Brain death certification comes with extensive

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Brain death certification comes with extensive parameters that must be carried out and documented closely; a brain death determination is a legal and a clinical judgment. First and foremost, a brain death diagnosis cannot occur without a definite proximal cause. The physician must also rule out any condition that might confuse the lack of brain function: shock, hypotension, hypothermia, drugs like neuroparalytics or barbituates, brain encephalitis, or Guillain-Barre’ syndrome (Goila, & Pawar, 2009, p.8). Also, a complete neurological examination must be carried out and documented: an examination of absence of spontaneous movement, decerebrate or decorticate posturing, seizures, shivering, response to verbal or noxious stimuli, the absence of pupillary, corneal, cough and gag reflexes, the absence of oculovestibular reflex when ice water is irrigated into an eternal auditory canal, failure of the heart rate to increase by more than five beats per minute after giving between one and two milligrams of atropine, and absence of respiratory efforts in the presence of hypercarbia (Goila, & Pawar, 2009, p.8). Further brain death criterion include a minimum of a 6 hour observation period after the initial neurological examination, angiographic confirmation of brain death by determining the absence of intracerebral blood flow at the level of the carotid bifurcation or Circle of Willis, electroencephalography confirmation of the absence of electrical activity during at least 30
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THE NURSING IMPLICATIONS OF BRAIN DEATH 4 minutes of recording, and transcranial doppler ultrasonography to show high vascular resistance associated with greatly increased intracranial pressure (Goila, & Pawar, 2009, p.8). The idea that the brain could lose its functionality while the body continued to live did not occur until healthcare facilities acquired the equipment to make such a thing a reality. Moran (2009) suggests that with the opening of the first intensive care units in the mid-1950s, healthcare staff gained the ability to maintain circulation and respiration for longer periods of time, and got a better idea of what brain death truly was. In 1963, Dr. Alexandre and his team performed a landmark kidney transplant in which they did not discontinue mechanical ventilation and wait for the donor’s heart to stop beating before commencing the surgery (p.12). Moran (2009) continues by stating, “While some physicians offered tentative support for Dr. Alexandre's conception, many others were suspicious of – or repelled outright by – a proposition that they feared could be used to exploit trauma patients for harvesting transplantable organs” (p.12). In 1968, the Ad Hoc Committee of the Harvard Medical School published a report named “A Definition of Irreversible Coma” defining death by neurological criteria, and they moved the line that
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  • Summer '16
  • smith
  • Health care provider, Traumatic brain injury, Coma

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