical death.
Clinical death phase. This is a short-term stage, with a clear time interval, at which a return to previous life activities 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 yet die - metabolic reactions in them continue, dying out, by inertia. If, with the help of resuscitation steps, the heart and breathing are started, a person can be brought back to life, since brain cells - and they die first - are still preserved in a viable state. At normal temperature the clinical death phase lasts a maximum of 8 minutes, but as the temperature drops, it can extend 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 cessation of a person’s vital existence.
Phase of biological (final or true) death, which is characterized by irreversibility physiological changes inside cells, tissues and organs, caused long absence 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 delay its onset as much as possible.

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

Signs of clinical death

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

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

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

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

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

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

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

Signs of impending biological death

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

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

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

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

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

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

Beloglazov's symptom

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

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

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

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

Resuscitation steps in case of observed clinical death

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

Properly performed artificial respiration follows the following algorithm.

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

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

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

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

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

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

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

Concept and principles of first aid

First medical and first aid - it's a complex emergency measures carried out on the injured or sick person at the scene of the incident and during his delivery to a medical institution.

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

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

Immediate cessation of exposure to external damaging factors (electric current, high or low temperature, heavy compression) and removal of the victim from the favorable conditions where it got into (removal from water, removal from a burning or gas-filled room).
Providing first medical or pre-medical aid to the victim, depending on the nature and type of injury, accident or sudden illness(stopping bleeding, applying a bandage to the wound, artificial respiration, cardiac massage, etc.).
Organizing the prompt delivery (transportation) of the victim to a medical facility.

The fastest delivery of the victim to a medical facility is of great importance in the complex of first aid measures. The victim should not only be transported quickly, but also Right, those. in the position that is safest for him in accordance with the nature of the disease or type of injury. For example, in a position on the side - in an unconscious state or possible vomiting. The optimal method of transportation is by ambulance (ambulance and emergency medical care). If this is not available, you can use regular vehicles belonging to citizens, institutions and organizations. In some cases, when minor damage the victim can reach medical institution on one's own.

When providing first aid, the following principles should be adhered to:

All actions of the person providing assistance must be expedient, deliberate, decisive, quick and calm.
First of all, you should assess the situation and take measures to stop the impact of factors harmful to the body.
Quickly and correctly assess the condition of the victim. This is facilitated by clarifying the circumstances under which the injury or sudden illness occurred, the time and place of the injury. This is especially important if the victim is unconscious. When examining the victim, it is determined whether he is alive or dead, the type and severity of the injury is determined, whether there was and is bleeding continues.
Based on the examination of the victim, the method and sequence of first aid are determined.
Find out what equipment is needed to provide first aid, based on specific conditions, circumstances and capabilities.
Provide first medical care and prepare the victim for transportation.

Thus, first medical and first aid- it's a complex urgent measures, aimed at stopping the impact of a damaging factor on the body, eliminating or reducing the consequences of this impact and ensuring the most favorable conditions for transporting the injured or sick person to a medical institution.

Signs of life and death. Clinical and biological death

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

The onset of death is manifested in irreversible damage main vital functions body with subsequent cessation of vital activity of individual tissues and organs. Death from old age is rare. More often, the cause of death is disease or exposure to various factors.

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

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

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

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

Signs of life

Heartbeat. It is determined by ear by placing the ear to the left half of the chest.

Pulse. It is most convenient to determine the pulse on the radial, carotid and femoral arteries. To determine the pulse in the carotid artery, you need to place your fingers on the front surface of the neck in the area of the cartilage of the larynx and move your fingers to the right or left. Femoral artery passes in the area of the inguinal fold. The pulse is determined with the index and middle fingers. Pulse should not be taken thumb. The point is that according to inside The artery that supplies blood to the thumb is of a fairly large caliber, and in some cases it is possible to determine one’s own pulse. In critical situations, when the victim is unconscious, it is necessary to determine the pulse only in the carotid arteries. Radial artery It has a relatively small caliber, and if the victim has low blood pressure, it may be impossible to determine the pulse on it. Carotid artery- one of the largest in the human body and it is possible to determine the pulse even at the lowest pressure. The femoral artery is also one of the largest, however, determining the pulse on it may not always be convenient and correct.

Breath. Breathing is determined by the movement of the chest and abdomen. In cases where it is impossible to determine the movement of the chest, with very weak shallow breathing, the presence of breathing is determined by bringing a mirror to the victim’s mouth or nose, which fogs up from breathing. If there is no mirror, you can use any shiny cold object (watch, glasses, knife blade, glass shard, etc.). If these items are not available, you can use thread or cotton wool, which will vibrate in rhythm with your breathing.

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

Pupil reaction to light. The pupils of a living person react to light - they narrow and dilate in the dark. During daylight hours, the reaction of the pupils to light is determined as follows: if a person lies with eyes closed, then they lift his eyelids - the pupils narrow; if a person lies with with open eyes, then close your eyes with your palm for 5-10 seconds, and then remove your palm - the pupils will narrow. In the dark, it is necessary to illuminate the eye with a light source, for example, a flashlight. The reaction of the pupils to light must be checked in both eyes, since one eye may be artificial.

Signs of clinical death

No signs of life.
Agonal breathing. Death in most cases is preceded by agony. After death occurs, the so-called agonal breathing continues for a short time (15-20 seconds), that is, breathing is frequent, shallow, hoarse, and foam at the mouth may appear.
Cramps. They are also manifestations of agony and last a short time (a few seconds). A spasm occurs in both the skeletal and smooth muscle. For this reason, death is almost always accompanied by involuntary urination, defecation and ejaculation. Unlike some diseases accompanied by convulsions, when death occurs, the convulsions are not strong and not clearly expressed.
Pupil reaction to light. As mentioned above, there will be no signs of life, but the reaction of the pupils to light in a state of clinical death remains. This reaction is a higher reflex that closes on the cerebral cortex. Thus, as long as the cerebral cortex is alive, the reaction of the pupils to light will also be preserved. It should be noted that the first seconds after death as a result of convulsions, the pupils will be maximally dilated.

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

Signs of biological death

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

“Cat's eye” (Beloglazov's symptom). Appears 25-30 minutes after death. Where does this name come from? A person's pupil round shape, and in a cat it is elongated. After death, human tissues lose their elasticity and firmness, and if squeezed on both sides of the eyes dead person, it becomes deformed, and along with the eyeball, the pupil also becomes deformed, taking on an elongated shape, like a cat’s. In a living person, deforming the eyeball is, if not impossible, then very difficult.

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

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

Rigor mortis. After death occurs in the corpse biochemical processes, leading first to muscle relaxation, and then to contraction and hardening - rigor mortis. Rigor mortis develops within 2-4 hours after death. The mechanism of rigor mortis formation is not yet completely clear. Some researchers believe that the basis is biochemical changes in the muscles, others - in the nervous system. In this state, the muscles of the corpse create an obstacle to passive movements in the joints, therefore, to straighten the limbs that are in a state of severe rigor mortis, it is necessary to use physical strength. Full development of rigor mortis in all muscle groups is achieved on average by the end of the day. Rigor mortis does not develop in all muscle groups at the same time, but gradually, from the center to the periphery (first the muscles of the face, then the neck, chest, back, abdomen, and limbs undergo rigor). After 1.5-3 days, rigor disappears (resolves), which is expressed in muscle relaxation. Rigor mortis resolves in sequence, reverse development. The development of rigor mortis is accelerated in conditions high temperature, when low, its delay is noted. If death occurs as a result of a cerebellar injury, rigor mortis develops very quickly (0.5-2 seconds) and fixes the position of the corpse at the time of death. Rigor mortis is resolved ahead of schedule in the event of a violent muscle strain.

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

The body's response to injury

Fainting

Sudden loss of consciousness for a short time. It usually occurs as a result of acute circulatory failure, which leads to a decrease in blood supply to the brain. A lack of oxygen supply to the brain occurs most often with a decrease in blood pressure, vascular attacks, and heart rhythm disturbances. Fainting is sometimes observed when standing for a long time in a standing position, or when standing up suddenly from a lying position (the so-called orthostatic faint), especially in weakened people or those suffering from hypotension, as well as in patients taking medications that lower blood pressure. Fainting is more common in women.

Factors that provoke the onset of fainting are poor diet, overwork, heat or sunstroke, alcohol abuse, infection, intoxication, recent serious illnesses, traumatic brain injury, being in a stuffy room. Fainting can occur as a result of excitement, fear, the sight of blood, severe pain in case of impacts and injuries.

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

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

If the patient has lost consciousness, he is placed on his back with his head bowed and legs raised. It is necessary to unfasten the collar and belt, spray your face with water and rub it with a towel soaked in cold water, let the vapors inhale ammonia, cologne, vinegar. In a stuffy room, it is good to open a window to provide fresh air.

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

Shock

A severe general reaction of the body, acutely developing as a result of exposure to extreme factors (severe mechanical or mental trauma, burns, infection, intoxication, etc.). The basis of shock is sudden disturbances in vital important functions circulatory and respiratory systems, nervous and endocrine systems, metabolism.

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

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

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

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

Emotional shock occurs under the influence of strong, sudden mental trauma. It can manifest itself as a state of complete immobility, indifference - the victim is “numb with horror.” This condition can last from a few minutes to several hours. In other cases, on the contrary, a sharp excitement sets in, which is manifested by screams, senseless throwing, running, often in the direction of danger. Severe autonomic reactions are noted: palpitations, sudden paleness or redness of the skin, sweating, diarrhea. A patient in a state of emotional shock must be hospitalized.

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

Collapse

Heavy, life-threatening condition characterized sharp decline blood pressure, inhibition of the central nervous system and metabolic disorders. Vascular insufficiency and decreased blood pressure as a result of the fall vascular tone caused by inhibition of the vasomotor center in the brain. When organ vessels collapse abdominal cavity overflowing with blood, while the blood supply to the vessels of the brain, muscles and skin decreases sharply. Vascular insufficiency is accompanied by a decrease in oxygen content in the blood surrounding tissues and organs.

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

During collapse, the skin turns pale, becomes covered with cold, sticky sweat, the limbs become marble-blue, the veins collapse and become indistinguishable under the skin. The eyes become sunken, the facial features become sharper. Arterial pressure drops sharply, the pulse is barely palpable or even absent. Breathing is rapid, shallow, sometimes intermittent. May come involuntary urination and bowel movements. Body temperature drops to 35° and below. The patient is lethargic, consciousness is darkened, and sometimes completely absent.

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


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