Sudden adult death syndrome: causes. Presentation on the topic: Irradiation causes the death of only cells of the hematopoietic system capable of dividing

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The death of Lenin - what Vladimir Ilyich really died from. Cause of death

Throughout 1923, newspapers reported on Lenin's health, creating new myth about a leader who steadfastly fights an illness: reads newspapers, is interested in politics, hunts. It is known that Lenin suffered a series of strokes: the first turned 52-year-old Ilyich into an invalid, the third killed him.

IN recent months During his life, Lenin hardly spoke, could not read, and his “hunting” looked like walking in a wheelchair. Almost immediately after his death, Lenin's body was opened to determine the cause of death. After a thorough examination of the brain, it was determined that there was a hemorrhage. They announced to the workers: “the dear leader died because he did not spare his strength and did not know rest in his work.”

During the days of mourning, the press strongly emphasized the sacrifice of Lenin, the “great sufferer.” This was another component of the myth: Lenin, indeed, worked a lot, but he was also quite attentive to himself and his health, did not smoke, and, as they say, did not abuse.

Almost immediately after Lenin’s death, a version appeared that the leader was poisoned on Stalin’s orders, especially since no tests were done that would have detected traces of poison in his body. It was assumed that another cause of death could be syphilis - the drugs at that time were primitive and sometimes dangerous, and venereal diseases in some cases can indeed provoke a stroke, but the leader’s symptoms, as well as the post-mortem autopsy, refuted these speculations. Detailed Report The first public bulletin, which was released immediately after the opening, contained only summary causes of death. But already on January 25, “official autopsy results” appeared with numerous details

Except detailed description brain, the results of a skin examination were given, down to the indication of each scar and injury, the heart was described and its exact size, the condition of the stomach, kidneys and other organs were indicated. British journalist, head of the Moscow branch of the New York Times, Walter Duranty, was surprised that such detail did not make a depressing impression on the Russians; on the contrary, “the deceased leader was an object of such intense interest that the public wanted to know everything about him.”

However, there is information that the report caused “shocked bewilderment” among the non-party Moscow intelligentsia and they saw in it a purely materialistic approach to human nature characteristic of the Bolsheviks. Such detailed anatomy and emphasis shifted to the inevitability of death could have another reason - the doctors, who “failed” to save the patient, were simply trying to protect themselves.

In medicine, sudden death from heart failure is regarded as a fatal outcome that occurs naturally. This happens both to people who have had heart disease for a long time, and to people who have never used the services of a cardiologist. A pathology that develops quickly, sometimes even instantly, is called sudden cardiac death.

Often there are no signs of a threat to life, and death occurs within a few minutes. The pathology can progress slowly, starting with pain in the heart area and rapid pulse. The duration of the development period is up to 6 hours.

Cardiac death is distinguished between quick and instantaneous. The fulminant variant of coronary heart disease causes death in 80-90% of incidents. Also among the main causes are myocardial infarction, arrhythmia, and heart failure.

Read more about the reasons. Most of them are associated with changes in blood vessels and the heart (arterial spasms, hypertrophy of the heart muscle, atherosclerosis, etc.). Among the common prerequisites are the following:

ischemia, arrhythmia, tachycardia, impaired blood flow;
weakening of the myocardium, ventricular failure;
free fluid in the pericardium;
signs of heart and vascular diseases;
heart injuries;
atherosclerotic changes;
intoxication;
congenital defects of valves, coronary arteries;
obesity, as a result of poor nutrition and metabolic disorders;
unhealthy lifestyle, bad habits;
physical overload.

More often, the occurrence of sudden cardiac death is provoked by a combination of several factors simultaneously. The risk of coronary death increases in people who:

there are congenital cardiovascular diseases, ischemic heart disease, ventricular tachycardia;
there was a previous case of resuscitation after a diagnosed cardiac arrest;
a previous heart attack was diagnosed;
there are pathologies of the valve apparatus, chronic insufficiency, ischemia;
facts of loss of consciousness were recorded;
there is a reduction in blood ejection from the left ventricle by less than 40%;
A diagnosis of cardiac hypertrophy was made.

Secondary significant conditions for increasing the risk of death are considered to be: tachycardia, hypertension, myocardial hypertrophy, changes in fat metabolism, diabetes. Bad influence caused by smoking, weak or excessive physical activity

Signs of heart failure before death

Cardiac arrest is often a complication after cardiac arrest. vascular disease. Because of this, the heart can suddenly stop its activity. After the first signs appear, death can occur within 1.5 hours.

Previous dangerous symptoms:

shortness of breath (up to 40 movements per minute);
pressing pain in the heart area;
the skin acquires a gray or bluish tint, its cooling;
convulsions due to hypoxia of brain tissue;
separation of foam from the oral cavity;
feeling of fear.

Many people experience symptoms of exacerbation of the disease within 5-15 days. Heart pain, lethargy, shortness of breath, weakness, malaise, arrhythmia. Shortly before death, most people experience fear. You should immediately contact a cardiologist.

Signs during an attack:

weakness, fainting due to the high rate of ventricular contraction;
involuntary muscle contraction;
facial redness;
pale skin (it becomes cold, bluish or gray);
inability to determine pulse, heartbeat;
lack of reflexes of the pupils, which have become wide;
irregularity, convulsive breathing, sweating;
loss of consciousness is possible, and after a few minutes breathing cessation.

At fatal outcome against the background, it would seem wellness symptoms may have been present, just not clearly manifested.

Mechanism of disease development

As a result of a study of people who died due to acute heart failure, it was found that most of them had atherosclerotic changes that affected the coronary arteries. As a result, myocardial circulation was disrupted and it was damaged.

Patients experience enlargement of the liver and neck veins, and sometimes pulmonary edema. Coronary circulatory arrest is diagnosed; after half an hour, abnormalities in the myocardial cells are observed. The whole process lasts up to 2 hours. After cardiac activity stops, irreversible changes occur in brain cells within 3-5 minutes.

Often cases of sudden cardiac death occur during sleep after breathing has stopped. In a dream, the chances of salvation are practically absent.

Statistics of mortality from heart failure and age characteristics

One in five people will experience this during their lifetime. Instant death occurs in a quarter of victims. The mortality rate from this diagnosis exceeds the mortality rate from myocardial infarction by approximately 10 times. Up to 600 thousand deaths are reported annually due to this reason. According to statistics, after treatment for heart failure, 30% of patients die within a year.

More often, coronary death occurs in persons 40-70 years old with diagnosed vascular and cardiac disorders. Men are susceptible to it more often: at a young age 4 times, in the elderly – 7 times, by the age of 70 – 2 times. A quarter of patients do not reach the age of 60 years. The risk group includes not only elderly people, but also very young people. The cause of sudden cardiac death at a young age may be vascular spasms, myocardial hypertrophy, provoked by the use of narcotic substances, as well as excessive stress and hypothermia.

Diagnostic measures

90% of sudden cardiac death episodes occur outside of hospitals. It’s good if the ambulance arrives quickly and the doctors carry out a quick diagnosis.

Emergency doctors note the absence of consciousness, pulse, breathing (or its rare presence), and the absence of pupillary response to light. To continue diagnostic measures, you first need resuscitation actions(indirect cardiac massage, artificial lung ventilation, intravenous administration of medications).

After this, an ECG is performed. In case of a cardiogram in the form of a straight line (cardiac arrest), the administration of adrenaline, atropine, and other drugs is recommended. If resuscitation is successful, further laboratory examinations, ECG monitoring, and cardiac ultrasound are carried out. Based on the results, surgical intervention, implantation of a pacemaker, or conservative treatment with medications is possible.

Urgent Care

For symptoms sudden death from heart failure, doctors have only 3 minutes to help and save the patient. Irreversible changes occurring in brain cells after this time period lead to death. Timely first aid can save lives.

The development of symptoms of heart failure is facilitated by a state of panic and fear. The patient must calm down by removing emotional stress. Call ambulance(team of cardiologists). Sit comfortably, lower your legs down. Take nitroglycerin (2-3 tablets) under the tongue.

Cardiac arrest often occurs in crowded places. Those around you need to urgently call an ambulance. While waiting for her arrival, you need to provide the victim with an influx of fresh air, if necessary, perform artificial respiration and perform cardiac massage.

Prevention

To reduce mortality, preventive measures are important:

regular consultations with a cardiologist, preventive procedures and prescriptions (special attention
patients with hypertension, ischemia, weak left ventricle);
refusal from provoking bad habits, ensuring proper nutrition;
control of blood pressure;
systematic ECG (pay attention to non-standard indicators);
prevention of atherosclerosis ( early diagnosis, treatment);
implantation methods in risk groups.

Sudden cardiac death is a severe pathology that occurs instantly or in a short period of time. The coronary nature of the pathology is confirmed by the absence of injuries and the sudden and rapid cardiac arrest. A quarter of cases of sudden cardiac death are lightning fast, and without the presence of visible precursors.

You may also be interested in:

How to recognize and treat acute failure hearts
Signs of coronary heart disease in men: diagnostic methods

The causes of death are always determined by doctors. It can occur as a result of exposure to external or internal factors. In forensic medicine you can find a classification of the reasons why a person died.

Accepted terminology

By death we mean full stop life activity, during which physiological and biological processes. There is a special direction in medicine that studies the body in the final stage of the dying process. This science is called thanatology.

For most people at all times, death has been fraught with mysticism and mystery. It is inevitable, often unpredictable and unexpected. But the concepts of death in law, medicine, philosophy, and religion differ markedly.

Doctors separately identify several thermal conditions that precede immediate death. This is pre-agony, agony and clinical death. At this time, resuscitation measures may still be successful. If they were not carried out or were ineffective, then doctors diagnose biological death. In this state, an irreversible cessation of all physiological processes occurs in tissues and cells.

Subsequently, the decomposition process begins. This is the name for the destruction of the body, during which all nerve connections are damaged. Recovery after this becomes absolutely impossible. Experts call this stage information death.

Until it occurs, there is a theoretical possibility of preserving the body in a state of suspended animation (using, for example, cryonics), which can prevent further destruction of the body. In this case, the theoretical possibility of its restoration in the future remains.

Classification of causes

Death can be violent or non-violent. In the first case, it occurs as a result of exposure various factors from outside. K not violent death cause various diseases. It can also occur due to the appearance of deep age-related changes. Although at present it is impossible to say that a person died of old age, a specific reason is needed that led to this. Sometimes it happens that external and internal factors act simultaneously. In this case, it can be difficult to determine the cause of death. After all, forensic experts must identify which factor played a decisive role.

Nonviolent death can be:

Physiological: from senile decrepitude or prematurity of a newborn child;

Pathological.

The last type of death is caused not only by progressive diseases. It can also be sudden, it is also called sudden.

Violent death occurs as a result of:

suicide;
murders;
accident.

Forensic medicine studies and determines this.

Factors leading to natural non-violent death

Quite often people die from problems with various organs and systems. Sudden or pathological death can occur as a result of diseases:

of cardio-vascular system;
respiratory organs;
endocrine system;
gastrointestinal tract;
infectious lesions;
central nervous system;
genitourinary system;
other organs and systems of the body.

Malignant neoplasms also lead to non-violent death. Sometimes it occurs as a result of pregnancy and subsequent childbirth. The exact reasons can be found out only after a pathological autopsy. Based on its results, a death certificate is issued. It displays the reasons that led to the person dying.

Sudden death is a non-violent death that occurs in a healthy person, in the opinion of others. It occurs as a result of an acute form of the disease or a latent chronic disease.

Prevalence of causes of non-violent dying

By analyzing the factors that led to the cessation of people's lives, forensic experts can understand which causes of death are the most common.

More than 75% of people die from diseases of the circulatory system. However, most of them are diagnosed with chronic ischemic heart disease. They may have acute or repeated myocardial infarction or cardiomyopathy. Slightly less common are cerebral infarctions, subarachnoid hemorrhages, and arterial diseases.

Less common causes of nonviolent death are respiratory diseases. Chronic obstructive pulmonary disease leads to death. With chronic bronchitis, the airways become swollen and the passages become narrow. Emphysema occurs when the lungs are damaged. With these diseases, breathing problems begin.

Stage 4 cancer also leads to death slightly less often. Men often suffer from the appearance of malignant tumors in the prostate, and women - in the breast. But the most common cause of death is lung cancer. It is difficult to detect on initial stages. They don't show themselves in any way. Problems begin only when metastases appear.

It is worth noting that smokers are 12 times more likely to develop lung problems than non-smokers. Also, giving up this bad habit reduces the likelihood of developing kidney cancer.

Also, almost a quarter of people die from infectious diseases, eating disorders, and neonatal diseases. In low-income and low-income countries, birth injuries, asphyxia, and problems caused by prematurity are the leading causes of death in newborns.

Causes of violent death

People often die due to exposure not internal, but external factors. The main types of violent death are:

mechanical damage;
asphyxia;
exposure to extreme temperatures;
toxic substances, this also includes gas poisoning;
exposure to electric current;
beam energy.

TO mechanical damage include falls from heights, traffic accidents, injuries caused by sharp and with blunt objects. Any gunshot wound that causes cessation of life activity may also be included in this category.

Poisoning occurs as a result of exposure to the body toxic substances. They can be caused by low-quality or contaminated food, water, alcohol, and medicines. You can be poisoned by carbon monoxide in unventilated areas, in factories or in houses heated by stoves.

Death from suffocation can occur due to the development of oxygen starvation, which was caused by mechanical reasons. This can be strangulation, hanging, closing the airways with loose or liquid objects, closing the openings of the mouth and nose. Compression of the abdomen and chest can also lead to asphyxia.

We must understand that the type of violent death and the reasons that led to it are different concepts. They are determined by forensic experts. Even with the same exposures, a person can die from different causes.

The type of death is determined depending on the exact impact on the person. But the reasons are determined by what changes have occurred in the body as a result of certain influences on it. For example, it was determined that blunt trauma to the skull led to death. This means that a person could die from a contusion of the brain or its compression by the resulting hematoma.

Gas poisoning can also be voluntary, accidental or intentional. But the manner of death is determined by law enforcement agencies.

The need for a forensic medical examination

It is possible to determine what exactly caused a person to die during a special medical event. It's called forensic examination. It is mandatory if it is obvious that the death was violent. It also needs to be done in cases where:

there was a sudden death, but there is a suspicion that it could have been violent;
the cause of death is unknown, the person died outside the walls of a medical institution;
death occurred in the hospital, but the patient was not diagnosed;
the person died in the hospital, but the investigative authorities accepted a complaint from relatives.

Also, regardless of the place and presumed cause of death, a forensic medical examination is carried out on all unidentified persons.

Examination of the corpse allows us to determine why the person died. Depending on this, tactics are determined further actions. If the forensic examination establishes that death occurred from poisoning, for example, methyl alcohol, then law enforcement agencies will have to establish why this happened. This could be suicide: a person could pour himself methyl alcohol and drink it, wanting to end his life. He could also have used it by mistake. In this case, the death will be classified as an accident. But if it was a set-up, and another person poured methyl alcohol into the glass, then we are talking about murder.

Opening

In order to determine whether a death occurred natural or violent, it is necessary to examine the corpse. The autopsy can be a conventional pathological or forensic one. The first type is carried out in cases where the death was non-violent. Such an autopsy can be carried out in several ways:

Abrikosov method;
Leshka incision;
Shore's method;
Fisher's method.

But according to the instructions of the investigating authorities, a forensic autopsy is carried out. During its implementation, the following is established:

time of death;
the presence and nature of the damage is determined whether it was inflicted during life or after death;
mechanisms and methods of causing damage, their sequence;
reasons that led to death.

Also, forensic medical examination can resolve other issues of a medical and biological nature. She can tell which non-life-threatening injuries were sustained in the first place, and how exactly the person died.

Conducting a forensic examination

To determine the causes of violent death, a special examination is carried out by doctors who have been trained in Forensic Medicine.

The investigation begins with an examination of clothing and items that arrived with the corpse. The expert must identify possible damage, marks, or overlaps on them. After this, the body of the deceased is examined directly. The corpse is carefully examined, all post-mortem changes are described. If damage was detected, then its nature, features, and location are determined. Soft tissues and internal organs must be examined.

If poisoning is suspected, the corpses are sent for a special forensic chemical study. But this is not the only possible additional examination. If necessary, bacteriological, physical-technical, and histological examinations are carried out. The list of additional examinations is determined by the expert depending on what tasks were assigned to the forensic medical examination and on what the suspected cause of death is.

Based on the results of the study, not a death certificate is given, as with a conventional pathological autopsy, but a conclusion or report forensic medical examination. It describes all the procedures performed with the corpse, the results of examinations, establishes a diagnosis and gives a conclusion that contains answers to the questions posed to the forensic examination.

Stages of Dying

Regardless of whether death occurred from old age, violent or other non-violent causes, experts distinguish two types. Dying can be slow or fast. In the first case, a prolonged terminal state, agony, is observed. And with a quick death, which is also called acute, these stages are blurred.

The dying process begins in the preagonal state. In some cases it is completely absent. This is a protective reaction of the body. It can be observed in people who have stage 4 cancer. After all, they usually have severe and painful body injuries. IN last hours inhibition processes develop in the central nervous system. This is accompanied by a corresponding psychological condition. There is indifference to what is happening around, sensitivity disappears. Some people lose consciousness completely or partially.

In a preagonal state, a person may fall into a coma or stoppage, his blood pressure decreases, and blood circulation centralizes. Breathing may become rapid but shallow. The lungs are not fully ventilated.

If the patient does not undergo therapeutic measures, or they are ineffective, then this condition is replaced by a thermal pause. After this the agony begins. This is the name given to the body’s attempt to use all remaining capabilities to preserve life. In this state, blood pressure rises, heart function is restored, and breathing becomes strong. But the lungs are not ventilated due to malfunction muscles. It usually lasts about 5 minutes, in some cases it can last up to half an hour. Following the agony comes clinical death.

Necessary diagnostics

Before determining what exactly caused the cessation of a person’s life, doctors must make sure that the patient is really dead. Even if a gunshot wound is visible, an investigation is carried out. Perhaps it did not affect vital important organs, and the person is alive.

They look at a set of signs, the so-called vital tripod: the preservation of the functions of the central nervous system, breathing and heart activity. But there are situations when doctors can make mistakes.

For example, the safety of breathing can be checked using a mirror, fluff, auscultation or the Winslow test. But they can all be wrong. Any gust of wind, high humidity in the room, or passing traffic can cause incorrect results.

More informative is checking cardiovascular activity. Auscultation of heart contractions, palpation of the pulse, and cardiac impulse are performed. But very weak manifestations of vital activity may go unnoticed.

The most important indicator is the preservation of central nervous system functions. One of the valuable signs is the absence or presence of the corneal reflex. The doctor checks how the pupils react to light. One of the first signs of death is the Beloglazov phenomenon, or “cat's pupil.” The tone of the muscles that constrict the pupil disappears. When the eyeball is compressed, it takes on an oval shape.

The "primary devastation" phase

On day 5 after irradiation, the level of the majority shaped elements in the blood begins to fall - comes "primary devastation" phase.

Clinically, this phase manifests itself when the cell content decreases to critical low level. This time determines the duration of the latent period.

Dose determination

total body irradiation according to the content of leukocytes in peripheral blood on days 7-9 after irradiation

The duration of the latent period is shorter, the higher the dose

irradiation:

At mild form The ARS latent period may end in 30 or more days;

At average shape– after 15-30 days;

In severe cases - after 5-20 days;

In extremely severe forms, there may be no latent period.

III. Height period.

Occurs when the number of blood cells drops below a critical level:

In addition, it is observed:

toxemia,

predominance of catabolism over anabolism,

vegetative dystonia,

autoimmune lesions.

But the basis of the lesion is a violation of the hematopoietic function.

IV. Recovery period

If death does not occur during the peak period

regenerative processes in the hematopoietic system lead to an increase in the number of mature blood cells

the symptoms of the peak period are eliminated.

During this period, complete or partial normalization of the functions of critical body systems occurs.

Prognosis for life with ARS:

Mild degree – favorable;

Moderate – favorable with proper treatment;

Severe – doubtful; even intensive complex therapy is not always successful.

Ability to work with ARS:

Mild degree - retained. During the 2nd month of illness, restriction of heavy physical labor is required;

Average degree - by the beginning of the 3rd month of illness, a return to light work is possible, and after a year - to normal activities;

Severe degree - performance is not fully restored. Light work is possible from the 4th month of illness.

Intestinal form of ARS:

With general irradiation at a dose of 10-20 Gy, the intestinal form of ARS develops, the basis of which is the intestinal syndrome.

It is associated with damage and death of small intestinal epithelial cells. The consequence of this damage is:

cessation of resorption of water from the lumen of the small intestine and

electrolytes

dehydration develops; disruption of the barrier function of the intestinal wall

toxic substances (E. coli toxins) enter

into the blood and lymph

During the height of the intestinal form of ARS:

health worsens,

diarrhea develops

body temperature rises,

oropharyngeal syndrome develops,

dehydration,

intoxication,

endogenous infection.

If treated, those affected with the intestinal form of ARS can live up to two or even two and a half weeks. Causes of death may be:

Pancytopenic syndrome;

Attachment of a secondary infection;

Cause of death (causa mortis)

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First health care. - M.: Great Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet encyclopedia. - 1982-1984.

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