Brain Death

Posted by e-Medical PPT
Cardiac death:
 Heartbeat and breathing stop
Brain death:
 Irreversible cessation of all functions of the entire brain, including the brain stem

Coma
Deep coma
Non-responsive to most external stimuli
At most, such patients may have a dysfunctional cerebrum but, by virtue of the brain stem remaining intact, are capable of spontaneous breathing and heartbeat
PVS – persistent vegetative state

Basic examination
Cerebral motor response to pain
 Supra-orbital ridge, the nail beds, trapezius
 Motor responses may occur spontaneously during apnea testing (spinal reflexes)
 Spinal reflex responses occur more often in young
 If pt had NMB, then test w/ train-of-four
Spinal arcs are intact

Pupils
Round, oval, or irregularly shaped
Midsize (4-6 mm), but may be totally dilated
Absent pupillary light reflex
Although drugs can influence pupillary size, the light reflex remains intact only in the absence of brain death
IV atropine does not markedly affect response
Paralytics do not affect pupillary size
Topical administration of drugs and eye trauma may influence pupillary size and reactivity
Pre-existing ocular anatomic abnormalities may also confound pupillary assessment in brain death

Oculocephalic reflex
Rapidly turn the head 90° on both sides
Normal response = deviation of the eyes to the opposite side of head turning
Brain death = oculocephalic reflexes are absent (no Doll’s eyes) = no eye movement in response to head movement..


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