brain stem death

Question 1

you are a house officer who has been called to A&E

you are asked to see Mr MacDougall, a 30 y.o. male BIBA with a short hx of severe headache of sudden onset

was previously well and there is no sig. hx

he is now unconsious and breathing impaired

(a) what scoring system will you use to quantify level of consciousness?

Answer 1

GCS

Question 2

(b) what important conditions would you suspect to be the cause of the problem. list 3.

Answer 2

1. SAH (with bleeding that has extended into the brain)
2. Meningitis / encephalitis
3. Intracerebral haemorrhage
4. Stroke (can cause sudden severe headache)

Question 3

(c) what may be precipitated by lumbar puncture?

Answer 3

coning

downward shift of brain due to sudden decrease in ICP

medulla forced into foramen magnum, causing depression of respiration and other vital fxs

happens when LP performed on pt w raised ICP

Question 4

(d) what is the most important ix you would arrange to try and confirm the dx?

Answer 4

CT brain

Question 5

(e) sadly, within 24 h of presentation, in spite of appropriate mx, pt’s general condition deteriorates to a point where brain stem death is pronounced. organ donation is contemplated.

what medical conditions would preclude organ donation? list 2.

Answer 5

1. transmissible infection that will adversely affect the recipient e.g. HIV, CJD
2. active haematological or visceral neoplastic disease

Question 6

(f) the consultant in charge of the pt’s case is talking to the family about the concept of brainstem death.

what key points need to be covered?

Answer 6

1. pt’s basic vital fxs cannot function by themselves due to death of the part of the brain that controls them
2. the vital fxs are being supported by mechanical means
3. the pt will not improve because the death of the brainstem tissue is irreversible
4. verified by 2 Drs at 2 different occasions
5. organ donation