Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
14 Cards in this Set
- Front
- Back
|
Definition of brain death
|
Irreversible loss of brain function, including the brainstem, when the cause is known and demonstrable
|
|
|
4 prereqs for brain death determination
|
1. Evidence of acute CNS catastrophe
2. No other complicating conditions 3. No drug intox 4. Core temp less than 32 degrees |
|
|
3 cardinal findings in brain death
|
1. Coma
2. Absence of brainstem reflexes 3. Apnea |
|
|
Will a patient in brain death respond to pain?
|
No.
|
|
|
4 brainstem reflexes evaluated in brain death
|
1. Pupils
2. Ocular movement 3. Facial sensation/motor response 4. Pharyngeal/tracheal reflex |
|
|
Pupillary response
|
None to light, pupils either midsize or dilated ("blown pupil")
|
|
|
Ocular movement
|
No oculocephalic reflex, no response to cold water irrigation
|
|
|
Facial criterion
|
No corneal reflex
No jaw reflex No response to nail bed pressure, supraorbital ridge, temporomandibular joint |
|
|
Pharyngeal criterion
|
No gag reflex, no cough response
|
|
|
Apnea -- postive result (the patient must be viable to test)
|
8 minutes after O2 ventilation, if arterial PCO2 is > 60 m Hg and respiratory movements are absent
|
|
|
4 interferences in brain death diagnosis
|
1. Severe facial trauma
2. Preexisting pupil problems 3. Toxic drug levels 4. Chronic CO2 retention from another cause |
|
|
Clinical observations that may occur in brain death, and are not positive for its absence
|
Spontaneous limb movement, mimicry of respiration, sweating/blushing/tachy, normal BP, DTRs, babinski
|
|
|
Additional confirmatory tests, most sensitive first
|
1. Angiography -- no carotid or Willis expansion
2. EEG - .5 hour of no activity 3. Doppler - high ICP means no reverb 4. Radiation - brain does not uptake isotope 5. Somatosensory stim - negative |
|
|
What is the arbitrary but expected interval between initial diagnosis of BD and confirmation?
|
6 hours
|
