Death and apparent death

Death and apparent death

I. DEFINITION OF DEATH

“DEATH IS THE DEFINITIVE DISAPPEARANCE OF THE HUMAN PERSON, IT BEING UNDERSTOOD THAT WHAT SEPARATES THE LIVING FROM THE DEAD IS THE ACTIVITY OR NON-ACTIVITY OF THE BRAIN” 

III.PHYSIOPATHOLOGY OF BRAIN DEATH

In fact, when blood circulation stops, the organs, including the brain and the heart itself, are no longer supplied with oxygen and begin to die: brain damage appears from the third minute, and the chances of survival become almost zero after eight minutes of circulatory arrest.

• Brain death is secondary to a cessation of cerebral circulation resulting from two main mechanisms:

   –Increase in intracranial pressure which will exceed the mean arterial pressure (PPC = PAM-PIC)

   –Interruption of cerebral circulation by occlusion, compression or circulatory arrest.

                                                  Ischemia and anoxia will destroy the brain.

III.DIAGNOSTIC CONDITIONS

Clinical or imaging evidence of severe central nervous system (CNS) lesions of known etiology that can explain the brain death (BD) situation.

Absence of confounding circumstances

– Hypothermia <35°C.

-Hypotension PAM<50 mmHg.

-CNS depressant drugs.

-Curarization.

-Serious metabolic disorders.

IV. A NEUROLOGICAL EXAMINATION

1-Total absence of consciousness and spontaneous motor activity.

2 – Abolition of all brainstem reflexes

3- Total absence of spontaneous ventilation 

V. PARACLINICAL EXAMINATIONS 

• 2 null and reactive electroencephalograms performed at a minimum interval of 4 hours. with maximum amplification over a recording time of 30 minutes.

                                                      OR

• CEREBRAL ANGIOGRAPHY objectifying the cessation of encephalic circulation. 

VI. CARDIOPULMONARY RESUSCITATION: 

Must be performed on any person in a state of apparent death, that is to say:

• unconscious: the person does not move spontaneously, does not react to touch or speech;
• and who is not breathing: after clearing the airways and raising the chin (unfastening clothing that could hinder breathing, carefully tilting the head), no breathing movement is seen and no air is felt coming out of the nose or mouth.
• Cardiopulmonary resuscitation is the combination of  artificial ventilation and chest compressions or “external cardiac massage” (ECM).
• The concept was invented by Peter Safar , who coined the English acronym ABC  :
• A for airway , release of the airways  ;
• B for breathing , artificial ventilation;
• C for circulation , ensuring blood circulation through external cardiac massage. 

1. When breathing has stopped, it must be supplemented by artificial ventilation .

• without equipment (mouth-to-mouth, mouth-to-nose, mouth-to-mouth-and-nose on the infant).
• When using a resuscitator bag (with a mask or mouthpiece), pure air (21% oxygen) is delivered. If a medical oxygen cylinder is connected, the inspired oxygen fraction (FiO ₂ ) is further increased. 
•  The air we breathe in passes to the lungs, but also to the stomach.

2. Once the blood in the lungs has been oxygenated, it must then be circulated throughout the rest of the body. 

• This is done through chest compressions , also called external cardiac massage.
•  This involves pressing on the middle of the thorax in order to compress the chest:

)In adults and children over eight years old, the sternum should descend 4 to 5 cm;

                b) in children between one and eight years old, the sternum should descend 1/3 to 1/2 of the thickness of the thorax (CPR is performed with one hand);

           c) in infants under one year old, the sternum should descend 1/3 to 1/2 of the thickness of the thorax (CPR is performed with two fingers).

3) It is recommended that all rescuers alternate 30 compressions and 2 breaths.

• perform 30 chest compressions while counting out loud “one–and–two–and–…–and–twenty-nine–and–thirty” (which provides an effective rate of 100 to 120 compressions per minute);
• Call for help 
• Find a defibrillator 
• Defibrillation 

When cardiac arrest is due to ventricular fibrillation (the heart beats in a disorganized manner), the majority of cases of sudden death in adults, the only hope of saving the victim is to defibrillate the heart, that is, to resynchronize the heart with an electric shock. This can be done by an automatic external defibrillator.

Death and apparent death

4) Specialized cardiopulmonary resuscitation ( CPSR ) by a medical or paramedical team is the last link in the chain of survival before admission to hospital.

• The victim is intubated (connection of an artificial respirator to the patient’s airways via a tube that is inserted into the trachea).
• A venous access route 
• A capnometer is placed: it measures the quantity of carbon dioxide (CO2) expired, that is to say the effectiveness of the resuscitation. 

• In fact, if the patient exhales CO2 _, it means that the oxygen has reached the cells.
• drug administration: adrenaline 
• The duration of resuscitation without resumption of heart rhythm is largely empirical. However, it hardly exceeds thirty minutes. 

Death and apparent death

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Death and apparent death