Terminal states: Milestones in a better world

Terminal states.  Drawing from the site www.sciencephoto.com

Life the human body is subject to certain rhythms, all processes in it are subject to certain physiological laws. According to this unwritten code we are born, live and die. Death is any physiological process has certain stages varying degrees of reversibility. But there is a certain "point of no return" after which the motion is only one-sided. Terminal (from the Latin. terminalis — end, the last one) are called border state between life and death, when gradually and consistently violated and lost the function of various organs and systems. It is one of the possible outcomes of different diseases, trauma, injury or other pathological conditions. In our country adopted threefold classification of terminal conditions proposed by academician V.A.Negovskim: predagoniya, agony and clinical death. That was the sequence of life is fading. With the development of critical care medicine, the science of resuscitation, were attributed to the terminal state man after successful resuscitation of the complex.


The optional period of indefinite duration. In acute condition — such as sudden cardiac arrest — may not be available at all. Characterized by general lethargy, confusion or coma, systolic blood pressure below the critical level — 80-60 mm Hg, absence of heart rate on peripheral arteries (however it is still possible to detect the carotid or femoral arteries). Respiratory disorders — especially severe shortness of breath, cyanosis (cyanosis), and pale skin. The duration of this stage depends on the reserve capacity of the body. At the beginning of predagonii briefly, excitement — organism reflex is trying to fight for life, But amid the failure to eliminate the cause (illness, injury, injury), these attempts only hasten the process of dying. The transition between predagoniey agony and always takes place through a so-called terminal pause. This condition can last up to 4 minutes. The most characteristic symptoms — sudden respiratory arrest following his more frequent, dilated pupils and their lack of response to light, a sharp depression of cardiac activity (continuous series of pulses of the ECG is replaced by single bursts of activity). The only exception — dying in a state of deep anesthesia, in which case the terminal is no pause.


The agony begins with a sigh or a series of short breaths, and then the frequency and amplitude of respiratory movements grow — at least disabling brain centers controlling their fukntsii switching to redundant, less than perfect structures of the brain. The body makes a final effort mobilizes all of its reserves, trying to cling to life. That is why before his death restores the correct heart rate, blood flow is restored and the person may even come to the realization that repeatedly described in the literature and used in the film. However, all these attempts did not have any energy reinforcements, the body burns the remains of ATP — the universal carrier of energy and cleaned destroys cell stocks. Weight burn during the agony of substances is so great that the difference can be entrapped in weighing. It is these processes and explains the disappearance of the very few tens of grams that are considered "flying off" soul. Agony is usually short-lived, it ends the cessation of cardiac, respiratory and brain activity. There comes a clinical death.

Apparent death

How many books have been written about the "life after death" of those who have been "out there" and then come back to share their experiences or to convey to people the acquisition of a "higher" knowledge. The controversy surrounding this does not die down and fade away, because to prove or disprove this with absolute certainty is impossible. Interest in the penultimate stage of dying people is quite understandable. He whose heart is still a couple of minutes ago was not beating, whose lungs did not air, the one who was actually already dead, after the intervention of doctors coming back to life. Resurrection in all ages is considered a miracle. However, like any miracle, it is quite a material basis. Thus, clinical death ascertained by three criteria: full cardiac arrest, respiratory depression and the cessation of brain activity. But all of this so far is reversible, the body is still going anoxic metabolism. From now on takes minutes or even seconds. The faster the complex of resuscitation, the greater the chance it will be possible to bring back to life not only the man but also a person. The fact that neurons in the brain, the most highly cells of the body, is extremely sensitive to lack of oxygen — hypoxia. And they die very quickly in these conditions. Cell death means the loss of certain functions of the cerebral cortex responsible for higher nervous activity. The lifetime of neurons usually ranges from 2 to 5 minutes at a low temperature environment can be extended even up to 12-15 minutes (the classic case — drowning in winter). At some point, the number of dead cells in the brain becomes critical, and then return to full-fledged personality becomes impossible, is the so-called "social death." Feasibility of intensive care of these patients is the subject of a bitter dispute not only medical but also social, and religious figures.

What can doctors

Time initiated a complex resuscitation can restore cardiac and respiratory activity, then perhaps the gradual recovery of lost functions of other organs and systems. Of course, the success of resuscitation depends on the cause that led to the death experience. In some cases, such as massive blood loss, the effectiveness of resuscitation is close to zero. If attempts were in vain doctors or bailed out, after the apparent death comes true, or biological death. And this process is irreversible.

Alexei Vodovozov

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