 Keywords: mors, pathological physiology of terminal states, physiopathology of mors, a thanatogenesis, terminal states, apnoe, infringement of the vital functions, reanimation, the device of an artificial circulationPHYSIOPATHOLOGY OF TERMINAL STATESKey concepts
the General pathological valueTerminal states are one of outcomes of the disease. Representing phasic process of fading of vital signs of an organism, they are characterized by the general laws of development of sample pathological processes irrespective of the causes. The main initiation factor in development of terminal states is the hypoxia which results in distresses of functions of the vital organs, invokes disbolism, development of an autoinfection and an endointoxication. Distinguish the following stages of terminal states: preagonal (a hypotension and a terminal pause), an agony and clinical mors. Regeneration of vital activity of an organism probably at use of a complex method of resuscitation and a method of an artificial circulation. Regenerations of structurally functional departments of a brain at resuscitation of an organism descends in dependence on fastness of neurones to action of the hypoxic factor (myelencephalon, varoliev the bridge, a diencephalon, a bark). Functions of a bark of the big hemispheres of a brain are less resistant to a hypoxia and time of conservation of vitality of cortex neurones in the season of clinical mors is limited to 3-5 minutes. The main task of reanimation actions - regeneration of intelligence (a high-grade social aftertreatment) the patient who has transferred a terminal state. Educational elementsI. A terminal state. Definition. The causes of originating II. Leading sample pathological processes in development of terminal states - a hypoxia - pathochemical processes of infringement of a metabolism - auto-and a toxinfection III. A hypoxia as the integrating factor in development of terminal states - a hypoxia of cortex neurones A loss of consciousness - a hypoxia of neurones of a diencephalon A decortication - a hypoxia of neurones of a brainstem (varoliev the bridge, a mesencephalon) A decerebration set of symptoms - a hypoxia of neurones of myelencephalon An apnoea A stopping of palpitation IV. Pathochemical mechanisms of infringements of a metabolism at terminal states - gipoergoz Downstroke of formation ATF - a Sodium lactatum - acidosis An activation of a glycolysis V. Auto-and a toxinfection at terminal states - an activation of free radical processes and cells of peroxide oxidation of lipids An autolysis of cells - augmentation of concentration in a blood of endogenic toxins of an intestinal parentage Intensifying processes of a corruption and fermentation in an intestine Rising an adsorption of materials in an intestine Downstroke of decontaminating function of a liver - development of secondary immunodeficience Hypoxic damage of a thin intestine - an organ of B-immune system VI. Fading of vital signs as phasic process. Stages of terminal states - a preagony - an agony - clinical mors VII. A preagony as the first stage of development of terminal states - a hypotension Centralization of a circulation in the vital organs (a brain, heart, mild) A pathological deposition of a blood in an internals A slajdzh-phenomenon - a terminal pause The arrest of respiration, palpitation Conservation of sensitivity of receptors to adequate irritants VIII. An agony as the most serious stage of development of terminal states - periodicity of regeneration of vital signs Regeneration of respiration and palpitation Regeneration of consciousness Rising arterial pressure An activation of metabolic processes IX. Clinical mors, last stage of development of terminal states. Criteria of cerebral mors - longevity of cortex neurones at a hypoxia as criterion of duration of clinical mors - conservation of sensitivity of receptors only to superthreshold extreme irritants - criteria of cerebral mors at adults - means of elongation of time of clinical mors X. A thanatogenesis. Definition. Phylums of dying - cerebral phylum of dying - somatic phylum of dying XI. Mechanisms of an apnoea at dying - development of an acidosis of damage to respiratory neurones at a hypoxia of myelencephalon - rising of tone of a vagus nerve - interdigitation of respiratory neurones on "horizontal" The regulation of an inspiration and an expiration is broken- interdigitation of respiratory neurones on "vertical" Agonal respiration (gasping) - apnoe Inspiratory Expiratory XII. Mechanisms of a cardiac standstill for phylum of an asystolia - formation of brake postsynaptic potential An activation of a vagus nerve Blockage atsetilholinovyh receptors Intensifying an output of ions of a potassium from cardiomyocytes in environment Inhibition of an input of ions of a sodium and calcium in cardiomyocytes XIII. Mechanisms of a cardiac standstill for phylum of a fibrillation - formation of slow diastolic depolarization on membranes of cardiomyocytes Appearance in conditions of a hypoxia of ability of cardiomyocytes to self-excitation An activation of sympathetic nervous system A stimulation catecholamins of an input of calcium in cardiomyocytes Intensifying entering a sodium in cardiomyocytes Blockage of an output of a potassium of their cardiomyocytes XIV. Methods and means of resuscitation of an organism. Principles of carrying out of reanimation actions - a complex method of resuscitation of an organism Artificial respiration An artificial cardiac massage tsentripetalnoe an endarterial forcing of a blood A defibrillation (chemical and physical) An electrical stimulation - resuscitation of an organism on a method of an artificial circulation Application of the device of an artificial circulation A cross circulation ("donor - recipient") XV. A social aftertreatment - regeneration of intelligence of the patient - a major principle of resuscitation of an organism Uchebno-research work of studentsExperience 1. Modelling of a cardiac standstill for phylum fibrillations (terminal state) at transit of an electrocurrent through heart of a frog Dissect a thoracal cell of a frog anesthetized by an Aether. One electrode from a stimulator introduce into a muscle of a thoracal cell. A frog place under an objective of the binocular microscope (ΜΑΡ-3) and observe under small augmentation a cardiac performance in an initial state. Then render on heart some drops of a warm normal saline solution, invoking a tachycardia. The second electrode bring to an auricle at the included electrostimulator (a current 5 Β) and observe of a stopping of cardiac activity: there are worm-shaped isolated reductions of separate fields of a myocardium. Thus delivery function of heart, i.e. an auricular systole and ventricles, stops. The cardiac standstill for phylum of a fibrillation is observed. Pathophysiological problemsthe Problem 1.In dependence on character and features of the basic pathological process, the stopping of cardiac activity during fading vital signs of an organism comes for phylum of an asystolia or a fibrillation. At a myocardial infarction, an electrotrauma, etc. an immediate cause of a cardiac standstill the fibrillation is. The fibrillation of heart can be reproduced in experiment at action on an organism of an electric current. and. Open value of slow diastolic depolarization in mechanisms of a fibrillation of heart. . What parentage the ectopic locuses of exaltation in a myocardium in mechanisms of a fibrillation of heart have? Century. Give the pathophysiological characteristic of an ion exchange in mechanisms of development of a fibrillation. . Show pathophysiological difference of mechanisms of development of a fibrillation and an asystolia. the Problem 2.It is known, that concept of a thanatogenesis perceive mechanisms of dying. Distinguish cerebral and somatic phylums of dying. The mechanism of dying of an organism for cerebral phylum is connected to fast initial fading functions of a CNS whereas in a basis of the mechanism of fading of life for somatic phylum initial fading functions of an internals (hearts, mild, a liver, etc.) lays. a. Name the basic criteria of mors of a brain at adults. b. Name the basic criteria of a birth of the alive child. c. Explain, in what sequence there is a switching-off of neurones of various departments of a brain at a hypoxia and what pathological sets of symptoms thus educe. the Problem 3.It is known, that in a basis of development of terminal states the following sample pathological processes (a hypoxia, metabolic distresses, an autotoxinfection) lay. a. Explain mechanisms of a hypoxic lesion of neurones at terminal states. b. Explain mechanisms of development of metabolic distresses at terminal states. c. Explain mechanisms of development of an autotoxinfection and its consequence for an organism at terminal states. the Problem 4.the Initial stage of terminal states - the hypotension - is characterized by infringement of functions of a CNS, cardiovascular and respiratory systems, that further results in complete desintegration of all processes descending in an organism. In the beginning of development of a hypotension the adequate blood supply of such vital organs, as heart, a brain, mild is kept. It is reached due to a phenomenon of centralization of a circulation. At the same time the circulation on periphery that results in a pathological deposition of a blood is broken. Venous return to heart is reduced. and. Explain the mechanism of centralization of a circulation in a stage of a hypotension. . Explain the mechanism of venous return to heart in a stage of a hypotension. Century. Explain the mechanism of development of a pathological deposition of a blood in a stage of a hypotension. the Problem 5.Now it is possible to assert, that process of resuscitation is impossible without prime regeneration of a circulation and a gas exchange. To regeneration of these major functions in a complex method of resuscitation apply tsentripetalnoe an endarterial forcing of a blood, artificial respiration and a cardiac massage. And. Explain the mechanism of regeneration of respiration and palpitation at artificial respiration. . Explain mechanisms of regeneration of cardiac activity at an endarterial forcing of a blood and a cardiac massage. 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