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AA's Talk About Brain Stem Death

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JCole View Drop Down
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Joined: 03 Oct 2007
Location: United States
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  Quote JCole Quote  Post ReplyReply Direct Link To This Post Topic: AA's Talk About Brain Stem Death
    Posted: 06 Sep 2009 at 12:19pm
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Brain Stem Death


The department of health in 1998 set down definition, criteria a
and procedure for diagnosis of brain stem death


Definition

Irreversible loss of capacity for consciousness combined with irreversible capacity to breath.


Testing

Testing a patient for brain stem death requires 2 doctors, one of whom should be a consultant. Both should be competent and not a member of the transplant team. There are several preconditions to be fulfilled before testing can be performed.

Preconditions


    * Temperature >35C
    * Brain damage ought to be of known etiology and irreversible secondary to irremediable
       damage
    * Drugs- there should be no evidence or suspicion of sedatives or muscle relaxants
    * No significant metabolic, electrolyte or endocrine disturbance

All staff and relatives should be informed of patient's condition and intention to perform brain stem death testing.

Conditions

There should be:

    * No response to painful stimuli to the suborbital region
    * Absent corneal reflexes
    * Absent pupillary reflexes to light, which ought to be fixed
    * Vestibulo-ocular reflexes examine external auditory canal to ensure no obstruction
       with wax and inject 50ml of iced water whilst examining the eyes for absence of
       movement. repeat in the other ear also
    * Absent gag or cough reflex
    * Apnea testing- after pre-oxygenation with 100% O2 the patient should be
       disconnected from the ventilator, O2 should be supplied via an endotracheal catheter
       at 6l/min. Once the PaCO2 has reached 6.65kPa there should be no sign of respiratory
       effort.

These tests ought to be repeated at a later time, however time of death ought to be recorded at time of completion of the first set.


References
Department of health 1998 Code of practice for diagnosis of brain stem death.


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