Comms Flashcards
Brain death criteria includes…?
- a plausible cause for brain death: irreversible brain damage from a known cause
- exclusion of reversible causes: not due to drugs, hypothermia or reversible metabolic/endocrine factors
- clinical testing of the brainstem reflexes and the respiratory centre: pt should be in coma and apnoeic
Brainstem death testing includes?
Brainstem tests (for Cranial Nerves II, III, V, VI, VII, VIII, IX, X)
- Pupils fixed and unresponsive to light (CN II & III)
- Corneal reflex absent (CN V & VII)
- Vestibulo-ocular reflex absent on injecting ice-cold water into ears (CN III, VI & VIII)
- Motor movements absent on stimulating the body eg. pressure on sternum (CN VII)
- Limb movements absent on supra-orbital pressure (CN V)
- Gag reflex absent (CN IX & X)
- Cough reflex absent on inserting suction catheter into the bronchi (CN X)
Respiratory test
There is no spontaneous breathing when PCO2 is >6.6kPa
Is patient dead if brainstem is dead?
Yes
The ventilator is keeping the patient’s lungs moving and his/her heart beating
There may be occasional reflex twitches or movement even after brainstem death. There may also be occasional but irregular, laboured gasps of breath (‘agonal breaths’).
What part of the brain controls breathing and consciousness?
The pons and medulla, which have cranial nerve nuclei, also contain the reticular activating formation and the respiratory centre, responsible for consciousness and breathing.
What organs are included in the HOTA act?
kidneys, liver, heart and corneas
Any implications of opting out of HOTA?
Anyone who opts out of HOTA receives lower priority for receiving an organ on the national waiting list should he require an organ transplant in the future.
This will apply specifically to the organs which he opted out of.
Will my body be disfigured after organ donation?
The donor’s body will always be cared for with the utmost respect by the transplant team. The same surgical standards being applied to any living person undergoing surgery will also be applied to organ donors.
Any incisions made during the removal of organs are carefully repaired after the procedure.
In the case of cornea donation, only the cornea (the front part of the eye the size and shape of a contact lens) is removed and a plastic cap is inserted afterwards. The eye remains otherwise intact.
Will the medical care of potential organ donors be compromised to expedite the recovery of organs?
Medicine is an ethical profession. No doctor would risk one life to save another.
We would like to reassure you that every patient is given full medical care and every chance at survival irrespective of suitability and acceptance of organ donation.
Organ donation is only considered after death has been declared by two well-qualified independent doctors who are not involved in the care of the patient.
What conditions should be fulfilled before organ transplant is considered?
• First, the donors must be at least 21 years old, be not mentally disordered, and not be an objector.
• Second, the organs must be suitable for transplantation.
• Third, there must be a suitable recipient(s) to benefit from the organ(s) recovered.
What is cardiac death?
heart stops beating irreversibly.
all vital functions of the body stop.
The vital organs quickly become unusable for transplantation after cardiac death.
However tissues such as bone, skin, heart valves and corneas can be donated within 24 hours of death.
What is brain death? And how does this relate to organ donation?
Brain death means there is no flow of blood or oxygen to the brain and therefore, the brain cannot function in its capacity and never will again.
Other organs, such as the heart, lungs, kidneys, pancreas or liver, may function for a brief period of time after brain death if the person is supported on a ventilator.
Donation of kidneys, heart and liver is usually possible only after brain death.
Brain death is accepted as the legal definition of death in Singapore. It is determined based on a standard, well-defined set of clinical criteria.
Brain death versus coma?
Coma: person is unarousable but tests confirm that some brain functions are still present.
may still recover or regain consciousness. Organs are never taken from a person in a coma.
Brain death is when a person is unarousable and tests confirm that all brain functions have stopped irreversibly. Persons declared brain dead cannot recover or regain consciousness again.
Can someone who is declared brain dead come back to life?
A brain dead person on a ventilator can feel warm to the touch and look
‘alive’. The heart still beats and the ventilator is pushing oxygen and air into the lungs making the person’s chest rise and fall. When this happens, some families expect the person they love to be kept on the ventilator in the hope that their condition may improve.
However, to be brain dead is to be actually dead and no improvement or recovery is possible. There is no method to revive a brain that has been deprived of blood and whose cells have died.
Brain death is recorded only following certification by two independent medical practitioners.
There is no clinically documented case where a patient who has been declared brain dead following proper procedures, is later restored to a normal life.
what are the notifiable infectious diseases in singapore?
- HIV/AIDS
- Tuberculosis
- Sexually Transmitted Infections: chlamydia, gonorrhoea, genital herpes, syphilis
- Leprosy
- other infectious diseases: e.g. dengue fever, acute viral hepatitis, pretty much anything we tend to get vaccinations for
