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The duration of the process depends of the pathological basic, as well as the
nature and mechanism of compensatory safety: in stop of blood circulation due
to ventricular fibrillation (cardiac arrhythmia, when myocardial fibers contract
asynchronous, and the heart contractile ability becomes ineffective) predagonal
stage almost absents, but in blood loss or progressive respiratory failure it may
last for some hours.
Agony
(from the ancient Greek agonia – struggle) – the last stage of death,
characterized by the rise of the compensatory mechanisms activity with aim to
struggle with the extinction of the vital forces of the body.
A typical sign of the agony is agonal breathing, that is weak, rare respiratory
breath moves of small amplitude, or maximum short breaths in and quick full
breaths out with a large amplitude and a frequency of 2–6 per minute. At the ex-
treme stage of agony the muscles of the neck and torso are involved in the breath –
the head is thrown back, the mouth is wide open, foam at the mouth may appear.
Agonal breathing can go into the stridor. In a state of agony, heart rate and
blood pressure increase, consciousness can be restored briefly, convulsions of-
ten develop, involuntary urination and defecation, the gradual fading of the pu-
pil reaction to light, the face takes the form of a “mask of Hippocrates.”
The duration of the stage is from a few minutes to an hour. Heartbeat and
breathing for a few seconds or minutes during the agony stops – this is a terminal
pause.
Terminal pause
– is a condition continued 1–4 minutes. The breath stops,
bradycardia, sometimes asystolia develops, pupil reaction on light and corneal
reflexes disappears, pupil became wide. Corneal reflex (corneal reflex) –
unconditional reflex in response of closing eyes due to cornea irritation.
Care for the agonizing patient
1. Isolate the patient (move him to the intensive care unit).
2. To set up an individual nursing unit.
3. To observe breathing, pulse, blood pressure, awareness.
4. Carry out patient’s of personal hygiene (toilet, skin care, prevention of
bedsores).
5. To feed (via a feeder cup, by artificial feeding).
6. To monitor the physiological items.
7. To participate in making of all doctor’s appointment.
8. In case of clinical death to take part in reanimation.