Palliative care

Question 1

Criteria for brainstem death testing

Answer 1

Prior to testing, temp and biochemical markers in normal range and no sedative drugs given
1. Absence of reflexes: Pupil response, corneal, vestibulocochlear, gag, cough
2. No reaction to pain - supraorbital pressure
3. Apnoea test - Absence of respiration whilst disconnected from ventilator for 5 mins, PaCO2 increased by at lease 0.5kPa
Neonates - >2.7kPa above >8.0 kPa

Question 2

Mechanism of action of opioids

Answer 2

• Agonist at opioid receptors in the brain - Mu, delta, kappa
• Mainly Mu - analgesia, sedation, resp depression, constipation
• Activation of descending pathways –> inhibit ascending pain pathways