ICM - Death

Question 1

Diagnosis of death

Answer 1

Loss of capacity for consciousnessLoss of capacity for ventilation

Question 2

Modes of death verification

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

Total warm ischemia time (WIT) represents the time between withdrawal of mechanical ventilation and abdominal aorta cannulation with initiation of cold preservation. Cold ischemia time (CIT) starts with aortic flush using cold preservation solution

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 - 41 Uncontrroled DOA in ED2 - Uncontrolled unsuccessful resus in ED3 - Controlled - after withdraw in ICU4 - Either cardiac arrest after brain death in ICU