The last stage of dying is called agony. The agonal state is characterized by the fact that compensatory mechanisms begin to work actively. This is a struggle with the extinction of the last vitality of the body.
Terminal states
Irreversible changes in the brain tissues, which begin due to hypoxia and changes in the acid-base balance, are called terminal states. They are characterized by the fact that the functions of the body fade away, but this does not happen all at once, but gradually. Therefore, in some cases, doctors can restore them with the help of resuscitation.
Terminal states include the following points:
- severe shock (we are talking about IV degree of shock);
- coma IV degree (also called transcendent);
- collapse;
- preagony;
- cessation of respiratory movements - terminal pause;
- agony;
- clinical death.
Agony as a stage of the terminal state is characterized by the fact that the patient's vital functions are inhibited, although he can still be helped. But it can be done whenthe body has not yet exhausted its capabilities. For example, you can restore vitality if death occurs as a result of blood loss, shock or asphyxia.
All diseases are classified according to the ICD. The agonal state is referred to as R57. This is a shock that is not defined in other rubrics. Under this code, the ICD defines a number of thermal states, including preagony, agony, and clinical death.
Predagonia
Problems begin with disruption of the central nervous system. The patient falls into an unconscious state. In some cases, consciousness is preserved, but it is confused. At the same time, blood pressure drops significantly - it can drop below 60 mm Hg. Art. In parallel with this, the pulse quickens, it becomes threadlike. It can be felt only on the femoral and carotid arteries, it is absent on the peripheral ones.
Breathing in a state of preagony is shallow, it is difficult. The skin of the patient turns pale. The agonal state may begin immediately after the end of this period or after the so-called thermal pause.
The duration of this period directly depends on the reasons that caused the onset of this pathological process. If the patient had a sudden cardiac arrest, then this period is practically absent. But blood loss, respiratory failure, traumatic shock can cause the development of a pre-agonal state that will last for several hours.
Terminal pause
The preagonal and agonal states are not always inseparable. For example,with blood loss in most cases, there is a so-called transitional period - a terminal pause. It can last from 5 seconds to 4 minutes. It is characterized by a sudden cessation of breathing. Bradycardia begins. This is a condition in which the heart rate decreases markedly, in some cases asystole occurs. It's called cardiac arrest. Pupils stop responding to light, they dilate, reflexes disappear.
In this state, bioelectrical activity disappears on the electroencephalogram, ectopic impulses appear on it. During the terminal pause, glycolytic processes are intensified, and oxidative processes are inhibited.
A state of agony
Due to a sharp lack of oxygen, which occurs during a state of pre-agony and terminal pause, all body functions are inhibited. Its main symptom is respiratory failure.
Agonal state is characterized by the absence of pain sensitivity, the extinction of the main reflexes (pupillary, skin, tendon, corneal). Ultimately, the activity of the heart also stops. This process may vary depending on what caused the death.
With different types of death, the duration of the agony can vary significantly. For example, traumatic shock or blood loss leads to the fact that the last stage of dying can last from 2 to 20 minutes. With mechanical asphyxia (suffocation), it will be no more than 10 minutes. During cardiac arrest, agonal breathing may persistfor 10 minutes even after the circulation stops.
The most prolonged agony is observed in death resulting from prolonged intoxication. It can be with peritonitis, sepsis, cancer cachexia. As a rule, in these cases there is no terminal pause. And the agony itself can last for several hours. In some cases, it lasts up to three days.
Characteristic clinical picture
At the initial pores, many brain structures are activated. The patient's pupils dilate, the pulse may increase, motor excitation may appear. Vasospasm can lead to an increase in blood pressure. If this state lasts for a long time, then hypoxia intensifies. As a result, the subcortical structures of the brain are activated - and this leads to an increase in the excitation of the dying. This is manifested by convulsions, involuntary emptying of the intestines and bladder.
In parallel, the agonal state of the patient is characterized by the fact that the volume of blood in the veins decreases, which returns to the heart muscle. This situation arises due to the fact that the total volume of blood is distributed through the peripheral vessels. This interferes with normal pressure measurements. The pulse can be felt in the carotid arteries, heart sounds are not audible.
Breathing in agony
It can become weak with small amplitude movements. But sometimes patients sharply inhale and exhale. They can make from 2 to 6 such respiratory movements per minute. Before dying, the muscles of the entire torso and neck are involved in the process. Outwardly, it seems thatbreathing is very efficient. After all, the patient inhales deeply and completely releases all the air. But in fact, such breathing in an agonal state allows very little ventilation of the lungs. Air volume does not exceed 15% of normal.
Unconsciously, with each breath, the patient throws his head back, his mouth opens wide. From the outside, it looks like he is trying to swallow the maximum amount of air.
But the agonal state is accompanied by terminal pulmonary edema. This is due to the fact that the patient is in a state of acute hypoxia, in which the permeability of the capillary walls is increased. In addition, the rate of blood circulation in the lungs significantly decreases, and microcirculation processes are disturbed.
Definition by ICD
Knowing that all diseases are defined according to the International Classification of Diseases (ICD), many people are interested in the code of agonal states. They are listed under section R00-R99. Here are collected all the symptoms and signs, as well as deviations from the norm, which are not included in other headings. Subgroup R50-R69 are common signs and symptoms.
R57 includes all types of shocks not classified elsewhere. Among them are thermal states. But it is worth noting separately, if death occurs from any other causes, then there are separate types of classification for this. R57 refers to a sudden cessation of blood circulation and respiration, which occurred under the influence of external or internal factors. In this case, clinical death will also berefer to this section.
Therefore, it is necessary to understand the reasons due to which the agonal state developed. ICD 10 suggests that it is important to determine blood pressure to determine thermal signs. If it is above 70 mm Hg. Art., then the vital organs are in relative safety. But when it falls below the level of 50 mm Hg. Art. death processes begin, the heart muscle and brain suffer first of all.
Features described in the rubricator
Medical classification allows you to accurately determine the signs by which a thermal and agonal state is diagnosed. The ICD 10 R57 code indicates that the following symptoms are observed:
- general lethargy;
- impaired consciousness;
- lowering pressure below 50 mm Hg. Art.;
- the appearance of severe shortness of breath;
- no pulse on peripheral arteries.
Other clinical signs of agony are also noted. They are followed by signs of clinical death. It belongs to the same section as the agonal state. The ICD R57 code defines all the symptoms that a doctor needs to know in order to determine the extinction of life.
Clinical death
Primary symptoms occur within 10 seconds of circulatory arrest. The patient loses consciousness, his pulse disappears even on the main arteries, convulsions begin.
Secondary signs may start between 20-60 seconds:
- pupils stop responding to light;
- breathing stops;
- facial skin turns earthy gray;
- muscles relax, including sphincters.
As a result, involuntary bowel movements and urination may begin.
Resuscitation measures
You should know that thermal states, which include agony and the final stage - clinical death, are considered reversible. The body can be helped to overcome this state if it has not yet exhausted all its functional capabilities. For example, this can be done when dying from asphyxia, blood loss or traumatic shock.
Resuscitation methods include chest compressions and artificial respiration. The person who provides such assistance can be misled by the patient's independent respiratory movements and signs of irregular heart activity. It is necessary to continue to take resuscitation measures until the person is removed from the state of agony until the condition is completely stabilized.
If these measures are not enough, then they can apply muscle relaxants and carry out tracheal intubation. If this is not possible, then artificial ventilation of the lungs is done from the mouth to the nose or into the mouth. In cases where thermal pulmonary edema has already begun, intubation is indispensable.
In some cases, against the background of an indirect heart massage, the agonal state continues. Its signs are ventricular fibrillation of this organ. In this case, an electric defibrillator must be used. It is also important to carry out intra-arteri altransfusion of blood and necessary plasma-replacement fluids, if dying occurs as a result of blood loss, traumatic shock.
Status after resuscitation
Thanks to timely and complete measures taken to restore the patient's life, it is often possible to eliminate the agonal state. After that, the patient needs long-term observation and intensive care. The need for these measures remains even if the cause that caused the indicated thermal state was quickly eliminated. After all, the body of such a patient is prone to repeating the development of agony.
It is important to fully eliminate hypoxia, circulatory disorders and metabolic disorders. It is necessary to prevent the possible development of septic and purulent complications. Ventilation and transfusion therapy should continue until all signs of respiratory failure have resolved and circulating blood volume has returned to normal.
Animal Agony
Our smaller brothers also have situations when they are on the border between life and death. The agonal state of an animal, according to clinical signs, does not differ much from what happens in a similar situation with a person.
Experiments conducted on rats showed that after their heart stopped, brain activity increased by 30 seconds. At the same time, high-frequency waves emanating from it became more frequent, neurotransmitters were released. This was established by evaluating brain activity using an electroencephalograph and an electrocardiograph. death in ratscame as a result of suffocation.
By the way, it is this brain activity that scientists explain the visions that people who have experienced clinical death love to talk about. They attribute it to just the feverish activity of this organ.
