Early symptoms of biological death include. What is clinical death - signs, maximum duration and consequences for human health

Biological death is an 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, occurs after a violent murder or an accident.

Causes of biological death

The primary reasons are :

Damage that is incompatible with life.
Profuse bleeding.
Concussion, squeezing of vital organs.
State of shock.

Secondary reasons include:

Different .
The strongest intoxication of the body.
non-communicable diseases.

Symptoms of death

It is on the basis of some signs that death is ascertained. First, the heart stops, the person stops breathing, and after 4 hours a large number of cadaveric spots appear. Rigor numbness occurs due to circulatory arrest.

How to recognize biological death?

There is no respiratory and cardiac activity - there is no pulse on the carotid artery, the beat of the heart is inaudible.
Absence of cardiac activity for more than half an hour.
The pupils are maximally dilated, while there is no corneal reflex, there is no reaction to light.
Hypostasis (the 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 symptomatology appears in case of severe hypothermia of the body, which depresses the effect of drugs on the nervous system.

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

The heart after death can be viable for two hours, and the liver and kidneys live for about four hours. The longest viable tissue is muscle, 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 on the body of Larcher spots (triangles of dried skin).
Cat's eye syndrome (elongated pupil shape during squeezing of the eyes).
Cloudy pupil with white film.
The lips become brown, thick and wrinkled.

Attention! If all of the above symptoms are present, resuscitation is not carried out. It is meaningless in this case.

Late symptoms include:

Spots on the body of a marble color.
Cooling of the body, because the temperature drops.

When does the doctor declare death?

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

motor response to pain.
Consciousness.
Corneal reflex.
Cough, gag reflex.

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

Electroencephalography.
Angiography.
Ultrasonography.
Magnetic resonance angiography.

The main stages of biological death

Predagony- sharply suppressed or completely absent. In this case, the skin turns pale, it is poorly palpable on the carotid, femoral artery, the pressure decreases 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 the case of the negative impact of destructive processes, the above stages are absent. As a rule, the first and last stages last several minutes or days.

Medical diagnosis of biological death

In order not to be mistaken in death, many experts use different tests and methods:

Winslow test- a vessel filled with water is placed on the chest of a dying person, with the help of vibration they learn about respiratory activity.
Auscultation , palpation of the central, peripheral vessels.
Magnus test - tightly pull the finger, if it is gray-white, then the person has died.

Previously, more stringent samples were used. For example, the José test involved pinching the skin fold with special forceps. During the Desgrange test, boiling oil was injected into the nipple. But during the Raze test, red-hot iron was used, heels and other parts of the body were burned with it.

Assistance to the victim

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

Immediately eliminate the damaging factor - squeezing the body, electricity, low or high temperature.
Save the victim from adverse conditions - take out of the burning room, pull out of the water.
First aid will depend on the type of disease, injury.
Urgent transport of the victim to the hospital.

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

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

Actions should be quick, expedient, calm, deliberate.
Realistically evaluate the environment.
Don't panic, you need to assess what state the person is in. To do this, you need to learn about the nature of the injury, disease.
Call an ambulance or transport the victim yourself.

Thus, biological death is the end of human life. It is very important to distinguish it from, in the latter case, the victim can be helped. If, nevertheless, it was not possible to avoid a tragic situation, you should not take action 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 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 heavy 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 watch glass to your lips, 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. The upper eyelid of the victim rises and the size of the pupil is determined visually, the eyelid drops 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 case of biological (irreversible) death, when irreversible changes occur in the tissues of the brain and many organs.

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. The eyeball is squeezed with the thumb and forefinger, if the person is dead, then his pupil will change shape and turn into a narrow slit - the “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 of skeletal muscles "from top to bottom", i.e. face - neck - upper limbs - torso - 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, since under his clothes on the sternum there may be a pectoral cross, a medallion, buttons, etc., which can become sources of additional injury, as well as unfasten the waist belt.

For airway management it is necessary: 1) to clean the oral cavity from mucus, vomit with a cloth wound around the index finger. 2) to eliminate the retraction of the tongue in two ways: by tilting the head back or by protruding the lower jaw.

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 of the right hand. The left hand is released, so with it (thumb and forefinger) it is necessary to pinch the victim's nose. So the victim is prepared for artificial lung ventilation (ALV).

2. Clinical death, its causes and signs. biological death.

When the heart stops, the supply of oxygen to all cells in the body is cut off. However, they do not die immediately, but continue to function for some time. For brain cells, this time is 4-6 minutes. This period, when brain cells have not yet died, is called the state of clinical death. V.A. Negovsky defines it this way: "No longer life, but not yet death." If during this time to restore cardiac activity and breathing, then the victim can be revived. Otherwise, biological death occurs.

Causes clinical death can be: blockage of the respiratory tract with vomit and earth, electrical injury, drowning, poisoning with OM, flooding with earth, myocardial infarction, severe nervous shock (fear or joy), etc.

Signs of clinical death.

The victim, who is in a state of clinical death, is motionless, he has no consciousness. The skin is pale or cyanotic. The pupils are sharply dilated and do not react to light. There is no breathing and heart activity. Its absence is determined by the pulse on the large arteries (carotid and femoral) and by listening to heart sounds.

With the development biological death the victim also has no pulse on the carotid artery, no breathing, no pupillary reflex, skin temperature below 20ºС. 30 minutes after cardiac arrest, cadaveric spots and rigor mortis appear (difficult movements in the joints). One of the early signs of the onset of biological death is the sign of Beloglazov (a symptom of the cat's pupil). With lateral compression of the eyeball, the pupil of the corpse acquires an oval shape, and with clinical death, the shape of the pupil does not change.

The constant of biological death is carried out by a doctor. If there are signs of biological death, the police should be called.

3. First aid for sudden cessation of breathing and cardiac activity

In life, such a (or similar) situation may occur: a person is sitting, talking, and suddenly suddenly loses consciousness. Those present have a natural desire to help him, but they do not know how to do it. And, nevertheless, in cases of sudden cessation of breathing and cardiac activity, only people who are nearby at that moment can help the victim. To do this correctly, you must be able to assess the condition of the victim and master first aid techniques.

How to assess the condition of the victim? If he turned pale, lost consciousness, but breathing persists (the chest or epigastric region rises) and the heart works (pulsation on the carotid artery is determined), then the victim faints. In those cases when the cyanosis of his lips, fingertips, face grows, one must think about the primary cessation of breathing. Secondary respiratory arrest occurs shortly after cardiac arrest. The victim's face is pale grey.

What are the causes of sudden respiratory arrest? This is, first of all, the obstruction of the respiratory tract, caused by the ingress of foreign bodies, the retraction of the tongue in persons who are in an unconscious state; swelling and spasm of the glottis, drowning, compression of the larynx from the outside. Sudden cessation of breathing is also possible in case of damage to the respiratory center by electric current or lightning, poisoning with sleeping pills or narcotic drugs, with a sharp inhalation of highly irritating and toxic substances, etc.

After stopping breathing, cardiac activity stops very soon, so you need to hurry with helping the victim. If the victim's heart is still working, then first aid will consist of artificial respiration.

First aid for sudden respiratory arrest

First of all, it is necessary to examine the victim's oral cavity and remove foreign bodies. You can do this with two fingers, wrapping them in a napkin or handkerchief. Lay the victim on a flat, hard surface on their back. Release the chest and abdomen from clothing. Place a cushion under your shoulders and tilt your head back so that your chin is almost in line with your neck. Pull up the tongue if it sinks deep. These techniques allow you to create better air permeability into the lungs.

If you have a special s-shaped breathing tube at hand, then artificial respiration is best done using this tube. One end is inserted into the mouth, pushing the root of the tongue away, and the other end is blown.

In the absence of a breathing tube, artificial respiration is carried out from mouth to mouth, and in case of damage to the oral cavity, from mouth to nose. Before that, a napkin or handkerchief is placed on the face (for hygienic purposes). With one hand, support the lower jaw, push it forward and open the mouth. The palm of the other hand is pressed on the forehead, and the nose is squeezed with the first and second fingers so that when blowing in, the air does not come out through it. After that, the assisting person presses his lips tightly to the victim's lips and makes an energetic blow. In this case, the chest of the victim expands (inhale). Exhalation is passive. In order not to interfere with exhalation, the caregiver after each inhalation should turn his head to the side. Artificial respiration is usually performed at a frequency of 12-14 per minute.

In children, blowing is performed at a frequency of about 20 per minute, and the volume of air must be appropriate for age so as not to damage the lungs. In practice, the volume of air blown in can be determined by the degree of respiratory excursions (movements) of the chest.

If the victim's head is not tilted back enough, then air will enter the stomach, and not the lungs. You can notice this by the increasing in size of the epigastric region. If this happens, it is necessary to turn the head of the victim on its side and gently press on the epigastric region to remove air from the stomach. After that, inspect the oral cavity, remove the contents of the stomach from it, throw back the head and continue artificial respiration.

Artificial ventilation of the lungs is carried out until spontaneous breathing occurs. It is restored gradually and at the beginning it may be insufficient, therefore, the so-called auxiliary breathing is carried out for some more time: at the height of an independent breath, an additional amount of air is blown into the lungs of the victim.

There are, however, also such cases when at first the heart stops, and then breathing also stops. Cells of tissues and organs, deprived of oxygen and nutrients, begin to die. Before others die brain cells, as the most sensitive to lack of oxygen. At normal temperature, the cells of the cerebral cortex die, as previously mentioned, 4-6 minutes after the cessation of blood circulation in the body.

If the victim is diagnosed with a state of clinical death, it is necessary to urgently carry out a set of resuscitation measures at the scene of the incident - artificial respiration and external (indirect) heart massage. With the help of resuscitation measures, the victim can be saved. If they themselves fail to restore cardiac activity, then these measures will artificially maintain blood circulation and respiration until the arrival of a medical worker.

clinical death

clinical death- a reversible stage of dying, a transitional period between life and biological death. At this stage, the activity of the heart and the process of breathing cease, all external signs of the vital activity of the organism completely disappear. At the same time, hypoxia (oxygen starvation) does not cause irreversible changes in the organs and systems most sensitive to it. This period of the terminal state, with the exception of rare and casuistic cases, lasts on average no more than 3-4 minutes, a maximum of 5-6 minutes (with an initially low or normal body temperature). Possibly survival.

Signs of clinical death

Signs of clinical death include: coma, apnea, asystole. This triad concerns the early period of clinical death (when several minutes have passed since asystole), and does not apply to cases where there are already clear signs of biological death. The shorter the period between the statement of clinical death and the start of resuscitation, the greater the chances of life for the patient, so diagnosis and treatment are carried out in parallel.

Coma is diagnosed based on the absence of consciousness and dilated pupils that do not respond to light.

Apnea is recorded visually, by the absence of respiratory movements of the chest.

Asystole is recorded by the absence of a pulse in the two carotid arteries. Before determining the pulse, it is recommended that the victim be artificially ventilated.

Treatment

Main article: Cardiopulmonary resuscitation

In 2000, the I World Scientific Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care was held, at which for the first time unified international recommendations were developed in the field of resuscitation of the body (Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care).

From a practical point of view, cardiopulmonary resuscitation (CPR) can be divided into 2 stages:

1. Basic Life Support- basic resuscitation (basic CPR or primary resuscitation complex), which may conduct non-professional rescuers (trained volunteers, firefighters, and others), as well as must carried out by medical workers.

Basic CPR is airway management ( A irway), artificial lung ventilation ( B reathing) and chest compressions ( C circulation). In fact, basic CPR is the initial stage of recovery, when the rescuer often finds himself alone with the victim, and is forced to carry out resuscitation "empty-handed".

2. Advanced Cardiovascular Life Support- specialized resuscitation measures (specialized or extended CPR), which must be performed by medical personnel trained and equipped with appropriate equipment and medicines (ambulance service, doctors of the intensive care unit and intensive care unit).

Specialized CPR implies the consistent implementation of the same techniques as in basic CPR, but with the use of resuscitation equipment, medicines, which makes it much more effective.

Pathophysiological basis of clinical death

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

First term clinical death lasts only 3-5 minutes. This is the time during which the higher parts of the brain retain their viability during anoxia (lack of oxygen supply to organs, in particular the brain) under normothermic conditions (body temperature - 36.5 ° C). All world practice shows that if this period is exceeded, people can be revived, but as a result, decortication (death of the cerebral cortex) or even decerebration (death of all parts of the brain) occurs.
But maybe second term clinical death that doctors have to deal with when providing care or in special conditions. The second period of clinical death can last tens of minutes, and resuscitation measures (methods of resuscitation) will be very effective. The second period of clinical death is observed when special conditions are created to slow down the processes of degeneration of the higher parts of the brain during hypoxia (decrease in the oxygen content in the blood) or anoxia (see above).

The duration of clinical death increases under conditions of hypothermia (artificial cooling of an organ or the whole organism), with electric shocks, and with drowning. In clinical practice, this can be achieved through physical effects (hypothermia of the head, hyperbaric oxygenation - breathing oxygen at elevated pressure in a special chamber), the use of pharmacological substances that create a state similar to suspended animation (a sharp decrease in metabolism), hemosorption (hardware blood purification), transfusion of fresh (not canned) donor blood and some others.

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

Clinical death in culture

There is a point of view that during an episode of clinical death, a person sees the “afterlife”. Some patients who have experienced near-death experience describe similar experiences (see Near-Death Experiences). Common to all these observations is often the feeling of flying, moving through a dark tunnel towards the light, a feeling of calm and peace, meeting with deceased relatives, etc. This phenomenon is called near-death experiences.

The main problem is that the brain almost completely stops its work soon after the heart stops. It follows that in a state of clinical death, a person, in principle, cannot feel or experience anything.

There are two ways to explain this problem. According to the first, human consciousness can exist independently of the human brain. And near-death experiences could well serve as confirmation of the existence of the afterlife. Most scientists consider such experiences to be hallucinations caused by cerebral hypoxia. According to this point of view, near-death experiences are experienced by people not in a state of clinical death, but in the earlier stages of brain death during the preagonal state or agony, as well as in the period of coma, after the patient has been resuscitated. Despite this, science knows cases when patients, leaving the state of clinical death due to resuscitation, later said that they remember what happened in the place where they were resuscitated, including the actions of resuscitators to the smallest detail[ source not specified 434 days]. From a medical point of view, this is impossible, if only because the activity of the brain is practically absent.

From the point of view of pathological physiology, these sensations are quite naturally conditioned. As a result of hypoxia, the work of the brain is inhibited from top to bottom from the neocortex to the archeocortex.

The cerebral cortex is depressed: tunnel vision develops, the recognition of images coming from the retina ceases to function - this is precisely what causes the vision of a light spot in front.

Then the brain stops receiving data from the visual analyzer, and foci of stable excitation of the cortex are formed, supporting the picture of continuous illumination, the person, as it were, approaches the light, this illusion arises due to signal reverberation in the visual cortex of the brain, which imitates the amplification and propagation of light in front of the eyes sick. This also explains the phenomenon of seeing light spots in the blind, when the eyes are damaged, the visual cortex, as a rule, does not suffer, and is quite capable of generating a signal that imitates the flow of data from the visual analyzer. source not specified 423 days]

The sensation of flying or falling occurs as a result of ischemia. There is a lack of oxygen for the vestibular analyzer, as a result of which the brain ceases to analyze and adequately perceive the data coming from the receptors of the vestibular apparatus.

Also, in some cases, this condition may be accompanied by specific hallucinations. For religious people, these can indeed be pictures of the afterlife, and what a person sees can vary significantly depending on his life experience and individual characteristics. These hallucinations are often very similar to similar experiences in mental illness.

/ Death

Death, cessation of the vital activity of the organism and, as a result, the death of the individual as a separate living system, accompanied by decomposition proteins and others biopolymers, which are the main material substrate life. At the heart of modern dialectical-materialist ideas about S. lies the idea expressed by F. Engels: “Even now, they do not consider scientific that physiology that does not consider death as an essential moment of life ... that does not understand that the denial of life essentially contains in life itself, so that life is always conceived in relation to its necessary result, which is constantly in its embryo - death "(K. Marx and F. Engels, Soch., 2nd ed., g. 20, p. 610 ).

Sometimes the concept of partial S. is distinguished, that is, S. of a group of cells, part or whole organ (see. Necrosis). In unicellular organisms protozoa- natural S. of an individual manifests itself in the form of division, since it is associated with the cessation of the existence of a given individual and the emergence of two new ones instead of it. The page of an individual is usually followed by formation of a corpse. Depending on the reasons for the onset of S., in higher animals and humans, there are: natural S. (also called physiological), which occurs as a result of a long, sequentially developing extinction of the main vital functions of the body (see. Aging), and S. premature (sometimes called pathological), caused by painful conditions of the body, lesions of vital organs (brain, heart, lungs, liver, etc.). Premature S. can be sudden, that is, it can occur within a few minutes and even seconds (for example, with a heart attack). S. violent can be the result of an accident, suicide, murder.

The page of warm-blooded animals and the person is connected with the termination first of all breath and blood circulation. Therefore, there are 2 main stages C .; so-called. clinical death and the following so-called. biological, or true. After the period of clinical S., when a full restoration of vital functions is still possible, biological S. sets in - an irreversible cessation of physiological processes in cells and tissues. All processes connected with S., studies thanatology.

Lit.: Mechnikov I.I., Etudes of optimism, 4th ed., M., 1917; Shmalgauzen I. I., The problem of death and immortality, M. - L., 1926; Ilyin N. A., Modern science of life and death, Kish., 1955; Lunts AM, On the evolution of death in connection with the evolution of reproduction, "Journal of General Biology", 1961, vol. 22, no. 2; Polikar A., Bessie M., Elements of cell pathology, trans. from French, Moscow, 1970.

clinical death

clinical death, a state of the body characterized by the absence of external signs of life (cardiac activity and respiration). During To. the functions of the central nervous system fade away, however, metabolic processes are still preserved in the tissues. K. s. continues 5-6 min after cardiac and respiratory arrest (dying from blood loss); with a sudden cessation of blood flow (for example, with ventricular fibrillation of the heart), the dying time is extended to 8-10 min. After this time, a full restoration of vital functions is no longer possible. For more details, see

biological death comes after the clinical and is characterized by the fact that against the background of ischemic damage, irreversible changes in organs and systems occur. Its diagnosis is carried out on the basis of the presence of signs of clinical death, followed by the addition of early, and then late signs of biological death.

TO early signs of biological death include drying and clouding of the cornea and the symptom of "cat's eye" (to detect this symptom, you need to squeeze the eyeball. The symptom is considered positive if the pupil is deformed and stretched in length). By late signs of biological death include cadaveric spots and rigor mortis.

biological death(irreversible cessation of biological processes in the cells and tissues of the body). Distinguish between natural (physiological) death, which occurs as a result of a long, sequentially developing extinction of the body's main vital functions, and premature (pathological) death, which is caused by a diseased state of the body, damage to vital organs. Premature death can be sudden, i.e. occur within minutes or even seconds. Violent death can be the result of an accident, suicide, murder.

The biological death of an individual after stopping breathing and cardiac activity does not occur immediately. The most vulnerable to hypoxia and circulatory arrest is the brain. Irreversible brain damage develops with uncorrected severe hypoxia or with circulatory arrest for more than 3-5 minutes. Immediate application of modern methods cardiopulmonary resuscitation(revival) can prevent the onset of biological death.

Signs of biological death The fact of the onset of biological death can be established by the presence of reliable signs, and before they appear - by the totality of signs.

Reliable signs of biological death:

1. Cadaverous spots - begin to form 2-4 hours after cardiac arrest. 2. Rigor mortis - manifests itself 2-4 hours after circulatory arrest, reaches a maximum by the end of the first day and spontaneously disappears on 3-4 days. A set of signs that allows stating biological death before the appearance of reliable signs:

1. Absence of cardiac activity (no pulse on the carotid arteries, heart sounds are not heard). 2. The time of the absence of cardiac activity was reliably established for more than 30 minutes under conditions of normal (room) ambient temperature. 3. Lack of breath. 4. The maximum expansion of the pupils and the absence of their reaction to light. 5. Lack of corneal reflex. 6. The presence of postmortem hypostasis (dark blue spots) in the sloping parts of the body. These signs are not grounds for ascertaining biological death when they occur under conditions of deep cooling (body temperature + 32 ° C) or against the background of the action of drugs that depress the central nervous system.

The biological death of the subject does not mean the simultaneous biological death of the tissues and organs that make up his body. The time to death of the tissues that make up the human body is mainly determined by their ability to survive in conditions of hypoxia and anoxia. In different tissues and organs, this ability is different. The shortest lifetime under anoxic conditions is observed in the brain tissue, to be more precise, in the cerebral cortex and subcortical structures. The stem sections and the spinal cord have a greater resistance, or rather resistance to anoxia. Other tissues of the human body have this property to a more pronounced degree. Thus, the heart retains its viability for 1.5-2 hours after the onset, according to modern concepts, 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. The phenomenon of survival of organs and tissues of the human body is associated with the possibility of their transplantation, and the earlier after the onset of biological death organs are removed for transplantation, the more viable they are, the greater the likelihood of their successful further functioning in a new organism.

Diagnosis of death

The fear of making a mistake in diagnosing death pushed doctors to develop methods for diagnosing death, create special life tests, or create special conditions for burial. So, in Munich for more than 100 years there was a tomb in which the hand of the deceased was wrapped with a cord from the bell. The bell rang only once, and when the attendants came to help the patient who had woken up from a lethargic sleep, it turned out that rigor mortis had resolved. At the same time, from the literature and medical practice, there are known cases of delivery to the morgue of living people who were mistakenly diagnosed as dead by doctors.

The biological death of a person is ascertained by a set of signs associated with the "vital tripod": the activity of the heart, the safety of breathing and the function of the central nervous system. Checking the safety of respiratory function. Currently, there are no reliable signs of respiratory safety. Depending on the environmental conditions, you can use a cold mirror, fluff, auscultate (listen to) breathing or Winslow's test, which consists in placing a vessel with water on the patient's chest and the presence of respiratory movements of the chest wall is judged by fluctuations in the water level. A gust of wind or draft, high humidity and temperature in the room, or passing traffic can affect the results of these studies, and conclusions about the presence or absence of breathing will be incorrect.

More informative for the diagnosis of death are tests that indicate the preservation of cardiovascular function. Auscultation of the heart, palpation of the pulse on the central and peripheral vessels, palpation of the heart impulse - these studies cannot be fully considered reliable. Even when examining the function of the cardiovascular system in the clinic, very weak heartbeats may not be noticed by the doctor, or the contractions of one's own heart will be assessed as the presence of such a function. Clinicians advise auscultation of the heart and palpation of the pulse at short intervals, lasting no more than 1 minute. Very interesting and conclusive, even with minimal blood circulation, is the Magnus test, which consists in a tight constriction of the finger. With the existing blood circulation at the site of the constriction, the skin turns pale, and the peripheral one acquires a cyanotic hue. After removing the constriction, the color is restored. Certain information can be given by viewing the earlobe through the lumen, which, in the presence of blood circulation, has a reddish-pink color, and in a corpse it is gray-white. In the last century, very specific tests were proposed to diagnose the preservation of the function of the cardiovascular system, for example: Verne's test - an arteriotomy (opening) of the temporal artery, or Bush's test - a steel needle injected into the body, loses its luster in a living person after half an hour, the first Icarus test - intravenous administration of a solution of fluorescein gives a quick staining of the skin of a living person in a yellowish color, and the sclera in a greenish color, and some others. These samples are currently only of historical and not practical interest. It is hardly reasonable to perform an arteriotomy in a person who is in a state of shock and at the scene where it is impossible to comply with the conditions of asepsis and antiseptics, or to wait half an hour until the steel needle becomes dull, and even more so to inject fluorescein, which in the light of a living person causes hemolysis (destruction of red blood cells). blood with the release of hemoglobin into the environment).

Preservation of the function of the central nervous system is the most important indicator of life. At the scene of the incident, the ascertainment of brain death is fundamentally impossible. The function of the nervous system is checked by the preservation or absence of consciousness, the passive position of the body, the relaxation of the muscles and the absence of its tone, the absence of a reaction to external stimuli - ammonia, weak pain effects (needle pricking, rubbing the earlobe, tapping on the cheeks and others). Valuable signs are the absence of a corneal reflex, the reaction of pupils to light. But both these and the previous signs, in principle, may be absent even in a living person, for example, in case of poisoning with sleeping pills, drugs, collapse and in other conditions. Therefore, it is impossible to treat these signs unambiguously, they must be evaluated critically, taking into account a possible disease or pathological condition. In the last century, extremely unusual and sometimes quite cruel methods have been used to test the function of the nervous system. So, the Josa test was proposed, for which special forceps were invented and patented. When a skin fold was pinched in these forceps, a person experienced severe pain. Also, based on the pain reaction, the Degrange test is based - the introduction of boiling oil into the nipple, or the Raze test - blows to the heels, or cauterization of the heels and other parts of the body with a hot iron. The tests are very peculiar, cruel, showing to what tricks the doctors reached in the difficult problem of ascertaining the function of the central nervous system.

One of the earliest and most valuable signs of the onset of death is the "feline pupil phenomenon", sometimes called Beloglazov's sign. The shape of the pupil in a person is determined by two parameters, namely: the tone of the muscle that narrows the pupil, and intraocular pressure. And the main factor is muscle tone. In the absence of the function of the nervous system, the innervation (connection of organs and tissues with the central nervous system with the help of nerves) of the muscle that narrows the pupil stops, and its tone is absent. When squeezed with fingers in the lateral or vertical directions, which must be done carefully so as not to damage the eyeball, the pupil becomes oval. Contributing moment for changing the shape of the pupil is the drop in intraocular pressure, which determines the tone of the eyeball, and it, in turn, depends on blood pressure. Thus, the sign of Beloglazov, or "the phenomenon of the cat's pupil" indicates the absence of innervation of the muscle and, at the same time, a drop in intraocular pressure, which is associated with arterial pressure.

Declaring the death of a person Ascertaining the death of a person occurs with brain death or biological death of a person (irreversible death of a person). Biological death is established on the basis of the presence of cadaveric changes (early signs, late signs). Brain (social) death. Clinic (signs) of brain death.

« Brain (social) death"- this diagnosis appeared in medicine with the development of resuscitation. Sometimes in the practice of resuscitators there are cases when, during resuscitation, it is possible to restore the activity of the cardiovascular system in patients who were in a state of clinical death for more than 5-6 minutes, but these patients have already undergone irreversible changes in the brain.

The diagnosis of brain death is established in health care institutions that have the necessary conditions for ascertaining brain death. The death of a person on the basis of brain death is established in accordance with Instructions for ascertaining the death of a person on the basis of the diagnosis of brain death, approved by the order of the Ministry of Health of the Russian Federation of December 20, 2001 No. 460 "On approval of the Instructions for ascertaining the death of a person on the basis of the diagnosis of brain death" (the order was registered by the Ministry of Justice of the Russian Federation on January 17, 2002 No. 3170).

35. Signs of life and absolute signs of death.

SIGNS OF LIFE

The signs of life are:

retained breath. It is determined by the movement of the chest and abdomen, the fogging of a mirror applied to the nose and mouth, the movement of a ball of cotton wool or a bandage brought to the nostrils;

the presence of cardiac activity. It is determined by probing the pulse - jerky, periodic oscillations of the walls of peripheral vessels. You can determine the pulse on the radial artery, located under the skin between the styloid process of the radius and the tendon of the internal radial muscle. In cases where it is impossible to examine the pulse on the radial artery, it is determined either on the carotid or temporal artery, or on the legs (on the dorsal artery of the foot and posterior tibial artery). Usually, the pulse rate in a healthy person is 60-75 beats / min, the pulse rhythm is correct, uniform, the filling is good (it is judged by squeezing the artery with fingers with different strengths).

pupillary response to light. It is determined by directing a beam of light from any source to the eye; constriction of the pupil indicates a positive reaction. In daylight, this reaction is checked as follows: close the eye with a hand for 2-3 minutes, then quickly remove the hand; if the pupils narrow, then this indicates the preservation of the functions of the brain.

The absence of all of the above is a signal for immediate resuscitation (artificial respiration, chest compressions) until signs of life are restored.

SIGNS OF DEATH

The onset of biological death - the irreversible cessation of the life of the body - is preceded by agony (a condition preceding the onset of death and from the outside representing a kind of struggle between life and death) and clinical death (a reversible state of deep oppression of all vital functions)

Agony is characterized by:

darkened consciousness,

lack of pulse

respiratory disorder, which becomes irregular, superficial, convulsive,

lowering blood pressure.

the skin becomes cold, with a pale or bluish tint.

after the agony comes clinical death.

Clinical death is a condition in which the main signs of life are absent:

heartbeat;

consciousness

but irreversible changes in the body have not yet developed.

Clinical death lasts 5-8 minutes. This period must be used to provide resuscitation. After this time, biological death occurs.

Signs of biological death are:

lack of breathing;

lack of heartbeat;

lack of sensitivity to pain and thermal stimuli;

decrease in body temperature;

clouding and drying of the cornea of \u200b\u200bthe eye;

residual deformation of the pupil after careful compression of the eyeball with fingers (cat's eye syndrome).

lack of a gag reflex;

cadaveric spots of blue-violet or purple-red color on the skin of the face, chest, abdomen;

rigor mortis, which manifests itself 2-4 hours after death.

The final decision on the death of the victim is made in accordance with the procedure established by law.

Question 2. Clinical and biological death, brain death

Clinical death is the last stage of dying, which is a reversible state in which there are no visible signs of life (cardiac activity, respiration), the functions of the central nervous system fade away, but metabolic processes in tissues remain. It lasts for several minutes (up to 3-5, less often - up to 7), is replaced by biological death - an irreversible condition in which the restoration of vital functions is impossible.

Clinical death diagnosis based on the main and additional features.

Main:

Lack of consciousness - the victim does not respond to speech addressed to him, pain stimuli;

Absence of a pulse in the carotid artery;

Absence of breath.

Additional:

Discoloration of the skin (severe pallor or cyanosis)

Pupil dilation.

Irreversible cessation of the activity of the respiratory, cardiovascular and central nervous systems is biological death. The statement of biological death is carried out on the basis of probabilistic and reliable signs of death.

The probabilistic signs of death include the absence of activity of the nervous system, heartbeat and external respiration. There is no reaction to an external stimulus, sensitivity, muscle tone. The position of the body is passive and immobile. The activity of the heart (blood pressure, pulse, any other signs of heart contractions) is not determined, breathing is not detected.

Reliable signs of death include a complex of cadaveric changes - early (cadaveric cooling, local cadaveric drying, muscle rigor mortis, cadaveric spots), or late (rotting, preserving cadaveric phenomena - fat wax, mummification, etc.). Reliable signs of death should also include the phenomenon of the "cat's pupil" (Beloglazov's sign), which can be observed 10–15 minutes after cardiac arrest and cessation of blood supply to the brain. The sign is that when the eyeball of a corpse is squeezed in the transverse or vertical direction, the pupil, respectively, takes the form of a vertical or horizontal slit (the pupil of a living person remains round). The manifestation of the symptom is due to post-mortem relaxation (relaxation) of the circular muscle of the eye, which determines the round shape of the pupil in humans during life. Damage incompatible with life (for example, dismemberment of the body) also indicates a reliably occurring biological death.

For the human condition, the social and legal concept of "brain death" is defined - the irreversible cessation of activity (death) of the higher parts of the central nervous system (cerebral cortex). “Brain death” is a condition when there is a total death of the entire brain, while with the help of resuscitation measures, the function of the heart and blood circulation are artificially maintained, creating the appearance of life. In a state of brain death, a person is dead. We can say that the death of the brain is the death of the whole organism. Currently, “brain death” is understood as a pathological condition associated with total necrosis of the brain, as well as the first cervical segments of the spinal cord, while maintaining cardiac activity and gas exchange, provided by continuous mechanical ventilation. Brain death is caused by the cessation of blood circulation in the brain. The actual synonym for brain death is the concept of "transcendental coma", the treatment of which is meaningless. The patient, who has been diagnosed with brain death, is a living corpse, as they say, the drug "heart - lungs". The introduction of the concept was dictated primarily by the tasks of transplantology (the science of tissue or organ transplantation). The concept is legal. With brain death, the functions of respiration and cardiac activity can be artificially maintained by medical measures or sometimes be preserved. Human brain death naturally and irreversibly eventually leads to biological death. However, even before the onset of biological death, with the death of the higher parts of the central nervous system, a person completely ceases to exist as a social individual, although biological death as such does not yet occur. Quite often, in various literature, including scientific literature, the state of relative life during brain death is defined by the term "plant life".

Ascertaining brain death is a rather rare situation in medical practice. Much more often in clinical practice and at the scene, doctors have to state biological death. The problem of ascertaining death is extremely complex and requires an integrated approach for a correct solution; it is most closely connected with the professional, ethical and legal side of the activity of a doctor of any specialty. Questions of life and death have always excited and excited the minds of mankind. And when there were problems of the correct definition of death, its certification, the average person cannot always correctly assess the actions of a professional doctor and correctly interpret his actions. Diagnosis (stating) of death, or rather an assessment of the actions of a doctor, is associated with widely held ideas about burial in a state of lethargic sleep (imaginary death), that is, such a state of the body in which the main functions are expressed so weakly that they are invisible to an outside observer. Legends of those buried alive have been around for a long time. In a number of cases, they are based on quite understandable facts, the cause of which is some post-mortem processes. P.A. Minakov at the beginning of our century listed post-mortem phenomena that can simulate intravital processes and cause suspicion of being buried alive. First of all - this is "birth in a coffin." During the burial of the corpse of a pregnant woman, as a result of the pressure of putrefactive gases and rigor mortis, the fetus is mechanically squeezed out of the uterus; and during exhumation, the skeleton of the fetus is found between the legs of the corpse. Change in the posture of the corpse, due to the resolution (destruction) of rigor mortis. Deposition of drops of moisture from the air on the body of a corpse, which is perceived as intravital sweating. Pink coloration of the skin and visible mucous membranes upon death from carbon monoxide poisoning (fumes), which are perceived by others as a natural skin color. Rigor rigor or its resolution can cause air to be squeezed out of their lungs, accompanied by sounds. Leakage of blood from wounds, especially if the wounds are localized on the lower parts of the body in the area of cadaveric spots.

The fear of making a mistake in diagnosing death pushed doctors to develop methods for diagnosing death, create special life tests, or create special conditions for burial. So, in Munich for more than 100 years there was a tomb in which the hand of the deceased was wrapped with a cord from the bells. The bell rang one single time, and when the attendants came to help the patient who had awakened from a lethargic sleep, it turned out that rigor mortis had resolved.

Thus, summing up the issue under consideration, it should be noted that the social and legal concept of "brain death" is defined for the human condition - the death of the higher parts of the central nervous system, which is ascertained by a doctor in a medical institution. At the scene of the incident and in the morgue, a statement of biological death is made, the probabilistic signs of the onset of which include the absence of activity of the nervous system, heartbeat and external respiration (i.e. signs of clinical death), and the reliable - a complex of cadaveric changes.

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 injury, drowning, reflex cardiac arrest, acute poisoning, etc.

clinical death

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.

Definition of signs of clinical death:

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

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

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

biological death

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

Determination of signs of 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.

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.

5. Rigor mortis - 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 a day after death.

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 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.

The human eye has a complex structure, its components are connected to each other and function according to a single algorithm. Ultimately, they form a picture of the surrounding world. This complex process works thanks to the functional part of the eye, the basis of which is the pupil. Pupils before death or after it change their qualitative state, therefore, knowing these features, it is possible to determine how long ago a person died.

Anatomical features of the structure of the pupil

The pupil looks like a round hole in the center of the iris. It can change its diameter by adjusting the area of absorption of light rays falling on the eye. This opportunity is provided to him by the eye muscles: sphincter and dilator. The sphincter surrounds the pupil, and when contracted, it narrows. The dilator, on the contrary, expands, communicating not only with the pupillary opening, but also with the iris itself.

The pupillary muscles perform the following functions:

Change the diametrical size of the pupil under the action of light and other stimuli that enter the retina.
Set the diameter of the pupillary hole depending on the distance at which the image is located.
Converge and diverge on the visual axes of the eyes.

The pupil and the muscles surrounding it work according to a reflex mechanism that is not associated with mechanical irritation of the eye. Since the impulses passing through the nerve endings of the eye are sensitively perceived by the pupil itself, it is able to respond to the emotions experienced by a person (fear, anxiety, fright, death). Under the influence of such a strong emotional arousal, the pupillary openings expand. If the excitability is low, they narrow.

Causes of narrowing of the pupillary openings

During physical and mental stress, the eye holes in people can narrow to ¼ of their usual size, but after rest they quickly recover to their usual dimensions.

The pupil is very sensitive to certain drugs that affect the cholinergic system, such as heart and sleeping pills. That is why the pupil temporarily narrows when they are taken. There is a professional deformation of the pupil in people whose activities are associated with the use of a monocle - master jewelers and watchmakers. In diseases of the eye, such as corneal ulcer, inflammation of the vessels of the eye, omission of the eyelid, internal hemorrhage, the pupillary opening also narrows. Such a phenomenon as a cat's pupil at death (Beloglazov's symptom) also passes through the mechanisms inherent in the eyes and muscles of those around them.

pupil dilation

Under normal circumstances, an increase in pupils occurs at night, in low light conditions, with the manifestation of strong emotions: joy, anger, fear, due to the release of hormones into the blood, including endorphins.

Strong expansion is observed with injuries, drug use and eye diseases. A constantly dilated pupil may indicate intoxication of the body associated with exposure to chemicals, hallucinogens. With craniocerebral injuries, in addition to a headache, the pupillary openings will be unnaturally wide. After taking atropine or scopolamine, their temporary expansion may occur - this is a normal side reaction. In diabetes mellitus and hyperthyroidism, the phenomenon occurs quite often.

Pupil dilation at death is a normal reaction of the body. The same symptom is characteristic of coma.

Classification of pupillary reactions

Pupils in a normal physiological state are round, of the same diameter. When the light changes, a reflex expansion or contraction occurs.

Constriction of the pupils depending on the reaction

What do pupils look like when you die?

The reaction of pupils to light at death passes first by the mechanism of field expansion, and then by their narrowing. Pupils during biological death (final) have their own characteristics when compared by pupils with a living person. One of the criteria for establishing a post-mortem examination is to check the eyes of the deceased.

First of all, one of the signs will be the "drying" of the cornea of the eyes, as well as the "fading" of the iris. Also, a kind of whitish film is formed before the eyes, called “herring shine” - the pupil becomes cloudy and dull. This is due to the fact that after death, the lacrimal glands stop functioning, producing tears that moisturize the eyeball.
In order to fully ascertain the death, the victim's eye is gently squeezed between the thumb and forefinger. If the pupil turns into a narrow slit (a symptom of "cat's eye"), a specific reaction of the pupil to death is stated. In a living person, such symptoms are never detected.

Attention! If the deceased had the above signs, then death occurred no more than 60 minutes ago.

Near-death pupils will be unnaturally wide, without any reaction to lighting. With successful resuscitation, the victim will begin to pulsate. The cornea, whites of the eyes, and pupils acquire brownish-yellow stripes after death, called Larcher spots. They are formed if the eyes remain ajar after death and indicate a strong drying of the mucous membrane of the eyes.

Pupils at death (clinical or biological) change their characteristics. Therefore, knowing these features, one can accurately state the fact of death or immediately proceed to save the victim, more precisely, to cardiopulmonary resuscitation. The popular phrase “Eyes are the reflection of the soul” perfectly describes the human condition. Focusing on the reaction of the pupils, in many situations it is possible to understand what is happening to a person and what actions to take.

Early symptoms of biological death include. What is clinical death - signs, maximum duration and consequences for human health

Causes of biological death

Symptoms of death

Early and late signs of death

When does the doctor declare death?

Medical diagnosis of biological death

Assistance to the victim

2. Clinical death, its causes and signs. biological death.

3. First aid for sudden cessation of breathing and cardiac activity

clinical death

Signs of clinical death

Treatment

Pathophysiological basis of clinical death

Clinical death in culture

/ Death

35. Signs of life and absolute signs of death.

Question 2. Clinical and biological death, brain death

clinical death

biological death

Anatomical features of the structure of the pupil

Causes of narrowing of the pupillary openings

pupil dilation

Classification of pupillary reactions

What do pupils look like when you die?

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