What is Terminal Status?

The critical state in which all the vital systems of an organism die out is called the terminal state preceding biological death. The terminal state is a reversible process characterized by profound disturbances in metabolism and gas exchange, as well as by an emergency drop in blood pressure.

In the process of life, the human body can be in a state of health, disease or in a terminal state, which has its own characteristics. The terminal condition is always a consequence of any trauma or disease, can not be stopped by the forces of the body and in the absence of assistance leads to death.

The main pathophysiological mechanism is the deficiency of oxygen in the body (hypoxia), which leads to a variety of compensatory-adaptive and pathological changes.

There are four stages of terminal states:

1. Teaching.
2. Terminal pause is a transient state.
3. Agony.
4. Clinical death.

Tutoring is an optional stage, which may not be present at all, for example, when the heart is stopped. This condition is characterized by systolic blood pressure of 60 mm Hg and lower, tachycardia, which is followed by bradycardia, unstable breathing (first frequent and deep, then superficial and rare), and confusion, inhibition and seizures. At the beginning of the stage of pre-teaching, a state of short-term excitation can arise, explained by the reflex attempts of the organism to fight for one's life. In addition, there is a lack of excretion of the body by urine (oligoanuria) and a discoloration of visible mucous membranes and skin that become pale with a cyanotic shade. The length of the stage of pre-teaching depends on the capabilities of the organism and can range from a few minutes to a day.

The transition from pre-agony to agony occurs through the stage of terminal pause. For this stage, a sudden stop of breathing is characteristic, accompanied by a slowing of the pulse and even a complete absence of it, an expansion of the pupils and a sharp depression of the cardiac activity. The duration of this stage is from a few seconds to five minutes.

At the stage of agony, there is no arterial pressure, the pulse is felt only on the carotid artery, bradycardia and bradypnoe are observed , and there is no consciousness. Usually the agony is short-lived, its duration ranges from a few minutes to six hours.

The final stage of the terminal state is a clinical death, which is fixed from the moment of complete cessation of cardiac activity and complete cessation of breathing. If within five to seven minutes the recovery and stabilization of vital functions does not occur, then the cells of the cerebral cortex die, and then biological death occurs , which precludes the possibility of revitalization.

Terminal status requires urgent assistance from outside. There is a whole range of measures that are used to revitalize (resuscitate) the patient and remove him from the state of clinical death. The success of these events depends more on the time factor.

The state of the organism that is brisk after resuscitation is also called terminal ("terminalis" - borderline, referring to the end, lat.), I.e. Border between life and death. Terminal status of this type has a complex pathophysiological nature, since in its etiology the main role is played by a combination of reoxygenation and recirculation against a background of deep hypoxic changes in organs and tissues. The borderline terminal state is characterized by the instability of all vital functions due to complete disorganization of the system of maintaining homeostasis during the period of dying and very slow, gradual, insufficiently coordinated restoration of this system after revitalization.