Brain Death

Question 1

Pediatric waiting time between BD exams

Answer 1

37wk gestation to 30 days = 24 hrs

31days to 18yrs = 12 hrs

Question 2

waiting time between BD exams

37wk gestation to 30 days

Answer 2

24 hrs

Question 3

waiting time between BD exams

31days to 18yrs

Answer 3

12 hrs

Question 4

Peds- Waiting period before initial

brain death examination

Answer 4

24 hrs after CPR or severe
acute brain injury is
suggested

Question 5

How many clinical exams are suggested in peds if CBF used

Answer 5

2, even if ancillary testing

done

Question 6

How can you shorten the Pediatric observation time

Answer 6

Permitted in either age group
if cerebral blood flow or EEG
consistent with dx

Question 7

Apnea test in Peds

Answer 7

2 required unless clinically

contraindicated

Question 8

Final pCO2 threshold in Peds BD testing

Answer 8

≥60 mmHg & ≥20 mmHg

above baseline

Question 9

Are ancillary test required in peds?

Answer 9

only if unable to
complete exam and apnea
test

Question 10

When is TOD in Peds BD testing?

Answer 10

Time of 2nd exam & apnea
test or ancillary study.
When a patient meets all criteria for brain death, they are legally dead.

Question 11

Pediatric BD Testing pre reqs

Answer 11

-Clinical or radiographic evidence of an acute
catastrophic cerebral event consistent w/ dx of brain
death
-Exclusion of conditions that confound clinical
evidence (i.e.-metabolic)
-Confirmation of absence of drug intoxication or
poisoning
-Barbiturates, NMB’s, etc.
-Core body temp >35C

Question 12

OCULOCEPHALIC REFLEX

Dolls Eyes

Answer 12

-Tests the extraocular muscle movements controlled by cranial nerves III and VI
-In brain death, the eyes always point in the direction
of the nose and do not lag behind or move (Negative Dolls Eye Reflex)
-Even someone who is blind will have doll’s eye reflex if the brainstem is intact

Question 13

OCULOVESTIBULAR:

COLD CALORICS

Answer 13

• Tests cranial nerves III, VI, and VIII

- In the brain dead patient, no nystagmus will be observed

Question 14

Apnea Test

Answer 14

• Pre-oxygenate with 100% oxygen several minutes
• Allow baseline PaCO2 to be ~40 mmHg
• Observe for respiratory effort for ~6-10 minutes
• draw an arterial blood gas at minute 5-6 of apnea, Repeat gas every 2 minutes until the apnea criteria have been met or the test must be aborted.

Question 15

When is Ancillary testing indicated?

Answer 15

• Unable to safely perform or to complete apnea testing
• Unable to perform all components of the neurologic examination
• Uncertainty exists about the neurologic examination results
• A medication effect may be present that interferes with neurologic testing
• Ancillary testing may be used to reduce the intra-examination observation period.