Biological death

Biological death is an irreversible stop of biological processes. Consider the main signs, causes, types and methods of diagnosing the extinction of the body.

Death is characterized by cardiac arrest and respiratory depression, but it does not occur immediately. Modern methods of cardiopulmonary resuscitation can prevent dying.

Distinguish physiological, that is, natural death (the gradual extinction of the basic life processes) and pathological or premature. The second kind can be sudden, that is, to attack for a few seconds or violent, as a result of a murder or an accident.

ICD-10 code

The international classification of diseases of the 10th revision has several categories in which death is considered. Most of the fatal cases are caused by nosological units that have a specific code in μb.

• R96.1 Death occurring less than 24 hours after the onset of symptoms, which has no other explanation

R95-R99 Inaccurately indicated and unknown causes of death:

• R96.0 Instant death
• R96 Other sudden deaths due to unknown cause
• R98 Death without witnesses
• R99 Other inaccurate and unspecified causes of death
• I46.1 Sudden cardiac death, as described

Thus, cardiac arrest caused by essential hypertension I10 is not considered to be the main cause of death and in the death certificate it is indicated as a concomitant or background lesion in the presence of nosology of ischemic diseases of the cardiovascular system. Hypertensive disease can be identified by μb 10 as the leading cause of death in the event that the deceased has no indication of ischemic (I20-I25) or cerebrovascular disease (I60-I69).

Causes of biological death

Determination of the cause of biological cardiac arrest is necessary for its ascertainment and identification according to mcb. To do this, it is necessary to determine the signs of the effect of damaging factors on the body, the duration of the damage, the establishment of tanatogenesis and the exclusion of other damages that could cause a fatal outcome.

The main etiological factors are:

Primary causes:

• Incompatible damage to life
• Abundant and sharp blood loss
• The squeezing and shaking of important organs for life
• Asphyxia with aspirated blood
• Shock condition
• Embolism

Secondary causes:

• Infectious diseases
• Intoxication of the body
• Non-infectious diseases.

[1], [2], [3], [4]

Signs of biological death

The signs of a biological death are considered a reliable fact of death. After 2-4 hours after the cardiac arrest, corpse stains begin to form on the body. At this time there is rigor mortis, which is caused by the stop of blood circulation (spontaneously passes on 3-4 days). Let's consider the main signs that allow us to recognize dying:

• Absence of cardiac activity and respiration - the pulse is not probed on the carotids, heart tones are not listened to.
• Cardiac activity is absent for more than 30 minutes (assuming room temperature of the environment).
• Max pupillar dilatation, lack of response to light and corneal reflex.
• Posthumous hypostasis, that is, dark blue spots in the sloping parts of the body.

The above-described manifestations are not considered to be the main ones for detecting death when they occur in conditions of deep cooling of the body or when the drugs are depressing on the central nervous system.

Biological dying does not mean the simultaneous death of organs and tissues of the body. Their time of death depends on the ability to survive in conditions of anoxia and hypoxia. In all tissues and organs this ability is different. The fastest of all die brain tissue (brain cortex and subcortical structures). The spinal cord and stem departments are resistant to anoxia. The heart is viable for 1.5-2 hours after the death, and the kidneys and liver for 3-4 hours. Skin and muscle tissue are viable up to 5-6 hours. The bone tissue is considered to be the most inert, since it retains its functions for several days. The phenomenon of the experience of tissues and organs of man makes it possible for them to transplant and further work in the new organism.

Early signs of biological death

Early signs show up within 60 minutes of the moment of dying. Consider these:

• With pressure or light stimulation there is no reaction of the pupils.
• On the body appear triangles of dried skin (Lärše spots).
• When the eye is squeezed from both sides, the pupil assumes an elongated shape due to lack of intraocular pressure, which depends on the arterial pressure (cat's eye syndrome).
• The iris of the eye loses its original color, the pupil becomes turbid, covered with a white film.
• The lips acquire a brown color, become wrinkled and dense.

The appearance of the above symptoms indicates that it is meaningless to carry out resuscitation.

Late signs of biological death

Late symptoms appear within a day from the moment of dying.

• Cadaver spots - appear 1,5-3 hours after cardiac arrest, have a marble color and are located in the lower parts of the body.
• Stiff rigor is one of the reliable signs of death. It is due to biochemical processes in the body. Full rigor sets in after 24 hours and disappears in 2-3 days.
• Cadaver cooling is diagnosed when the body temperature has dropped to the air temperature. The speed of cooling the body depends on the temperature of the environment, on average decreases by 1 ° C per hour.

Reliable signs of biological death

Credible signs of biological death make it possible to state a demise. This category includes phenomena that are irreversible, that is, a set of physiological processes in tissue cells.

• Drying of the gall bladder and cornea.
• The pupils are wide, do not respond to light and touch.
• Change in pupil shape when squeezing the eye (a sign of Beloglazov or cat eye syndrome).
• Decrease in body temperature to 20 ° C, and in the rectum to 23 ° C.
• Cadaveric changes - characteristic spots on the body, rigor, drying, autolysis.
• Absence of a pulse on the main arteries, there is no independent breathing and cardiac contractions.
• Bloody hypostasis spots are pale skin and blue-violet spots that disappear when pressed.
• Transformation of cadaveric changes - rotting, fattening, mummification, peat tanning.

If the above signs appear, resuscitation is not carried out.

Stages of biological death

The stages of biological death are stages characterized by the gradual oppression and arrest of basic vital functions.

• Pre-conditioned state - severe oppression or complete absence of consciousness. Pale skin, the pulse is weakly felt on the femoral and carotid arteries, the pressure drops to zero. Oxygen starvation rapidly worsens the patient's condition.
• Terminal pause is an intermediate stage between life and dying. If at this stage there are no resuscitation measures, then death is inevitable.
• Agony - the brain stops regulating the functioning of the body and the processes of life.

If the organism was affected by destructive processes, then all three stages may be absent. The duration of the first and last stage can be from a few weeks to days, up to a couple of minutes. Completion of agony is a clinical death, which is accompanied by a complete stop of life processes. From this moment, we can state a cardiac arrest. But irreversible changes have not yet occurred, therefore, for active resuscitation measures for the return of a person to life, there are 6-8 minutes. The last stage of dying is irreversible biological death.

Types of biological death

Types of biological death is a classification that allows doctors to establish the main signs determining the species, genus, category and cause of death in each case of death. To date, in medicine, there are two main categories - violent and non-violent death. The second sign of dying is a genus - a physiological, pathological or sudden death. At the same time, violent death is divided into: murder, accident, suicide. The last classifying sign is the species. Its definition is associated with the identification of the main factors that caused death and combined effects on the body and origin.

The type of death is determined by the nature of the factors that caused it:

• Forced - mechanical damage, asphyxiation, extreme temperature and electric current.
• Sudden fast - diseases of the respiratory system, cardiovascular system, gastrointestinal tract, infectious lesions, diseases of the central nervous system and other organs and systems.

Particular attention is paid to the cause of death. This may be a disease or major damage that caused a cardiac arrest. When violent deaths are injuries caused by gross traumatism of the body, blood loss, concussion and bruise of the brain and heart, shock of 3-4 degrees, embolism, reflex stop of the heart.

Statement of biological death

The statement of biological death comes after the death of the brain. The statement is based on the presence of cadaveric changes, that is, early and late signs. It is diagnosed in health care facilities that have all the conditions for such a finding. Let's consider the basic signs, allowing to define destruction:

• Lack of consciousness.
• Absence of motor reactions and movements to pain stimuli.
• Absence of reaction of pupils to light and corneal reflex on both sides.
• Absence of oculocephalic and oculovestibular reflexes.
• Absence of pharyngeal and cough reflexes.

In addition, a test for spontaneous breathing can be used. It is carried out only after obtaining complete data confirming the death of the brain.

There are instrumental studies used to confirm the non-viability of the brain. For this, cerebral angiography, electroencephalography, transcranial Doppler ultrasonography or nuclear magnetic resonance angiography are used.

Diagnosis of clinical and biological death

Diagnosis of clinical and biological death is based on the signs of dying. Fear of mistaking the definition of death pushes doctors to continual improvement and development of life test methods. So, more than 100 years ago in Munich there was a special tomb in which the hand of the deceased was tied with a bell with a bell, hoping that in the definition of death they made a mistake. The bell rang once, but when the doctors came to help the sick from the lethargic sleep, it turned out that it was a resolution of rigorous rigor mortis. But in medical practice, cases of erroneous statement of cardiac arrest are known.

Biological death is determined by a set of characteristics that are associated with the "vital tripod": cardiac activity, central nervous system functions and respiration.

• To date, there are no reliable symptoms that would confirm the safety of breathing. Depending on the conditions of the external environment, use a cold mirror, listening to breathing or a Winslow's test (a vessel with water is placed on the dying man's chest, according to whose fluctuations the chest stethoscope is judged).
• To check the activity of the cardiovascular system, palpation of the pulse on peripheral and central vessels, auscultation, is used. These methods are recommended to be carried out with short intervals not more than 1 minute.
• To identify the blood circulation, use a Magnus test (tight pulling of the finger). The lumbar lumen can also give certain information. In the presence of blood circulation, the ear has a reddish-pink color, while the corpse has a gray-white color.
• The most important indicator of life is the preservation of the central nervous system. The efficiency of the nervous system is checked by the absence or presence of consciousness, relaxation of the musculature, passive position of the body and reaction to external stimuli (pain, ammonia). Particular attention is paid to the pupils' reaction to light and corneal reflex.

In the last century cruel methods were used to test the functioning of the nervous system. For example, with Jose's trial, people were infringed by skin folds with special forceps, causing painful sensations. During the Degrange sample, boiling oil was injected into the nipple, Rye's test involved cauterizing the heels and other parts of the body with a red-hot iron. Such peculiar and cruel methods show to what tricks the physicians reached when stating a death.

[5], [6],

Clinical and biological death

There are such concepts as clinical and biological death, each of which has certain characteristics. This is due to the fact that the living organism does not die simultaneously with the cessation of cardiac activity and the stopping of breathing. He continues to live for a while, which depends on the brain's ability to survive without oxygen, usually 4-6 minutes. In this period, the decaying vital processes of the body are reversible. This is called clinical death. It can occur due to heavy bleeding, acute poisoning, drowning, electric trauma or reflex heart failure.

The main signs of clinical dying are:

• Absence of a pulse on the femoral or carotid artery is a sign of stopping blood circulation.
• Lack of breath - check for visible movements of the chest during exhalation and inspiration. To hear the noise of breathing, you can put your ear to your chest, bring a glass or a mirror to your lips.
• Loss of consciousness - lack of response to pain and sound stimuli.
• The dilatation of the pupils and the absence of their reaction to light - the affected person lifts the upper eyelid to determine the pupil. As soon as the eyelid descends, it must be raised again. If the pupil does not taper, then this indicates a lack of response to light.

If the above two signs have the first two, then you need to urgently carry out resuscitation. If irreversible processes have started in the tissues of the organs and brain, resuscitation is not effective and biological death sets in.

[7], [8], [9], [10], [11]

The difference between clinical death and biological

The difference between clinical and biological death is that in the first case the brain has not yet died and timely resuscitation can revive all of its functions and body functions. Biological dying comes gradually and has certain stages. There is a terminal state, that is, a period that is characterized by a sharp malfunction in the functioning of all organs and systems to a critical level. This period consists of stages by which biological death can be distinguished from clinical death.

• Teaching - at this stage, there is a sharp decline in the vital activity of all organs and systems. The work of the heart muscles, the respiratory system, the pressure drops to a critical level. Pupils still respond to light.
• Agony - is considered the stage of the last burst of life. There is a weak heartbeat, a person breathes in air, the pupils' reaction to light slows down.
• Clinical death is an intermediate stage between death and life. Lasts no more than 5-6 minutes.

Complete disconnection of the circulatory and central nervous system, stopping of the respiratory tract are signs that unite clinical and biological death. In the first case, resuscitation measures allow returning the victim to life with complete restoration of the body's main functions. If during the resuscitation the state of health improves, the complexion is normalized and there is a reaction of the pupils to the light, then the person will live. If after the emergency help there is no improvement, then this is indicated on the stoppage of the functioning of the basic life processes. Such losses are irreversible, so further resuscitation is useless.

First aid for biological death

First aid in biological death is a complex of resuscitation measures that allow the restoration of the functioning of all organs and systems.

• Immediate cessation of the impact of damaging factors (electric current, low or high temperatures, squeezing the body with weights) and adverse conditions (extraction from water, release from a burning building, etc.).
• The first medical and first aid, depending on the type and nature of injury, illness or accident.
• Transportation of the victim to a medical institution.

Of particular importance is the rapid delivery of a person to the hospital. Transportation is necessary not only quickly, but also correctly, that is, in a safe position. For example, in the unconscious state or when vomiting is best on your side.

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

• All actions should be expedient, fast, thoughtful and calm.
• It is necessary to assess the environment and take measures to stop the impact of damaging factors.
• Correctly and quickly assess the condition of a person. For this, it is necessary to find out the circumstances under which trauma or disease occurred. This is especially important if the victim is unconscious.
• Determine what funds are needed to help and prepare the patient for transportation.

[12], [13], [14], [15], [16],

What to do with biological death?

What to do with biological death and how to normalize the condition of the victim? The fact of death is established by a paramedic or a doctor in the presence of reliable signs or by a combination of certain symptoms:

• Lack of cardiac activity for more than 25 minutes.
• Lack of independent breathing.
• Max pupillar dilatation, lack of response to light and corneal reflex.
• Posthumous hypostasis in the sloping parts of the body.

Resuscitation measures are actions of doctors aimed at maintaining breathing, circulatory functions and revitalization of the dying organism. In the process of resuscitation, massage of the heart is mandatory. The basic complex of CPR includes 30 compressions and 2 inhalations, regardless of the number of rescuers, after which the cycle is repeated. An indispensable condition for revitalization is a constant monitoring of efficiency. If there is a positive effect of the actions being carried out, they continue until the death signs permanently disappear.

Biological death is considered the last stage of dying, which without timely assistance becomes irreversible. When the first symptoms of death appear, an urgent resuscitation is necessary, which can save lives.