Brain Death

Question 1

Cushing’s Triad

Answer 1

irregular respirations, bradycardia, widened pulse pressure

Sign of impending brain herniation

Question 2

S/S of brain herniation

Answer 2

Sensorimotor: withdrawal to pain, abnormal posturing

Respiratory: cheyne-stokes respirations (period of tachypnea followed by period of apnea), agonal breathing (gasping)

Vitals: Cushing’s triad

Status epilepticus: seizure lasting more than 30 minutes

Question 3

Characteristics of vegetative state

Answer 3

no cognitive function or self-awareness

autonomic, motor, and sleep-wake cycle maintained

Question 4

Characteristics of brain death

Answer 4

irreversible cessation of brain function

coma, apnea, absence of reflexes

EEG flatline

Motor and reflexes are absent

Question 5

Pupillary response in brain death

Answer 5

bilateral pupil dilation is a sign of brain death (cranial nerve 3)

Question 6

Corneal reflex

Answer 6

person should blink bilaterally when you touch their cornea; tests cranial nerves 5 & 7

Question 7

Doll’s eyes

Answer 7

Move head side to side

normal: eyes should move to look in the opposite direction you are turning their head/midline
negative: eyes stay midline while turning head from side to side; this is a sign there is no brainstem activity

Question 8

Cold caloric

Answer 8

aka vestibulo-occular reflex

inserting water into the ear will cause the person’s eyes to look in the direction of the stimulus

No response = brain death

Question 9

Apnea test

Answer 9

preoxygenate patient, take CO2 lab, take pt off of vent for 8-10 min, take another ABG, CO2 > 60 indicates brain death

Question 10

Atropine

Answer 10

no increase in heart rate when administered indicates brain death

Question 11

Transcranial doppler

Answer 11

measures blood flow in the brain

blood should always move forward in the brain

blood flows forward, then background during brain death