Determination of brain death

Question 1

what is def. of neuro death

Answer 1

irreversible loss of capacity for consciousness combined with irreversible loss of all brainstem functions, including capacity to breath

Question 2

minimum crit. for NDD (5)

Answer 2

1. established etiology causing death that is irreversible
2. deep unresponsive coma
3. loss of stem functions and reflexes
4. absent resp. effort based on apnea test
5. no confounds

Question 3

potential confounding factors

Answer 3

1. unresuscitated shock
2. hypothermia
3. severe metabolic disorder - glucose, lytes
4. peripheral nerve or muscle dysfunction of NMJ blockade
5. drug intoxication

Question 4

what is apnea test

Answer 4

give oxygen and pull ventilator - positive is no response for 10 minutes and pCO2

Question 5

when is ancillary test performed

Answer 5

1. when impossible to complete minimum criteria

2. deep unresponsive coma

Question 6

what is ancillary test

Answer 6

demonstration of global absence of intracranial blood flow - CT angio

Question 7

minimum requirments for physician to declare NDD (3)

Answer 7

1. current license
2. skill and knowledge in mgmt of severe brain injury
3. no transplant conflicts of interest

Question 8

what are brainstem reflexes tested

Answer 8

1. pupillary - shine light
2. extraoular - doll’s head and caloric reflex
3. corneal reflex
4. gag - stim back of pharynx
5. cough - stim tracheobronchial tree by passing canula into endo tube

Question 9

5 physiological changes in NDD

Answer 9

1. central diabetes insipidus
2. vasodilation
3. apnea
4. hypothermia
5. other endo dysfunction

Question 10

4 diffs between NDD and pesistent veg. state

Answer 10

1. spontaneous breathing in PVS
2. cardio stability
3. sleep wake in PVS
4. long duration in PVS vs hours to day in NDD

Question 11

what to do after diagnosis

Answer 11

1. offer organ donation
2. complete death cert.
3. offer autopsy
4. coroner?