2. Terminal conditions, its characteristic

The termination of vital signs occurs gradually and dynamism of this process allows to allocate some phases, observable at dying an organism: preagony, an agony, clinical and biological death.

Preagony, the agony and clinical death concern to terminal (final) conditions. Prominent feature of terminal conditions is inability of a dying organism without the help from the outside independently to leave from its even if the etiological factor, its caused, any more does not operate.

The terminal condition is a convertible fading functions of the organism, previous to biological death, when the complex protective - compensator mechanisms appears insufficient to remove consequences of action of the pathogenic factor on an organism.

Preagony (a preagonal condition) - the terminal condition previous to an agony, described by development of braking in the supreme departments of the central nervous system and shown by twilight obscuring of consciousness.

The preagony condition comes to an end a terminal pause (the termination of breath and sharp delay of intimate activity down to time asystolia).

Agony is the terminal condition previous to clinical death and described by deep infringement of functions of the supreme departments of a brain, especially a bark of hemispheres of the big brain, with simultaneous excitation of an oblong brain. Develops after a terminal pause. The consciousness is absent (sometimes quickly clears up), eye reflexes and reaction on external stimulus disappear. There is a relaxation sphincters, involuntary allocation feces and urine is observed.

As the main attribute of an agony occurrence after a terminal pause of the first independent breath serves. Breath in the beginning weak, then amplifies on depth and having reached a maximum, gradually again weakens and stops absolutely.

At last stages of an agony arterial pressure is reduced almost up to zero, tones of heart deaf persons or are not listened. It is defined only carotid pulse. Then the agony passes in clinical death.

Clinical death - the terminal condition coming after the terminationof intimate activity and breath and proceeding before irreversible changes in the supreme departments of the central nervous system. During clinical death external attributes of a life (the consciousness, reflexes, breath, intimate reductions) are absent, but an organism as the whole has not died yet, in his fabrics power substrata are kept and metabolic processes proceed, therefore at the certain influences it is possible to restore both an initial level, and an orientation of metabolic processes so to restore all functions of an organism.

Duration of clinical death is defined by time which is experienced with a bark of a brain at the termination of blood circulation and breath. Moderate destruction of the neurones, synapses begins from the moment of clinical death, but even later 5-6 more mines of clinical death these damages remain convertible.

Global clinical practice testifies that in usual conditions duration of clinical death at the person does not exceed 3-4 mines, a maximum - 5-6 minutes. At animals it sometimes reaches up to 10-12 minutes. Duration of clinical death in each concrete case depends on lines of conditions: durations of dying, age, an ambient temperature, specific features of an organism, a degree of activity of processes of excitation during dying.

At fast dying (an electrotrauma, asphyxia, sharp hemorrhage), it is especial in conditions of hypothermia as in bodies and fabrics heavy irreversible changes and duration of clinical death have not time to develop is extended.

Older persons, patients with chronically current diseases experience clinical death of smaller duration, than young, healthy persons. Duration of clinical death is influenced with methods of reanimation. Use of the device of artificial blood circulation allows to recover an organism and to restore functions the central nervous system and after 20 minutes of clinical death.

Biological death is the irreversible termination of ability to live of the organism, being an inevitable final stage of its individual existence. Works of the professor of Tomsk university And. A.Kuljabko (1866-1930) is shown an opportunity of restoration of separate bodies functions (heart, for example) after death of an organism as single whole. To absolute attributes of biological death concern:

Cadaveric cooling is the process of downturn of temperature of a corpse up to a level of an ambient temperature.

Occurrence on a leather of cadaveric spots. They are formed as a result of posthumous running off of blood in underlaying departments, overflow and expansion of vessels of a leather and imbibition by blood of fabrics surrounding vessels.

Cadaveric stiffenness is process of posthumous condensation of skeletal muscles and smooth muscles of internal bodies.

Cadaveric decomposition is process of destruction of bodies and fabrics of a corpse under action own proteolytic enzymes and enzymes, developed microorganisms.

To define precisely time of transition of clinical death in biological it is very difficult, however it is very important, as is connected to necessity of carrying out of reanimation actions or their uselessness.