Biological death resuscitation. Sports club of travel and adventures "Horizon"

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

Causes of biological death

Primary reasons include :

Damage that is incompatible with life.
Heavy bleeding.
Concussion, compression of vital organs.
State of shock.

Secondary causes include:

Different .
Severe intoxication of the body.
Non-communicable diseases.

Symptoms of human death

It is on the basis of certain signs that death is declared. First, the heart stops, the person stops breathing, and after 4 hours a large number of cadaveric spots appear. Due to the stoppage of blood circulation, rigor occurs.

How to recognize biological death?

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

Please note that the listed signs do not always indicate the death of a person. The same symptoms appear in the case of severe hypothermia of the body, the inhibitory effect of medications on the nervous system.

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

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

Early and late signs of death

Within an hour the following symptoms appear:

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

Attention! If all the above symptoms are present, resuscitation is not performed. In this case it is meaningless.

Late symptoms include:

Spots on the body are marbled in color.
Cooling of the body because the temperature drops.

When does the doctor pronounce death?

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

Motor response to pain.
Consciousness.
Corneal reflex.
Cough and pharyngeal reflex.

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

Electroencephalography.
Angiography.
Ultrasonography.
Magnetic resonance angiography.

Main stages of biological death

Predagonia– is sharply suppressed or completely absent. In this case, the skin turns pale, is difficult to palpate on the carotid and femoral arteries, and the pressure drops to zero. The patient's condition deteriorates sharply.
Terminal pause is an intermediate stage between life and death. If resuscitation is not carried out in a timely manner, the person will die.
Agony– the brain ceases to control all physiological processes.

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

Medical diagnosis of biological death

To avoid the mistake of death, many experts use different tests and methods:

Winslov test– a vessel filled with water is placed on the chest of a dying person, and with the help of vibrations they learn about respiratory activity.
Auscultation , palpation of central and peripheral vessels.
Magnus Test - they tighten the finger tightly; if it is gray-white, it means the person has died.

Previously, more stringent tests were used. For example, Jose's test involved pinching a skin fold using special forceps. During the Desgrange test, boiling oil was injected into the nipple. But during the Raza test, a hot iron was used, they burned the heels and other parts of the body.

Providing assistance to the victim

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

Immediately eliminate the damaging factor - body compression, electricity, low or high temperature.
Remove the victim from unfavorable conditions - take him out of the burning room, pull him out of the water.
First aid will depend on the type of disease and injury suffered.
Urgent transportation of the victim to the hospital.

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

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

Actions must be quick, expedient, calm, and deliberate.
Really assess your surroundings.
Don't panic, you need to assess the person's condition. To do this, you need to find out about the nature of the injury or disease.
Call an ambulance or transport the victim yourself.

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

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

Clinical and biological death.

Signs of clinical death:

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

Therefore, first of all, it is necessary to determine the presence of blood circulation and breathing in the patient or victim.

Definition of signs clinical death:

1. Absence of pulse in the carotid artery is the main sign of circulatory arrest;

2. Lack of breathing can be checked by visible movements of the chest when inhaling and exhaling, or by placing your ear to the chest, hearing the sound of breathing, feeling (the movement of air during exhalation is felt by the cheek), and also by bringing a mirror, a piece of glass or a watch glass, or a cotton swab to your lips or thread, holding them with tweezers. But it is precisely on the determination of this characteristic that one should not waste time, since the methods are not perfect and unreliable, and most importantly, they require a lot of precious time for their determination;

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

4. The victim’s upper eyelid is raised and the size of the pupil is determined visually, the eyelid lowers and immediately rises again. If the pupil remains wide and does not narrow after lifting the eyelid again, then we can assume that there is no reaction to light.

If one of the first two of the 4 signs of clinical death is determined, then resuscitation must be started immediately. Since only timely resuscitation (within 3–4 minutes after cardiac arrest) can bring the victim back to life. Resuscitation is not performed only in the case of biological (irreversible) death, when irreversible changes occur in the tissues of the brain and many organs.

Signs of biological death :

1) drying of the cornea; 2) the “cat’s pupil” phenomenon; 3) decrease in temperature;. 4) body cadaveric spots; 5) rigor mortis

Definition of signs biological death:

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

2. The thumb and forefinger squeeze the eyeball; if the person is dead, then his pupil will change shape and turn into a narrow slit - a “cat’s pupil.” This cannot be done in a living person. If these 2 signs appear, this means that the person died at least an hour ago.

3. Body temperature drops gradually, by about 1 degree Celsius every hour after death. Therefore, based on these signs, death can only be confirmed after 2–4 hours or later.

4. Purple cadaveric spots appear on the underlying parts of the corpse. If he lies on his back, then they are identified on the head behind the ears, on the back of the shoulders and hips, on the back and buttocks.

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

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

Resuscitation.

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

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

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

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

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

Preparing the victim for resuscitation

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

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

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

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

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

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

Biological death

Biological death(or true death) represents an irreversible cessation of physiological processes in cells and tissues. See Death. 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.

Early signs of biological death include:

Lack of eye response to irritation (pressure)
Clouding of the cornea, formation of desiccation triangles (Larche's spots).
The appearance of the “cat’s eye” symptom: with lateral compression of the eyeball, the pupil transforms into a vertical fusiform slit, similar to a cat’s pupil.

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 until death of the tissues that make up the human body is mainly determined by their ability to survive 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, more precisely, 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 of biological death. Kidneys, liver and some other organs remain viable for up to 3-4 hours. Muscle tissue, skin and some other tissues may well be viable up to 5-6 hours after the onset of biological death. Bone tissue, being the most inert tissue of the human body, retains its vitality for up to several days. Associated with the phenomenon of survivability of organs and tissues of the human body is the possibility of transplanting them, and the earlier the organs are removed for transplantation after the onset of biological death, the more viable they are, the greater the likelihood of their successful further functioning in another organism.

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 the function of the nervous system, a drop in blood pressure, and 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 by inertia, fading. 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 temperatures, the clinical death phase lasts a maximum of 8 minutes, but when 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 irreversible physiological changes inside cells, tissues and organs, is caused by a prolonged lack of blood supply, primarily to the brain. This phase, with the development of nano- and cryo-technologies in medicine, continues to be closely studied in order to try to 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;
cessation of 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 a complete lack of 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 the prolonged absence of biological processes within the body.

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

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

on the side of the eye cornea, clouding first occurs for 15 to 20 minutes, and then dries out;
from the pupil side - 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;
the appearance of cadaveric spots in sloping areas;
rigor of a deceased body;
cadaveric decomposition.

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

The heart, as an organ, loses complete viability within an hour or two from the moment biological death is declared, internal organs - within 3 - 4 hours, skin and mucous membranes - within 5 - 6 hours, and bones - within 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, you need to empty the nasal and oral cavities of all contents, tilt your head back so that there is an acute angle between the neck and the back of the head, and a blunt angle between the neck and chin; only in this position will the airways open.
Having closed the dying 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 one on top of the 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.

Scheme for describing the declaration of death in the call card

Location. The body of a man (woman) is on the floor (on a bed) in a position lying on his back (stomach) with his head towards the window, his feet towards the door, his arms along his body. Unconscious .

Anamnesis. /F. I. O. (if known)/ was discovered in this condition by the son (neighbor) / F. I.O./ at 00 o'clock. 00 min. Relatives (neighbors) carried out resuscitation measures (if any) to the following extent: /list what was carried out and when/. According to my son (neighbor), I suffered from: /list of chronic diseases/. What did you use for treatment? Indicate the date and time of your last visit to medical care, if it was within the last 7-10 days.

Inspection.
Examination. It is especially important in the absence of cadaveric spots and rigor.

Conclusion: the death of a citizen was confirmed /F. I.O./ at 00 o'clock. 00 min. Approximately, the time of identification should differ by 10-12 minutes from the time of arrival.

Callback time for corpse transportation : 00 o'clock 00 min, dispatcher No. 111. (Indicate in the appropriate place). This time may be 7-15 minutes longer than the time of death and should not coincide with the time of the call back to release the team.

Territorial data. Clinic no. ATC name. In the case of crime or child death, it is necessary to indicate the name and rank of the arriving police officer (the senior one in the group).

To prevent a possible conflict situation, it is possible to make a note in the call card about the free corpse transportation service with the signature of a relative (neighbor) of the deceased.

Attachments to the plan for describing the ascertainment of death.

Stages of the dying process.

Ordinary dying, so to speak, consists of several stages that successively replace each other:

1. Pre-agonal state.

It is characterized by profound disturbances in the activity of the central nervous system, manifested by the victim’s lethargy, low blood pressure, cyanosis, pallor or “marbling” of the skin. This condition can last quite a long time, especially in the context of medical care.

2. The next stage is agony.

The last stage of dying, in which the main functions of the body as a whole are still manifested - breathing, blood circulation and the governing activity of the central nervous system. Agony is characterized by a general deregulation of body functions, therefore the provision of tissues with nutrients, but mainly oxygen, is sharply reduced. Increasing hypoxia leads to the cessation of respiratory and circulatory functions, after which the body enters the next stage of dying. With powerful destructive effects on the body, the agonal period may be absent (as well as the preagonal period) or may not last long; with some types and mechanisms of death, it can last for several hours or even more.

3. The next stage of the dying process is clinical death.

At this stage, the functions of the body as a whole have already ceased, and it is from this moment that the person is considered dead. However, the tissues retain minimal metabolic processes that maintain their viability. The stage of clinical death is characterized by the fact that an already dead person can still be brought back to life by restarting the mechanisms of breathing and blood circulation. Under normal room conditions, the duration of this period is 6-8 minutes, which is determined by the time during which the functions of the cerebral cortex can be fully restored.

4. Biological death

Postmortem skin changes.

Immediately after death, the skin of a human corpse is pale, perhaps with a slight grayish tint. Immediately after death, body tissues still consume oxygen from the blood and therefore all blood in the circulatory system acquires the character of venous. Cadaveric spots are formed due to the fact that after circulatory arrest, the blood contained in the circulatory system, under the influence of gravity, gradually descends into the underlying parts of the body, overflowing mainly the venous part of the bloodstream. Blood shining through the skin gives it a characteristic color.

Cadaveric spots.

Cadaveric spots go through three stages in their development: hypostasis, diffusion and imbibition. To determine the stage of development of cadaveric spots, the following technique is used: press on the cadaveric spot; if at the point of pressure the cadaveric spot completely disappears or at least turns pale, then measure the time after which the original color is restored.

Hypostasis - stage , in which the blood descends into the underlying parts of the body, overflowing their vascular bed. This stage begins immediately after circulatory arrest, and the first signs of coloration of the skin can be observed within 30 minutes, if there was no blood loss and the blood in the corpse is liquid. Clearly cadaveric spots appear 2-4 hours after death. Cadaveric spots in the stage of hypostasis completely disappear when pressed, due to the fact that the blood only fills the vessels and easily moves through them. After the pressure stops, blood fills the vessels again after some time, and the cadaveric spots are completely restored. When the position of the corpse changes at this stage of development of cadaveric spots, they completely move to new places, in accordance with which parts of the body have become underlying. The hypostasis stage lasts on average 12-14 hours.

The next stage of the formation of cadaveric spots is diffusion stage , also called the stasis stage. As a rule, pronounced manifestations characteristic of this stage are noted 12 hours after death. At this stage, the overstretched walls of the vessels become more permeable and an exchange of fluids begins through them, which is uncharacteristic for a living organism. In the diffusion stage, when pressure is applied to cadaveric spots, they do not disappear completely, but only turn pale, and after a while they restore their color. Full development of this stage occurs within 12 to 24 hours. When the position of the corpse changes during this period of time, the cadaveric spots partially move to those parts of the body that become underlying, and partially remain in the old place due to the saturation of the tissues surrounding the vessels. Previously formed spots become somewhat lighter than they were before the corpse was moved.

The third stage of development of cadaveric spots - imbibition stage . This process of tissue saturation with blood begins already at the end of the first day after death and completely ends after 24-36 hours from the moment of death. When you press on a cadaveric spot that is in the stage of imbibition, it does not turn pale. Thus, if more than a day has passed since the death of a person, then when such a corpse is moved, the cadaveric spots do not change their location.

The unusual color of cadaveric spots may indicate the cause of death. If a person died with significant blood loss, then the cadaveric spots will be very weakly expressed. When dying from carbon monoxide poisoning, they are bright, red due to the large amount of carboxyhemoglobin; when exposed to cyanide, they are cherry red; when poisoning with methemoglobin-forming poisons, such as nitrites, cadaveric spots have a grayish-brown color. On corpses in water or a damp place, the epidermis loosens, oxygen penetrates through it and combines with hemoglobin, this causes the pinkish-red tint of corpse spots along their periphery.

Rigor mortis.

Rigor mortis is usually called a condition of the muscles of a corpse in which they become denser and fix parts of the corpse in a certain position. A numb dead body seems to become stiff. The process of rigor mortis develops simultaneously in all skeletal and smooth muscle muscles. But its manifestation occurs in stages, first in small muscles - on the face, neck, hands and feet. Then rigor becomes noticeable in large muscles and muscle groups. Pronounced signs of rigor are observed 2-4 hours after death. The increase in rigor mortis occurs up to 10-12 hours from the moment of death. For about 12 more hours, rigor remains at the same level. Then it starts to disappear.

In agonal death, that is, death accompanied by a long terminal period, a number of specific signs can also be identified. During external examination of a corpse, these signs include:

1. Weakly expressed, pale cadaveric spots that appear after a much longer period of time after death (after 3 - 4 hours, sometimes more). This phenomenon is due to the fact that during agonal death the blood in the corpse is in the form of clots. The degree of blood coagulation depends on the duration of the terminal period; the longer the terminal period, the weaker the cadaveric spots are expressed, the longer the time it takes for them to appear.

2. Rigor mortis is weakly expressed, and in the corpses of persons whose death was preceded by a very long process of dying, it may be practically absent altogether. This phenomenon is due to the fact that during prolonged dying in the terminal period, all energy substances (ATP, creatine phosphate) of muscle tissue are almost completely consumed.