Red Book - Brain stem Death

Question 1

Define Death

Answer 1

Simulataneous and irreversible loss of:

capacity for conciousness

capacity to breathe

Question 2

Define brain death

Answer 2

Complete and irreversible loss of brain and brainstem function

Due to neurological injury

Heart still beats but resp depends on ventilator

Question 3

What are the essential components for diagnosis of death by neurological criteria

Answer 3

Academic of Medical Royal Colleges code:

1) fulfil essential preconditions
2) exclude potential reversible causes of coma
3) formally demonstrate apnoea AND coma

Question 4

What are the pre conditions for brain stem testing

Answer 4

1) patient is deeply unconcious, apneoic and mechnically vented
2) there is irreversible brain damage of known aetiology
3) none of the exclsuion critera are mett

Question 5

Exclusion criteria:

Answer 5

1) that coma is not secondary to reversible factors

CNS depressant drugs
Biochemical/metabolic abnormalities
Hypothermia

Question 6

How do you approach drugs as a cause of coma

Answer 6

1) observe for 2-3 times the half life of the drug
2) give antidotes/antagonists
3) plasma levels
4) alternative tests —> absence of blood flow/perfusions

Question 7

Levels of: midaz

thio

Answer 7

Midaz : >10ug/L

Thio: > 5mg/L

Question 8

Reversible causes (physiology and metabolic)

Answer 8

MAP > 60mmHg

Resp: pH 7.35 to 7.45
CO2 < 6
pO2>10

Temp >34C

Na 115-160
K - >2
Mg >0.5
Phos >0.5

Glucose 3-20

Question 9

Who can do tests

Answer 9

Two doctors
1 consultant
1 more than 5 years GMC registered

Clinically competent to do it

Paeds - a doctor not associated with the case

Question 10

When is the legal time of death

Answer 10

Conclusion of the first test

Question 11

Tests and cranail nerves

Answer 11

Pupillary 2 —> 3. Light in eyes
Corneal 5 —> 6. Swab to cornea
Pain 5 —> 7. Supra orbital pressure
Vestibulo ocular —> 8 —> 3,4,6 50mls cold water toauditory meatus
Gag 9–> 10 Pharynx and tonuge depressor
Cough. 10–> 10 Suction

Question 12

Describe apnoea test

Answer 12

FiO2 to 1.0
ABG —> values for PaCO2 and SaO2 correlate with monitor

Decreased MV to get etCO2 > 6

(ABG to check CO2>6)

Observe for 5 minutes

Maintain O2 by 5litres via suction catheter

ABG - CO2 up by 0.5

Question 13

When cant you do BSD

Answer 13

1) cannot exclude sedative drugs
2) high c-spine injury
3) maxfax injruy

Question 14

If you cant do BSD, what can you do

Answer 14

Auxillary tests:

Measure of electrical activity —> EEG
SSEP

Flow studies: Cerebral angiograph
TCD