Brain Death_Hoover

Brain Death_Hoover - Brain Death Nancy G. Hoover, MD...

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Brain Death Nancy G. Hoover, MD
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Background President’s Commission report - 1981 First formalized criteria for determination of brain death Criteria for adults National Task Force – 1987 Assembled to recommend guidelines for the determination of cerebral death in children
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1987 Task force Recommendations Presence of coma and apnea Absent brainstem function Absent oculocephalic and oculovestibular reflexes No cough, gag or corneal reflexes Spinal arcs could be present Time delay between exams recommended based on patient age 7 d – 2 mo = 48 hr and 2 EEG 2 mo – 1 yr = 24 hr and 2 EEG >1 yr = 12 hr, no EEG
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Criteria for CNS Determination of Death (Brain Death) Irreversible coma Absence of cortical function Absence of brainstem function Apnea 2 examinations with interval according to patient’s age Ancillary tests
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Irreversible Coma Known etiology and or reversible causes ruled out Must have an absence of Hypothermia (>32.5 0 C) Neuromuscular blockade Shock or significant hemodynamic instability Significant levels of sedatives Severe metabolic distrubance
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Basic exam 1 - Pain Cerebral motor response to pain Supraorbital 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!
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Basic exam 2 - Pupils Round, oval, or irregularly shaped Midsize (4-6 mm), but may be totally dilated
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Brain Death_Hoover - Brain Death Nancy G. Hoover, MD...

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