Signs of biological and clinical death. Early and late signs of biological death: decrease in body temperature, Beloglazov's symptom (cat's eye), cadaveric spots

Biological death always comes gradually, it goes through certain stages. People often talk about its suddenness, in fact, we are simply not able to recognize the first manifestations of death in time.

There is a so-called that is, a period characterized by a sharp malfunction in the work of all internal organs, while the pressure drops to a critical level, metabolism is noticeably disturbed. It is this state that includes certain periods that characterize biological death. Among them, pre-agony, agony, clinical and biological death can be distinguished.

Predagonia is the first stage in the process of dying. At this stage, there is a sharp decrease in the activity of all vital functions, for example, pressure drops to a critical level, the work of not only the heart muscle of the myocardium, the respiratory system, but also the activity of the brain is disrupted. A characteristic feature of preagony is that the pupils still react to light.

By agony, experts mean literally the last surge of life. After all, during this period there is still a weak heartbeat, but it is no longer possible to determine the pressure. At the same time, a person inhales air from time to time, and the reaction of the pupils to bright light slows down significantly, becomes lethargic. It can be concluded that the hope to bring the patient back to life is fading before our eyes.

The next stage is It is also called the intermediate stage between final death and life. It lasts no more than five minutes in the warm season, and in the cold season, the process of dying of brain cells slows down significantly, so biological death occurs only after half an hour. The main signs of clinical and biological death, which unite them and at the same time distinguish them from other stages, include the complete shutdown of the central nervous system, the stoppage of the respiratory tract and the circulatory system.

Clinical death means that the victim can still be brought back to life with a full restoration of the main functions. After it is established, it should be carried out, namely, if there are positive dynamics, resuscitation can be carried out for several hours in a row, until the ambulance arrives. Then a team of doctors will provide qualified assistance. The first signs of improvement in well-being are the normalization of complexion, the presence of a pupillary reaction to light.

Biological death involves the complete cessation of the functioning of the basic processes of the body, which ensure further life. But most importantly: these losses are irreversible, so any measures to restore life will be completely useless and make no sense.

Signs of biological death

The first symptoms are considered to be the complete absence of a pulse, the cessation of the activity of the cardiovascular and respiratory systems, and no dynamics are observed for half an hour. Sometimes it can be very difficult to distinguish the biological stage from the clinical stage. After all, the fear that the victim can still be brought back to life is always tormented. In such a situation, the main criterion should be followed. Remember that during clinical death, the human pupil resembles a "cat's eye", and during biological it is maximally expanded. In addition, the reaction of the eye to bright light or to the touch of a foreign object is not manifested. A person is unnaturally pale, and after three to four hours, rigor numbness occurs on his body, and a maximum of a day later.

The concept and causes of clinical and biological death. Difference signs.

People live as if the hour of their death will never come. Meanwhile, everything on planet Earth is subject to destruction. Everything that is born will die after a certain period of time.

In medical terminology and practice, there is a gradation of the stages of dying of the body:

• preagony
• agony
• clinical death
• biological death

Let's talk in more detail about the last two states, their signs and distinguishing features.

The concept of clinical and biological death: definition, signs, causes

photo of resuscitation of people from a state of clinical death

Clinical death is a borderline state between life and biological death, lasting 3-6 minutes. Its main symptoms are the absence of activity of the heart and lungs. In other words, there is no pulse, no breathing process, no signs of vital activity of the body.

• Medical terms for signs of clinical death are coma, asystole and apnea.
• The reasons for its occurrence are different. The most common are electrical injury, drowning, reflex cardiac arrest, heavy bleeding, acute poisoning.

Biological death is an irreversible state when all the vital processes of the body have stopped, brain cells die. Its signs in the first hour are similar to clinical death. But then they become more pronounced:

• herring shine and veil on the iris of the eyes
• cadaveric purple spots on the lying part of the body
• dynamics of temperature decrease - every hour per degree
• stiffness of muscles from top to bottom

The causes of biological death are very different - age, cardiac arrest, clinical death without resuscitation attempts or their later use, injuries incompatible with life received in an accident, poisoning, drowning, falling from a height.

How clinical death differs from biological: comparison, difference

the doctor makes entries in the card of the patient who is in a coma

• The most important difference between clinical death and biological death is reversibility. That is, a person can be brought back to life from the first state, if timely resuscitation methods are resorted to.
• Signs. With clinical death, cadaveric spots do not appear on the body, its rigor mortis, constriction of the pupils to "cat's", clouding of the irises.
• Clinical is the death of the heart, and biological is the death of the brain.
• Tissues and cells continue to live without oxygen for some time.

How to distinguish clinical death from biological?

a team of intensive care doctors is ready to return a patient from clinical death

It is not always easy for a person who is far from medicine to determine the stage of dying at first glance. For example, spots on the body, similar to cadaveric ones, can form in the observed during his lifetime. The reason is circulatory disorders, vascular diseases.

On the other hand, the absence of a pulse and respiration is inherent in both species. In part, it will help to distinguish clinical death from the biological state of the pupils. If, when pressed, they turn into a narrow gap like a cat's eyes, then there is biological death.

So, we examined the differences between clinical and biological death, their signs and causes. We established the main difference and vivid manifestations of both types of dying of the human body.

Video: what is clinical death?

Man, like every living organism on Earth, begins his journey from birth and inevitably ends with his death. This is a normal biological process. This is the law of nature. It is possible to prolong life, but it is impossible to make it eternal. People dream, create a lot of theories, offer different ideas about eternal life. Unfortunately, so far they are unjustified. And it is especially insulting when life ends not because of old age, but because of illness (see) or an accident. Clinical and biological death: what do they look like? And why doesn't life always win?

The concept of clinical and biological death

When all the vital functions of the body cease to function, death occurs. But a person, as a rule, does not die immediately. He goes through several stages before completely saying goodbye to life. The process of dying itself consists of 2 phases - clinical and biological death (see).

Signs of clinical and biological death give us the opportunity to consider how the death of a person occurs and, possibly, save him. Knowing the features and first symptoms of clinical death, as well as the early signs of biological death, it is possible to accurately determine the condition of a person and begin resuscitation.

Clinical death is considered a process that is reversible. This is an intermediate moment between a living organism and a dead one. It is characterized by cessation of breathing and cardiac arrest and ends with physiological processes in the cerebral cortex, which are considered irreversible. The maximum duration of this period is 4-6 minutes. At low ambient temperatures, the time for reversible changes is doubled.

Important! Finding that there is no pulse on the carotid artery, immediately proceed to resuscitation without wasting a minute. You need to remember how it is done. Sometimes situations arise when someone's life is in your hands.

Biological death is an irreversible process. Without access to oxygen and nutrients, the cells of various organs die, and it is not possible to revive the body. He will no longer be able to function, it is no longer possible to revive a person. This is the difference between clinical death and biological death. They are separated by a period of only 5 minutes.

Signs of clinical and biological death

When clinical death occurs, all manifestations of life are absent:

• no pulse;
• no breathing;
• "out of work" of the central nervous system;
• muscle tone is absent;
• skin color changes (pallor).

But imperceptibly for us, metabolic processes are still going on at a very low level, tissues are viable and can still fully recover. The time interval is determined by the work of the cerebral cortex. As soon as the nerve cells die, there is no way to completely restore a person.

Not all organs die immediately, some retain the ability to live for some time. After a few hours, you can revive the heart, the respiratory center. For several hours, the blood retains its properties.

Biological death happens:

• physiological or natural, which occurs during the aging of the body;
• pathological or premature, associated with a serious illness or injury incompatible with life.

In both cases, it is impossible to bring a person back to life. Signs of biological death in humans are expressed as follows:

• cessation of the heart rhythm up to 30 minutes;
• lack of breathing;
• pupil dilation that does not respond to light;
• the appearance of dark blue spots on the surface of the skin.

An early symptom of biological death is the “cat pupil symptom.” When pressing from the side of the eyeball, the pupil becomes narrow and oblong, like a cat.

Since organs do not die immediately, they are used in transplantation for organ transplantation. Patients whose kidneys, heart, and other organs fail are waiting for their donor. In European countries, people draw up documents allowing the use of their organs in the event of their death as a result of an accident.

How can you be sure a person is dead?

The diagnosis of clinical and biological death is important, it is carried out by doctors. But everyone should know how to define it. The irreversible death of a person can be established by signs:

1. "Symptom of the cat's pupil."
2. The cornea of ​​the eye dries out and becomes cloudy.
3. The formation of cadaveric spots due to a decrease in vascular tone. Usually they occur after a few hours, when a person died.
4. Decrease in body temperature.
5. Rigor mortis also sets in after a few hours. Muscles become rigid, and the body becomes inactive.

A reliable sign of biological death, doctors diagnose by the data of medical equipment, which determines that electrical signals are no longer coming from the cerebral cortex.

How can a person be saved?

Clinical death differs from biological death in that a person can still be saved. An accurate signal of clinical death is considered if the pulse on the carotid artery is not heard and there is no breathing (see). Then resuscitation actions are carried out: indirect heart massage, the introduction of adrenaline. In medical institutions with modern equipment, such measures are more effective.

If a person has minimal signs of life, proceed to immediate revival. If there are doubts about ascertaining biological death, resuscitation measures are taken to prevent the death of a person.

It is also worth paying attention to the harbingers of clinical death:

• lowering blood pressure to critical numbers (below 60 mm Hg);
• bradycardia (heart rate below 40 beats per minute);
• increased heart rate and extrasystoles.

Important! It should take no more than 10 seconds for a caregiver to establish a diagnosis of clinical death! Resuscitation measures taken no later than two minutes after the appearance of the first signs of clinical death are successful in 92% of cases.

Will the person be saved or not? At some stage, the body loses strength and stops fighting for life. Then the heart stops, breathing stops and death occurs.

The death of a person is a complete cessation of biological and physiological processes in his body. The fear of making a mistake in its recognition forced doctors and researchers to develop accurate methods for diagnosing it and identify the main signs that indicate the onset of the death of the human body.

In modern medicine, clinical and biological (final) death are distinguished. Brain death is considered separately.

We will talk about how the main signs of clinical death look like, as well as how the onset of biological death manifests itself, in this article.

What is clinical death of a person

This is a reversible process, which is understood as stopping the heartbeat and breathing. That is, life in a person has not yet died out, and, therefore, the restoration of vital processes with the help of resuscitation is possible.

Further in the article, the comparative signs of biological and clinical death will be considered in more detail. By the way, the state of a person between these two types of death of the body is called terminal. And clinical death may well pass into the next, irreversible stage - the biological one, the indisputable sign of which is the rigor of the body and the subsequent appearance of cadaveric spots on it.

What are the signs of clinical death: preagonal phase

Clinical death may not occur immediately, but go through several phases, characterized as pre-agonal and agonal.

The first of them is manifested in the inhibition of consciousness while maintaining it, as well as in violation of the functions of the central nervous system, expressed by stupor or coma. The pressure, as a rule, is low at the same time (maximum 60 mm Hg), and the pulse is rapid, weak, shortness of breath appears, the breathing rhythm is disturbed. This state can last for several minutes or several days.

The pre-agonal signs of clinical death listed above contribute to the appearance of oxygen starvation in the tissues and the development of the so-called tissue acidosis (due to a decrease in pH). By the way, in the preagonal state, the main type of metabolism is oxidative.

Manifestation of agony

The beginning of the agony is marked by a short series of breaths, and sometimes by a single breath. Due to the fact that a dying person simultaneously excites the muscles that carry out both inhalation and exhalation, ventilation of the lungs almost completely stops. The higher parts of the central nervous system are turned off, and the role of the regulator of vital functions, as proven by researchers, at this moment passes to the spinal cord and medulla oblongata. This regulation is aimed at mobilizing the last possibilities of preserving the life of the human body.

By the way, it is during the agony that the human body loses those very notorious 60-80 g of weight, which are attributed to the soul leaving it. True, scientists prove that in fact, weight loss occurs due to the complete combustion in the cells of ATP (enzymes that supply energy to the cells of a living organism).

The agonal phase is usually accompanied by a lack of consciousness. The pupils of a person dilate and do not react to light. Blood pressure can not be determined, the pulse is practically not palpable. Heart tones in this case are muffled, and breathing is rare and shallow. These signs of clinical death, which is impending, can last for several minutes or several hours.

How does the state of clinical death manifest itself?

With the onset of clinical death, respiration, pulse, blood circulation and reflexes disappear, and cellular metabolism takes place anaerobically. But this does not last long, because the number of energy drinks in the brain of a dying person is depleted, and his nervous tissue dies.

By the way, in modern medicine it has been established that after the cessation of blood circulation, the death of various organs in the human body does not occur simultaneously. So, the brain dies first, because it is most sensitive to a lack of oxygen. After 5-6 minutes, irreversible changes occur in the brain cells.

Signs of clinical death are: pallor of the skin (they become cold to the touch), lack of respiration, pulse and corneal reflex. In this case, urgent resuscitation measures should be taken.

Three main signs of clinical death

The main signs of clinical death in medicine include coma, apnea and asystole. We will consider each of them in more detail.

Coma is a serious condition that is manifested by loss of consciousness and loss of CNS functions. As a rule, its onset is diagnosed if the patient's pupils do not react to light.

Apnea - stopping breathing. It is manifested by the absence of movement of the chest, which indicates a stop in respiratory activity.

Asystole is the main sign of clinical death, which is expressed by cardiac arrest together with the absence of bioelectrical activity.

What is sudden death

A separate place in medicine is given to the concept of sudden death. It is defined as non-violent and occurring unexpectedly within 6 hours of the onset of the first acute symptoms.

This type of death includes cases of cardiac cessation that have arisen for no apparent reason, which are caused by the occurrence of ventricular fibrillation (scattered and uncoordinated contraction of certain groups of muscle fibers) or (less often) an acute weakening of heart contractions.

Signs of sudden clinical death are manifested by loss of consciousness, pallor of the skin, respiratory arrest and pulsation in the carotid artery (by the way, you can determine it if you put four fingers on the patient's neck between the Adam's apple and the sternocleidomastoid muscle). Sometimes this condition is accompanied by short-term tonic convulsions.

In medicine, there are a number of reasons that can cause sudden death. These are electrical injuries, lightning strikes, suffocation as a result of a foreign body entering the trachea, as well as drowning and freezing.

As a rule, in all these cases, a person's life directly depends on the promptness and correctness of resuscitation measures.

How is heart massage done?

If the patient shows the first signs of clinical death, he is placed on his back on a hard surface (floor, table, bench, etc.), the belts are unfastened, tight clothing is removed, and chest compressions are started.

The sequence of resuscitation actions looks like this:

• the assisting person takes a place to the left of the victim;
• puts his hands on top of each other on the lower third of the sternum;
• makes jerky pressures (15 times) at a frequency of 60 times per minute, while using your weight to achieve a deflection of the chest by about 6 cm;
• then grabs the chin and pinches the nose of the dying person, throws back his head, exhales as much as possible into his mouth;
• artificial respiration is done after 15 massage shocks in the form of two exhalations into the mouth or nose of the dying person for 2 seconds each (at the same time, you need to make sure that the victim’s chest rises).

Indirect massage helps to compress the heart muscle between the chest and spine. Thus, the blood is pushed into large vessels, and during the pause between the tremors, the heart fills with blood again. In this way, cardiac activity is resumed, which after a while can become independent. The situation can be checked after 5 minutes: if the victim's signs of clinical death disappear, and a pulse appears, the skin turns pink and the pupils constrict, then the massage was effective.

How does an organism die?

In various human tissues and organs, resistance to oxygen starvation, as mentioned above, is not the same, and their death after the heart stops, occurs in a different time period.

As you know, the cerebral cortex dies first, then the subcortical centers, and finally the spinal cord. Four hours after the cessation of the heart, the bone marrow dies, and a day later, the destruction of the skin, tendons and muscles of a person begins.

How does brain death manifest?

From the foregoing, it is clear that the exact determination of the signs of clinical death of a person is very important, because from the moment of cardiac arrest to the onset of brain death, which entails irreparable consequences, there is only 5 minutes.

Brain death is an irreversible stoppage of all its functions. And its main diagnostic sign is the absence of any reactions to stimuli, which indicates the cessation of the work of the hemispheres, as well as the so-called EEG silence even in the presence of artificial stimulation.

Doctors also consider the lack of intracranial circulation to be a sufficient sign of brain death. And, as a rule, this means the onset of the biological death of a person.

What does biological death look like?

To make it easier to navigate the situation, one should distinguish between signs of biological and clinical death.

Biological or, in other words, the final death of the organism is the last stage of dying, which is characterized by irreversible changes that develop in all organs and tissues. At the same time, the functions of the main body systems cannot be restored.

The first signs of biological death include the following:

• when pressing on the eye, there is no reaction to this irritation;
• the cornea becomes cloudy, drying triangles form on it (the so-called Lyarche spots);
• if the eyeball is gently squeezed from the sides, then the pupil will transform into a vertical slit (the so-called "cat's eye" symptom).

By the way, the signs listed above also indicate that the death occurred at least an hour ago.

What happens during biological death

The main signs of clinical death are difficult to confuse with late signs of biological death. The latter appear:

• redistribution of blood in the body of the deceased;
• cadaverous spots of purple color, which are localized in the underlying places on the body;
• rigor mortis;
• and, finally, cadaveric decomposition.

The cessation of circulation causes a redistribution of blood: it collects in the veins, while the arteries are almost empty. It is in the veins that the post-mortem process of blood coagulation takes place, and with a quick death there are few clots, and with a slow death there are many.

Rigor mortis usually begins with the facial muscles and hands of a person. And the time of its appearance and the duration of the process are highly dependent on the cause of death, as well as on the temperature and humidity at the location of the dying. Usually, the development of these signs occurs within 24 hours after death, and after 2-3 days after death, they disappear in the same sequence.

A few words in conclusion

To prevent the onset of biological death, it is important not to waste time and provide the necessary assistance to the dying.

It should be borne in mind that the duration of clinical death directly depends on what caused it, at what age the person is, and also on external conditions.

There are cases when signs of clinical death could be observed for half an hour if it occurred, for example, due to drowning in cold water. Metabolic processes throughout the body and in the brain in such a situation are greatly slowed down. And with artificial hypothermia, the duration of clinical death is increased to 2 hours.

Severe blood loss, on the contrary, provokes the rapid development of pathological processes in the nervous tissues even before the heart stops, and the restoration of life in these cases is impossible.

According to the instructions of the Ministry of Health of Russia (2003), resuscitation measures are stopped only when a person’s brain is dead or if medical assistance provided within 30 minutes is ineffective.

biological death

Biological death follows clinical death and is an irreversible state when the revival of the organism as a whole is no longer possible.

Biological death is a necrotic process in all tissues, starting with the neurons of the cerebral cortex, the necrosis of which occurs within 1 hour after the cessation of blood circulation, and then within 2 hours the cells of all internal organs die (skin necrosis occurs only after a few hours, and sometimes days).

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

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

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

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

Statement of biological death

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

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

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

Lack of spontaneous breathing;

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

Lack of corneal reflex;

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

brain death

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

Complete and permanent absence of consciousness;

Sustained lack of spontaneous breathing;

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

Atony of all muscles;

The disappearance of thermoregulation;

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

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

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

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

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

Resuscitation measures

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

Reanimator one

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

Two resuscitators

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

The effectiveness of resuscitation

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

efficiency of resuscitation

Efficiency of artificial respiration and blood circulation.

Resuscitation efficiency

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

Efficiency of artificial respiration and circulation

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

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

Constriction of the pupils.

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

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

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

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

Closed injuries of the skull and brain.

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

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

Symptoms and course.

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

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

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