Brain death: Difference between revisions

Revision as of 06:15, 28 March 2011

Criteria

Known proximate cause of condition
Exclusion of complicating medical conditions (severe electrolyte, acidbase, or endocrine disturbance)
No drug intoxication/poisoning
Core temp >32C (90F)
Cerebral unresponsiveness
Absence of brain stem relexes (see below)
Apneic (see below)
Irreversible condition (+/- repeat exam in 6hrs)

Brain Stem Reflexes

Pupils
1. no response to light (fixed and mid-dialated)
Ocular movement
1. no oculocephalic reflex (deviation of eyes to irrigation w/ 50mL cold water to ears - allow 1 min after and 5 min b/t)
Facial motor response/sensation
1. jaw reflex (grimacing to deep facial pressure)
2. corneal reflex (touch eye w/ swab)
Paryngeal/tracheal
1. gag (tounge blade)

Apnea Testing

Prerequisites:
1. Core temp >36.5 C (97 F)
2. SBP >90
3. Corrected DI
4. Nl PCO2 (>40)
5. Nl PO2 (preoxiginate >200)
Test:
1. Connect pulse ox, disconnect ventilator, place nasal cannula in ET (at carina), observe for resp movements, draw ABG @ 8 min
2. Pos test = PCO2 >60 (or 20 increase over baseline)
3. reconnect ventilator if SBP <90 or sig O2 desat (can draw ABG @ that time, with same criteria as above)

One-Legacy 800-338-6112

Source

2/8/07 DONALDSON (adapted from One-Legacy)

Authors:

@@ Line 1: / Line 1: @@
 ==Criteria==
+# Known proximate cause of condition
+# Exclusion of complicating medical conditions (severe electrolyte, acidbase, or endocrine disturbance)
-) Known proximate cause of contidition
+# No drug intoxication/poisoning
+# Core temp >32C (90F)
-) Exclusion of complicating medical conditions (severe electrolyte, acidbase, or endocrine disturbance)
+# Cerebral unresponsiveness
+# Absence of brain stem relexes (see below)
-) No drug intoxication/poisoning
+# Apneic (see below)
+# Irreversible condition (+/- repeat exam in 6hrs)
-) Core temp >32C (90F)
-) Cerebral unresponsiveness
-) Absence of brain stem relexes (see below)
-) Apneic (see below)
-) Irreversible condition (+/- repeat exam in 6hrs)
 ==Brain Stem Reflexes==
+# Pupils
+##no response to light (fixed and mid-dialated)
-. Pupils
+# Ocular movement
+##no oculocephalic reflex (deviation of eyes to irrigation w/ 50mL cold water to ears - allow 1 min after and 5 min b/t)
--no response to light (fixed and mid-dialated)
+# Facial motor response/sensation
+##jaw reflex (grimacing to deep facial pressure)
-. Ocular movement
+##corneal reflex (touch eye w/ swab)
+# Paryngeal/tracheal
--no oculocephalic reflex (deviation of eyes to irrigation w/ 50mL cold water to ears - allow 1 min after and 5 min b/t)
+##gag (tounge blade)
-. Facial motor response/sensation
--jaw reflex (grimacing to deep facial pressure)
--corneal reflex (touch eye w/ swab)
-. Paryngeal/tracheal
--gag (tounge blade)
 ==Apnea Testing==
+# Prerequisites:
+##Core temp >36.5 C (97 F)
-. Prerequisites:
+##SBP >90
+##Corrected DI
--Core temp >36.5 C (97 F)
+##Nl PCO2 (>40)
+##Nl PO2 (preoxiginate >200)
--SBP >90
+# Test:
+##Connect pulse ox, disconnect ventilator, place nasal cannula in ET (at carina), observe for resp movements, draw ABG @ 8 min
--Corrected DI
+##Pos test = PCO2 >60 (or 20 increase over baseline)
+##reconnect ventilator if SBP <90 or sig O2 desat (can draw ABG @ that time, with same criteria as above)
--Nl PCO2 (>40)
--Nl PO2 (preoxiginate >200)
-. Test:
-Connect pulse ox, disconnect ventilator, place nasal cannula in ET (at carina), observe for resp movements, draw ABG @ 8 min
-Pos test = PCO2 >60 (or 20 increase over baseline)
-*reconnect ventilator if SBP <90 or sig O2 desat (can draw ABG @ that time, with same criteria as above)
 One-Legacy 800-338-6112
 ==Source ==
 /8/07 DONALDSON (adapted from One-Legacy)
 [[Category:Neuro]]