It's called biological death. Clinical and biological death concept of clinical and biological death

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

"Cat's eye" (symptom of Beloglazov). Appears 25-30 minutes after death. Where does this name come from? A person has a pupil round shape, and in a cat it is elongated. After death, human tissues lose their elasticity and firmness, and if squeezed from both sides of the eyes dead man, it is deformed, and together with the eyeball, the pupil is also deformed, taking an elongated shape, like in a cat. In a living person, it is very difficult to deform the eyeball, if not impossible. In various accidents, when the victim has no breathing and signs of heart contraction, it is necessary to start artificial lung ventilation and closed heart massage as soon as possible.

Drying of the cornea of the eye and mucous membranes. Appears 1.5-2 hours after death. After death, the lacrimal glands cease to function, which produce tear fluid, which, in turn, serves to moisturize eyeball. 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 luster, becomes cloudy, sometimes a grayish-yellowish coating appears. The mucous membranes, which were more hydrated during life, dry out quickly. For example, lips become dark brown, wrinkled, dense.

Dead spots. Arise as a result of the post-mortem redistribution of blood in the 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 translucent through the skin in the form of bluish-purple spots, which are called cadaveric. The color of cadaveric spots is not uniform, but spotty, has a so-called “marble” pattern. They appear approximately 1.5-3 hours (sometimes 20-30 minutes) after death. located cadaveric spots in the lower parts of the body. With the position of the corpse on the back, cadaveric spots are located on the back and back - lateral surfaces of the body, on the stomach - on the front surface of the body, face, with 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 a change in condition. environment. For example, when the corpse of a drowned man is taken ashore, the bluish-purple cadaveric spots on his body, due to the penetration of air oxygen through loosened skin, can change color to pink-red. If death resulted from large blood loss, then cadaveric spots will have a much paler shade or be absent altogether. When a corpse is in conditions low temperatures cadaveric spots will form later, up to 5-6 hours. The formation of cadaveric spots takes place in two stages. As you know, cadaveric blood does not coagulate during the first day after death. Thus, on 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, cadaveric spots will not change their position. Determining the presence or absence of blood clotting is very simple - you need to press on the spot with your finger. If the blood has not clotted, when pressed, the cadaveric spot at the site of pressure will turn white. Knowing the properties of cadaveric spots, it is possible to determine the approximate prescription of death at the scene of the incident, and also to find out whether the corpse was turned over after death or not.

Rigor mortis. After the onset of death, biochemical processes occur in the corpse, 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 fully understood. Some researchers believe that the basis is biochemical changes in the muscles, others - in nervous system. In this state, the muscles of the corpse create an obstacle to passive movements in the joints, therefore, to extend the limbs in a state of pronounced rigor mortis, it is necessary to apply physical strength. The full development of rigor mortis in all muscle groups is achieved on average by the end of the day. Rigor mortis develops not 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, limbs). After 1.5-3 days, stiffness disappears (allowed), which is expressed in muscle relaxation. Rigor mortis is resolved in the sequence reverse development. The development of rigor mortis is accelerated at high temperatures, and at low temperatures it is delayed. If death occurs as a result of trauma to the cerebellum, rigor mortis develops very quickly (0.5-2 seconds) and fixes the posture of the corpse at the time of death. Rigor mortis is allowed before the deadline in case of forced muscle stretching.

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

A person is able to live without water and food for some time, but without access to oxygen, breathing will stop after 3 minutes. This process is called clinical death, when the brain is still alive, but the heart does not beat. A person can still be saved if you know the rules of emergency resuscitation. In this case, both doctors and the one who is next to the victim can help. The main thing is not to get confused, act quickly. This requires knowledge of the signs of clinical death, its symptoms and resuscitation rules.

Symptoms of clinical death

Clinical death is a reversible state of dying, in which the work of the heart stops, breathing stops. All external signs vital functions disappear, it may seem that the person is dead. Such a process is a transitional stage between life and biological death, after which it is impossible to survive. During clinical death (3-6 minutes), oxygen starvation practically does not affect the subsequent work of organs, general condition. If more than 6 minutes have passed, then the person will be deprived of many vital important functions due to brain cell death.

In order to recognize this condition in time, you need to know its symptoms. Signs of clinical death are as follows:

Coma - loss of consciousness, cardiac arrest with cessation of blood circulation, the pupils do not react to light.
Apnea - no respiratory movements chest, but the metabolism remains at the same level.
Asystole - the pulse on both carotid arteries is not heard for more than 10 seconds, which indicates the beginning of the destruction of the cerebral cortex.

Duration

Under conditions of hypoxia, the cortex and subcortex of the brain are able to maintain viability. certain time. Based on this, the duration of clinical death is determined by two stages. The first one lasts about 3-5 minutes. During this period, subject to normal temperature body, there is no oxygen supply to all parts of the brain. Exceeding this time range increases the risk of irreversible conditions:

decortication - destruction cerebral cortex;
decerebration - the death of all parts of the brain.

The second stage of the state of reversible dying lasts 10 or more minutes. It is characteristic of an organism with a reduced temperature. This process can be natural (hypothermia, frostbite) and artificial (hypothermia). In a hospital setting, this state is achieved by several methods:

hyperbaric oxygenation- saturation of the body with oxygen under pressure in a special chamber;
hemosorption - blood purification by the apparatus;
drugs that sharply reduce metabolism and cause suspended animation;
transfusion of fresh donated blood.

Causes of clinical death

The state between life and death occurs for several reasons. They can be caused by the following factors:

heart failure;
blockage respiratory tract(lung disease, suffocation);
anaphylactic shock- respiratory arrest with a rapid reaction of the body to the allergen;
big loss blood in case of injuries, wounds;
damage to tissues by electricity;
extensive burns, wounds;
toxic shock- poisoning with toxic substances;
vasospasm;
the body's response to stress;
excessive physical exercise;
violent death.

The main stages and methods of first aid

Before taking measures to provide first aid, one must be sure of the onset of a state of temporary death. If all of the following symptoms are present, it is necessary to proceed to the provision emergency assistance. You should make sure of the following:

the victim is unconscious;
the chest does not make inhalation-exhalation movements;
no pulse, pupils do not react to light.

In the presence of symptoms of clinical death, it is necessary to call an ambulance resuscitation team. Before the arrival of doctors, it is necessary to support as much as possible vital functions victim. To do this, apply a precordial blow with a fist on the chest in the region of the heart. The procedure can be repeated 2-3 times. If the condition of the victim remains unchanged, then it is necessary to switch to artificial lung ventilation (ALV) and cardiopulmonary resuscitation(CPR).

CPR is divided into two stages: basic and specialized. The first is performed by a person who is next to the victim. The second is trained medical workers on site or in a hospital. The algorithm for performing the first stage is as follows:

Lay the victim down on a flat, hard surface.
Put your hand on his forehead, slightly tilting his head. This will push the chin forward.
With one hand, pinch the victim's nose, with the other - stretch out the tongue, try to blow air into the mouth. The frequency is about 12 breaths per minute.
Go to chest compressions.

To do this, with the protrusion of the palm of one hand, you need to put pressure on the area of \u200b\u200bthe lower third of the sternum, and put the second hand on top of the first. The indentation of the chest wall is made to a depth of 3-5 cm, while the frequency should not exceed 100 contractions per minute. The pressure is performed without bending the elbows, i.e. direct position of the shoulders above the palms. It is impossible to blow in and squeeze the chest at the same time. It is necessary to ensure that the nose is tightly clamped, otherwise the lungs will not receive required amount oxygen. If the breath is taken quickly, air gets in into the stomach, causing vomiting.

Resuscitation of the patient in the clinic

Resuscitation of the victim in a hospital is carried out according to a certain system. It consists of following methods:

Electrical defibrillation - stimulation of breathing by exposure to electrodes with alternating current.
Medical resuscitation through intravenous or endotracheal administration of solutions (Adrenaline, Atropine, Naloxone).
Circulatory support with the introduction of Hecodese through the central venous catheter.
Correction acid-base balance intravenously (Sorbilact, Xylat).
Restoration of capillary circulation by drip(Rheosorbilact).

In the event of a successful resuscitation the patient is transferred to the ward intensive care, where further treatment and condition monitoring. Resuscitation stops at the following cases:

Ineffective resuscitation within 30 minutes.
Statement of the state of biological death of a person due to brain death.

Signs of biological death

Biological death is the final stage of clinical death if resuscitation measures are ineffective. The tissues and cells of the body do not die immediately, it all depends on the ability of the organ to survive during hypoxia. Death is diagnosed on certain grounds. They are divided into reliable (early and late), and orienting - immobility of the body, lack of breathing, heartbeat, pulse.

Biological death can be distinguished from clinical death by early signs. They are noted after 60 minutes from the moment of dying. These include:

lack of pupillary response to light or pressure;
the appearance of triangles of dried skin (Larcher spots);
drying of the lips - they become wrinkled, dense, brown in color;
symptom " cat eye"- the pupil becomes elongated due to the absence of the eye and blood pressure;
drying of the cornea - the iris is covered with a white film, the pupil becomes cloudy.

A day after death, late signs of biological death appear. These include:

the appearance of cadaveric spots - localization mainly on the arms and legs. The spots are marbled.
rigor mortis - a state of the body due to ongoing biochemical processes disappears after 3 days.
cadaveric cooling - states the completion of the onset of biological death, when the body temperature drops to a minimum level (below 30 degrees).

Consequences of clinical death

After successful resuscitation, a person from a state of clinical death returns to life. This process may be accompanied various violations. They can affect how physical development as well as psychological state. Damage done to health depends on time oxygen starvation important organs. In other words, than earlier man returns to life after a short death, the fewer complications he will experience.

Based on the above, it is possible to identify temporal factors that determine the degree of complications after clinical death. These include:

3 minutes or less - the risk of destruction of the cerebral cortex is minimal, as well as the appearance of complications in the future.
3-6 minutes - minor damage areas of the brain indicate that consequences may occur (impaired speech, motor function, coma).
More than 6 minutes - the destruction of brain cells by 70-80%, which will lead to total absence socialization (ability to think, understand).

At the level psychological state certain changes are also observed. They are called transcendental experiences. Many people claim that being able reversible death, soared in the air, saw a bright light, a tunnel. Some accurately list the actions of doctors during resuscitation procedures. Life values a person after this changes dramatically, because he escaped death and got a second chance at life.

Video

clinical death- this is when there are no signs of life, and all organs and tissues of the body are still alive. Clinical death is a reversible state. biological death- this is when the main organs of a person die: the brain, heart, kidneys, lungs. Biological death is an irreversible condition.

Without resuscitation, biological death of the brain occurs 5 minutes after cardiac arrest - in the warm season, or ~ 15 minutes later - in the cold season. Against the background of artificial respiration and indirect heart massage, this time increases to 20-40 minutes.

The only reliably determined sign of clinical death is the absence of a pulse on carotid artery. That is, if you approached a “broken” participant and found that there was no pulse on the carotid artery, the participant is dead and you need to immediately start resuscitation according to the ABC scheme.

Do not waste time determining the reaction of the pupils to light. Firstly, you need to be able to conduct the test correctly, and secondly, on a sunny day you will not determine anything reliably.

Similar don't try to check for breath with the help of fluffs, threads, a mirror, etc. Found the absence of a pulse - start resuscitation.

With biological death, resuscitation is not carried out. If signs of biological death appear during resuscitation, resuscitation is stopped.

From early reliable signs biological death, the presence of cadaveric spots and (sometimes) a sign of "cat's eye" should be checked.

cadaveric spots- this is a change in skin color to bluish / dark red / purple-red in those places that are facing downwards. For example, on the lower part of the neck, the lower edge of the ears, the back of the head, shoulder blades, lower back, buttocks. Corpse spots begin to appear 30-40 minutes after death. With blood loss, as well as in the cold, their appearance slows down, or they may not exist at all. The appearance of cadaveric spots is probably the most reliable and realistically determined early sign of biological death.

"Cat's eye"- this is a reliable sign of death (if it is correctly checked), which is determined 30-40 minutes after dying. To check, you need to squeeze hard enough (!) from the sides the eyeball of the deceased. In this case, the pupil, which is normally round, becomes oval and does not take its original shape. This sign should be checked only when it’s completely incomprehensible to you whether the person has died or not. Usually it is enough to detect emerging cadaveric spots.

resuscitation

Resuscitation should be carried out on the most horizontal, even and hard surface. Hanging on a wall or in a crack, you will not be able to carry out effective resuscitation. Therefore, first place the participant on a (if possible) flat, hard surface. If resuscitation takes place on a slope, then the head of the victim should be at the level of his legs or slightly lower.

Before the very beginning of resuscitation, it is necessary to at least approximately find out the mechanism of injury and the cause of death - this will determine the caution in handling a person, the ability to move him once again, the decision to administer / not administer any drugs.

So, the dead participant lies with his back on the ground, on skis placed under his back, on stones, on a glacier, on a shelf in a steep slope. The lifeguards are safe.

BUT- restore airway patency by tilting the victim's head back and raising his neck with his hand. Clean his mouth of saliva, blood, water, snow, or any other foreign matter.

AT- start artificial respiration: with the fingers of the hand that you press on the forehead, pinch the victim's nose. Cover your lips with a handkerchief (if any) and take two full slow exhalations with a pause between them of 3 ... 5 seconds. If it was not possible to inhale air into the lungs of the victim due to strong resistance, tilt his head back more before the second breath. If a artificial respiration carried out correctly - then in response to inhalation, the victim's chest rises, and after inhalation, a passive "exhalation" occurs.

FROM- Open the victim's chest as much as possible. Usually it is enough to unzip the puff and lift up the thick polar / fleece, but if this is difficult to do, work through a minimum of clothing. Find (grope) a point on the victim's sternum between its middle and lower third. Place your palm across the sternum, with your fingers on the left side, with your wrist at the found point. Place the second palm across the first, with maximum contact in the wrist area (you can clasp the wrist with the thumb of the “upper” palm). The participant performing the heart massage should bend over the victim and apply pressure on the sternum with all his weight. The frequency of pressure is 100 per minute.

Signs of correct chest compressions:

The fingers do not touch the ribs.
The arms at the elbows are absolutely straight during the pressure.
The sternum is "pressed through" 4-5 cm deep.
The second person, who puts his fingers on the carotid artery of the victim, feels a pulsation in response to your pressure.
It is possible, but not necessarily the appearance of a slight "crunch" during pressing. This torn thin tendon fibers passing from the ribs to the sternum.

During resuscitation, breaths and pressures on the heart area alternate: one person performs two artificial breaths, then the second makes 30 pressures on the heart area (in about 20 seconds). Once every two minutes, resuscitation is stopped and the pulse on the carotid artery is checked quickly (5-10 seconds). If there is no pulse, resuscitation is resumed. If there is, they monitor the pulse and breathing, administer drugs if necessary (see below), and organize the fastest possible rescues.

During resuscitation, it may be necessary to change the participant who is doing chest compressions. Resuscitation is difficult, and often people do not endure longer than 10 minutes out of habit. You have to be prepared for this, it's normal.

How long to resuscitate?

During resuscitation, every 2 minutes you need to stop for 10 seconds and check for a pulse and spontaneous breathing in the victim. If they are, then indirect heart massage is stopped, but the pulse and breathing are constantly monitored. If there is a pulse, but spontaneous breathing has not recovered, artificial respiration is performed and the pulse is monitored.

If resuscitation lasts 30 minutes, but it was not possible to revive the person, resuscitation measures are stopped. Make sure there is no pulse. It is advisable to examine the body for the appearance of cadaveric spots.

The human body is laid flat, arms along the body or on the chest. The eyelids are covered. The jaw, if necessary, is fixed with a bandage or a roller placed under the chin. If possible, they transport the body on their own, tightly wrapping it with karemats. If this is not possible, or living victims descend in priority, then the body hides from sun rays and (possible) wild animals, the place is marked with highly visible markers, and the group descends for help.

Can drugs be administered during resuscitation?

There are medications that increase the chances of successful resuscitation. And these drugs need to be able to apply in a timely manner.

The most efficient of available drugs- it's adrenaline. During resuscitation, a first-aid kit appears by 3 ... 5 minutes of active resuscitation, and if by this moment the heart has not been started, you can inject 1 ml of adrenaline soft tissues under the tongue (through the mouth). To do this, the head is thrown back and the mouth is opened (as during artificial respiration), and one ml of adrenaline solution is injected under the tongue of the victim using a 2-milliliter syringe. Due to the fact that the tongue has a very rich blood supply, part of the adrenaline will reach the heart with venous blood. The only condition is ongoing resuscitation.

After resuscitation of a person, it makes sense to inject 3 ml of dexamethasone into available muscle(shoulder, buttock, thigh) - this drug will begin to act in 15-20 minutes and will maintain pressure and reduce the severity of cerebral edema in case of injury.

If necessary, after revival, an anesthetic is administered: Ketanov 1-2 ml intramuscularly, analgin 2 ml intramuscularly, or Tramadol - 1 ml intramuscularly.

Signs of correctly conducted resuscitation measures:

After 3-5 minutes of proper resuscitation, the skin color becomes closer to normal.
During an indirect heart massage, the second resuscitator feels the pulsation of the victim's carotid artery.
During artificial respiration, the second resuscitator sees the rise of the victim's chest in response to inspiration.
Constriction of the pupils: when examining the eyes of the resuscitated, the pupils have a diameter of 2-3 mm.

Typical problems and mistakes during resuscitation:

Unable to give artificial breath. The reasons: foreign objects in the mouth, or insufficient tilting of the head, or insufficient exhaling effort.
During artificial respiration, the abdomen is inflated, or the victim begins to vomit. The reason is insufficient tilting of the head and, as a result, inhalation of air into the stomach of the victim.
There is no pulsation on the carotid artery in response to pressure on the chest. Reason - wrong position hands on the sternum, or slight pressure on the sternum (for example, when bending the elbows when pressing).
Putting a cushion or an impromptu “pillow” under the victim’s head makes spontaneous breathing almost impossible. The roller can be placed only under the shoulder blades of the victim, so that the head “hangs” back a little.
Attempts to find out whether the victim is breathing or not (search for feathers, threads, a mirror, glass, etc.) take precious time. You need to focus mainly on the pulse. Performing artificial respiration to a person who is barely breathing on his own will not bring any harm.

Resuscitation in severe, combined trauma:

The participant has a spinal injury, a fractured jaw, or other injuries that prevent him from tilting his head back. What to do?

All the same, the ABC algorithm is respected to the maximum extent possible. The head still throws back, the jaw opens - all this just needs to be done as carefully as possible.

The participant has a fractured rib(s) or fractured the ribs during the cardiac massage.

If one or two ribs are broken, then this usually does not lead to any terrible consequences. Indirect massage carry out in exactly the same way, Special attention so that the fingers do not touch the ribs (!). If there are multiple fractures of the ribs, then this sharply worsens the prognosis, since the sharp edges of the ribs can damage the lungs (pneumothorax will develop), cut through large arteries (there will be internal bleeding), or damage the heart (cardiac arrest occurs). Resuscitation is carried out as carefully as possible according to the same rules.

A living organism does not die simultaneously with the cessation of breathing and the cessation of cardiac activity, therefore, even after they stop, the organism continues to live for some time. This time is determined by the ability of the brain to survive without oxygen supply 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 profuse bleeding, electrical injury, drowning, reflex cardiac arrest, acute poisoning etc.

Signs of clinical death:

1) lack of pulse on 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 respiration in a sick or injured person.

Feature definition clinical death:

1. The absence of a pulse on the carotid artery is the main sign of circulatory arrest;

2. Lack of breathing can be checked by visible movements of the chest during inhalation and exhalation, or by putting your ear to your chest, hear the sound of breathing, feel (the movement of air during exhalation is felt on your cheek), and also by bringing a mirror, glass or glass to your lips watch glass, as well as cotton wool or thread, holding them with tweezers. But it is precisely on the definition of this feature 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 definition;

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

4. Rises upper eyelid the victim and the size of the pupil is determined visually, the eyelid falls and immediately rises again. If the pupil remains wide and does not narrow after repeated eyelid lift, then it can be considered that there is no reaction to light.

If one of the first two of the 4 signs of clinical death is determined, then you need to immediately start resuscitation. Since only timely resuscitation (within 3-4 minutes after cardiac arrest) can bring the victim back to life. Do not do resuscitation 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 phenomenon of "cat's pupil"; 3) decrease in temperature; 4) body cadaveric spots; 5) rigor mortis

Feature definition biological death:

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

2. Large and index fingers squeeze the eyeball, if a person is dead, then his pupil will change shape and turn into a narrow slit - " cat pupil". It is impossible for a living person to do this. If these 2 signs appear, then 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, according to these signs, death can be certified only after 2-4 hours and later.

4. Cadaverous spots of purple color appear on the underlying parts of the corpse. If he lies on his back, then they are determined on the head behind the ears, on the back of the shoulders and hips, on the back and buttocks.

5. Rigor mortis - post-mortem contraction skeletal muscle“top - down”, i.e. face - neck - upper limbs- trunk - lower limbs.

Full development of signs occurs within a day after death. Before proceeding with the resuscitation of the victim, it is necessary first of all determine the presence of clinical death.

! Proceed to resuscitation only in the absence of a pulse (on the carotid artery) or breathing.

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

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

To activities cardiopulmonary resuscitation relate: precordial beat , indirect heart massage and artificial lung ventilation (IVL) method "mouth-to-mouth".

Cardiopulmonary resuscitation consists of sequential stages: precordial beat; artificial maintenance of blood circulation (external heart massage); restoration of airway patency; artificial lung ventilation (ALV);

Preparing the victim for resuscitation

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

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

For airway management you need to: 1) clear oral cavity from mucus, vomit with a cloth wound around the index finger. 2) to eliminate the sinking of the tongue in two ways: by tilting the head back or by pushing mandible.

Tilt your head back the victim is necessary so 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 roll of clothing or under the neck or under the shoulder blades. (Attention! ), but not in the back!

Forbidden! Place hard objects under the neck or back: a satchel, a brick, a board, a stone. In this case, during an indirect heart massage, you can break the spine.

If there is a suspicion of a fracture of the cervical vertebrae, without bending the neck, protrude only the lower jaw. To do this, put the index fingers on the corners of the lower jaw under the left and right earlobe, push the jaw forward and fix it in this position with the thumb right hand. The left hand is released, so with it (thumb and forefinger) it is necessary to pinch the nose of the victim. So the victim is prepared for artificial lung ventilation (ALV).

The main personal and intellectual features that determine the personality of a person are associated with the functions of his brain. Therefore, brain death must be considered as the death of a person, and a violation of the regulatory functions of the brain quickly leads to disruption of the work of other organs and death of a person. Cases of primary brain damage leading to death are relatively rare. In other cases, brain death occurs due to circulatory disorders and hypoxia.

Large neurons of the cerebral cortex are very sensitive to hypoxia. Irreversible changes in them occur within 5-6 minutes from the moment of cessation of blood circulation. This period of acute hypoxia, when circulatory and (or) respiratory arrest has already occurred, but the cerebral cortex has not yet died, is called clinical death. This condition is potentially reversible, since if the brain is re-perfused with oxygenated blood, brain viability will be preserved. If the oxygenation of the brain is not restored, then the neurons of the cortex will die, which will mark the onset biological death, an irreversible state in which the salvation of a person is no longer possible.

The duration of the period of clinical death is influenced by various external and internal factors. This time interval is significantly increased during hypothermia, since with a decrease in temperature, the need for oxygen in brain cells decreases. Reliable cases of successful resuscitation up to 1 hour after stopping breathing during hypothermia are described. Some drugs that inhibit the metabolism in nerve cells also increase their resistance to hypoxia. These drugs include barbiturates, benzodiazepines and other antipsychotics. With fever, endogenous purulent intoxication, jaundice, on the contrary, the period of clinical death is reduced.

At the same time, in practice it is impossible to reliably predict how much the duration of the period of clinical death has increased or decreased and one has to focus on averages of 5-6 minutes.

Signs of clinical and biological death

Signs of clinical death are :

Respiratory arrest, ascertained by the absence of respiratory movements of the chest . Other methods for diagnosing apnea (fluctuation of a thread brought to the nose by an air current, fogging of a mirror brought to the mouth, etc.) are unreliable, since they give positive result even at very shallow breathing that does not provide efficient gas exchange.

Circulatory arrest, ascertained by the absence of a pulse on sleepy and (or) femoral arteries . Other methods (listening to heart sounds, determining the pulse on radial arteries) are unreliable, since heart sounds can be heard even with ineffective, discoordinated contractions, and the pulse in the peripheral arteries may not be determined due to their spasm.

Loss of consciousness (coma) with dilated pupils and lack of reaction to light talk about deep hypoxia of the brain stem and inhibition of the functions of stem structures.

The list of signs of clinical death could be continued by including the inhibition of other reflexes, ECG data, etc., however, from a practical point of view, the definition of these symptoms should be considered sufficient to state given state, since the determination of a large number of symptoms will take more time and delay the start of resuscitation.

Numerous clinical observations have established that after stopping breathing, circulatory arrest develops on average after 8-10 minutes; loss of consciousness after circulatory arrest - after 10-15 seconds; dilation of the pupil after circulatory arrest - after 1-1.5 minutes. Thus, each of the listed signs must be considered a reliable symptom of clinical death, which inevitably entails the development of other symptoms.

Signs of biological death or reliable signs of death appear 2-3 hours after its actual onset and are associated with the onset of necrobiotic processes in tissues. The most typical of them are:

rigor mortis lies in the fact that the muscles of the corpse become denser, due to which a slight bending of the limbs can even be observed. The onset of rigor mortis depends on the ambient temperature. At room temperature, it becomes noticeable after 2-3 hours, it is expressed after 6-8 hours from the moment of death, and after a day it begins to resolve, and completely disappears by the end of the second day. With more high temperature this process is faster, at low - slower. In the corpses of emaciated, debilitated patients, rigor mortis is weakly expressed.

cadaveric spots are bluish-purple bruises that appear at the places of contact of the corpse with a solid support. In the first 8-12 hours, when the position of the corpse changes, cadaveric spots can move under the influence of gravity, then they are fixed in the tissues.

Symptom of "cat pupil" lies in the fact that when the eyeball of a corpse is squeezed from the sides, the pupil takes on an oval and then a slit-like shape, like in a cat, which is not observed in living people and in a state of clinical death.

The list of signs of biological death could also be continued, however, these signs are the most reliable and sufficient for practical activities.

An extremely important fact is that between the moment of development of biological death and the appearance of its reliable signs, a rather significant time passes - at least 2 hours. During this period, if the time of circulatory arrest is unknown, the patient's condition should be regarded as clinical death, since there are no reliable signs of biological death.