What is the agonal state?

The last stage of dying is called agony. The agonizing state is characterized by the fact that the compensatory mechanisms begin to work actively. This is a struggle with the extinction of the last vital forces of the body.

Terminal states

Irreversible changes in the brain tissues that begin because of hypoxia and changes in the acid-base balance are termed terminal states. They are characterized by the fact that the body functions are extinguished, but this does not happen one by one, but gradually. Therefore, in a number of cases, doctors can restore them through resuscitation.

To terminal states include the following:

• A severe shock (this is a shock state of grade IV);
• Coma IV degree (it is also called transcendental);
• collapse;
• Pre-teaching;
• 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 is oppressed by all vital functions, although he can still be helped. But this can be done in cases where the body has not yet exhausted its capabilities. For example, it is possible to 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 headings. Under this code, a number of thermal conditions are defined in the ICD, including trauma, agony, and clinical death.

Torture

Problems begin with a violation of the central nervous system. The patient falls into an unconscious state. In some cases, consciousness remains, but it is confused. This significantly reduces blood pressure - it can drop below 60 mm Hg. Art. Parallel to this, the pulse becomes more frequent, it becomes threadlike. To probe it it is possible only on femoral and carotid arteries, on peripheric it is absent.

Breathing in a state of pre-admission is superficial, it is difficult. The skin of the patient pale. The agonizing state can begin immediately after the end of this period or after the so-called thermal pause.

The duration of this period directly depends on the causes that caused the onset of this pathological process. If the patient has a sudden cardiac arrest, then this period is practically absent. But blood loss, respiratory failure, traumatic shock can cause the development of a pre-condition, which will last several hours.

Terminal pause

Not always the preagonal and agonal state are 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. The bradycardia begins. This is a condition in which the heart rate decreases markedly, in a number of cases, asystole appears. This is called heart failure. The pupils cease to react to light, they expand, reflexes disappear.

In this state, on the electroencephalogram, bioelectric activity disappears, ectopic impulses appear on it. In the process of terminal pause glycolytic processes intensify, and oxidative processes become inhibited.

The state of agony

Because of the sharp lack of oxygen that occurs when the state of pre-teaching and terminal pause, all the functions of the body are suppressed. The main sign of it is a violation of breathing.

The agonal state is characterized by the absence of pain sensitivity, the extinction of the main reflexes (pupillary, cutaneous, tendon, and corneal). In the end, the heart stops working. This process can differ depending on what caused the dying.

With different types of death, the duration of 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 (strangulation), it will not be more than 10 minutes. When the heart stops, the agonal breath can persist for 10 minutes even after the blood circulation has stopped.

The longest agony is observed at death, which has occurred as a result of 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 several hours. In some cases, it lasts up to three days.

A typical clinical picture

At the beginning, many brain structures are activated. The patient dilates the pupils, the pulse may increase, and motor excitement may appear. Spasm of blood vessels can lead to increased blood pressure. If this condition lasts for a long time, then hypoxia increases. As a result, the subcortical structures of the brain are activated - and this leads to an increase in the excitation of the dying person. It is manifested by convulsions, involuntary emptying of the intestine and bladder.

Parallel 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 because the total volume of blood is distributed around the peripheral vessels. This interferes with the normal determination of pressure. Pulse can be palpated in the carotid arteries, heart sounds are not tapped.

Breathing in a state of agony

It can become weak with small amplitude movements. But sometimes the patients suddenly inhale and exhale. In a minute they can commit from 2 to 6 such respiratory movements. Before dying, the muscles of the entire body and neck are involved in the process. Outwardly it seems that such breathing is very effective. After all, the patient breathes in full and completely releases all air. But in fact, such a breath with the agonal state allows very weak ventilation of the lungs. The air volume does not exceed 15% of normal.

Unconsciously, with each inhalation the patient throws back his head, his mouth opens wide. From the side it seems as if he is trying to swallow the maximum amount of air.

But the agonal state is accompanied by terminal edema of the lungs. 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 pulmonary circulation rate is significantly reduced in the lungs, there is a violation of microcirculation processes.

ICD Definition

Knowing that all diseases are determined by the International Classification of Diseases (ICD), many are interested in the code of agonal states. They are listed in 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. In the subgroup R50-R69 there are common signs and symptoms.

R57 combines all types of shocks not classified elsewhere. Among them are thermal states. But separately it is worth noting, if death comes from any other reasons, then for this there are separate types of classification. R57 refers to the sudden arrest of blood circulation and respiration, which occurred under the influence of external or internal factors. In this case, clinical death will also apply to this section.

Therefore, it is necessary to understand the reasons for the development of the agonizing state. ICD 10 suggests that to determine the thermal signs it is important to determine blood pressure. If it is above 70 mm Hg. V., The vital organs are in relative safety. But when it falls below the level of 50 mm Hg. Art. The processes of withering begin, the heart muscle and the brain suffer first of all.

The characteristics described in the rubricator

Medical classification allows you to accurately identify the symptoms by which the thermal and agonal state is diagnosed. The ICD code 10 R57 indicates that the following features are observed:

• General retardation;
• Impaired consciousness;
• Decrease in pressure below 50 mm Hg. P.
• The appearance of pronounced dyspnea;
• Absence of pulse on peripheral arteries.

Other clinical signs of agony are also noted. After them, there are signs of clinical death. It refers to the same section as the agonal state. The ICD code R57 identifies all the symptoms a doctor needs to know in order to determine the extinction of life.

Clinical death

Primary symptoms occur within 10 seconds after the circulatory arrest. The patient loses consciousness, his pulse disappears even on the main arteries, cramps begin.

Secondary symptoms can begin in a period of 20-60 seconds:

• Pupils cease to respond to light;
• The breathing stops;
• The skin of the face is painted earthy gray;
• Musculature relaxes, including sphincters.

As a result, involuntary processes of defecation and urination can begin.

Resuscitative measures

You should know that the thermal states, which include agony and the final stage - clinical death, are considered reversible. An organism can help overcome this condition if it has not yet exhausted all its functionality. For example, it is possible to do this when dying from asphyxiation, blood loss, or traumatic shock.

Resuscitative methods consist of indirect heart massage and artificial respiration. A person who provides such help can deceive the patient's respiratory movements and signs of irregular cardiac activity. Continue to do resuscitation is necessary before the removal of a person from the state of agony until the complete stabilization of the state.

If these measures are not sufficient, then muscle relaxants and intubation of the trachea can be used. If this is not possible, then artificial ventilation of the lungs from the mouth into the nose or into the mouth is done. In cases where the thermal edema of the lungs has already begun, intubation can not be avoided.

In some cases, against the background of an indirect massage of the heart, the agonial state continues. Its signs are in the fibrillation of the ventricles of this organ. In this case, you need to use an electric defibrillator. It is also important to carry out an intra-arterial blood transfusion and the necessary plasma-replaceable fluids, if dying occurs as a result of blood loss, traumatic shock.

Condition after resuscitation

Thanks to timely and full measures taken to restore the life of the patient, it is often possible to eliminate the agonistic state. After this, the patient needs long-term follow-up and intensive care. The necessity of these measures is maintained even if the cause that caused this thermal state was quickly eliminated. After all, the body of such a patient tends to repeat the development of agony.

It is important to completely eliminate hypoxia, circulatory disorders and metabolic disorders. It is necessary to prevent the possible development of septic and suppurative complications. Ventilation and transfusion therapy should continue until all signs of respiratory failure are eliminated and the volume of circulating blood does not return to normal.

Agony of animals

Our smaller brothers also have situations when they are on the border between life and death. The agonal state of the animal according to clinical signs is not particularly different from what happens in a similar situation with a person.

Experiments performed on rats showed that after the arrest of their heart activity of the brain increased by 30 seconds. At the same time, high-frequency waves emanating from it were becoming more frequent, neurotransmitters were allocated. This was established by evaluating the activity of the brain with the help of an electroencephalograph and an electrocardiograph. Death in rats was the result of suffocation.

By the way, it is precisely this activity of the brain that scientists explain visions that people who have survived a clinical death like to tell. They explain this only with the feverish activity of this organ.