Definitions, Table, Facts - Death

Question 1

Diagnosis of death

Answer 1

Loss of capacity for consciousness

Loss of capacity for ventilation

Question 2

Modes of dying

Answer 2

Somatic death

Circulatory death

Neurological death

Question 3

Describe somatic death

Answer 3

Death based on visual signs

Decomposition, rigour mortis, amputation

Question 4

CIRCULATORY DEATH DEFINITION

Answer 4

Death diagnosed by HCPs

Occurs 5 minutes after cessation of circulation

Need to show:
	Lack of circulation
	Absence of ventilation
	Absence of brain function and reflexes
	Absence of movement

Question 5

Process of Neurological death

Answer 5

Pre-conditions met - irreversible coma, evidence on CT

Confounding factors met - metabolic/drugs

Absences on ventilation and brain function demonstrated

If BSD can’t be done
	Four vessel CT angio
	Radionucleotide
	TCD
	EEG

Question 6

Pre conditions of BSD

Answer 6

Structural and non reversible cause of come identified

Reversible causes absent -> temp, drugs, metabolic

Absence of cranial nerves
Pupils, caloric test, pain, gag and cough

Apnoea test
Pre ox for 5 minutes
Reduce minute volume to get pCO2>6 and pH<7.4
Baseline gas
Disconnect - observe 5 minutes, PaCO2 rises by 0.5

Question 7

Define warm ischaemia time

Define cold ischaemic time

Answer 7

Cessation of circulation to the cold perfusion organs is the “warm ischaemic time”

Time from cold perfusion to implantation is cold.

Question 8

Endocrine issues after BSD

Answer 8

DI —> low volume, hypernatramia.
Fluid and DDAVP

Hypothyroidism
T3 not routineyl given

Decreased adrenal axis
methylpred —> lung water

Hyperglycaemia

Temperature

Question 9

MAASTRICHT CLASS

Answer 9

1 - 4

1 Uncontrroled DOA in ED
2 - Uncontrolled unsuccessful resus in ED
3 - Controlled - after withdraw in ICU
4 - Either cardiac arrest after brain death in ICU