CC Nov 2015 Brain death

echoecho's version from 2015-11-27 20:33


Question Answer
Dx provides important information regarding what two considerations, although it is a stressful event for a family? 1) info regarding long-term care 2) help to assist in decision making when the pt has expressed a desire to be an organ donor
List the 4 principles that should be undertaken to confirm this dx?1) confirmation of irreversible coma 2) achievement normal systolic blood pressure ( > 100 mm Hg) and normal core body temperature (>36 C) 3) absence of brainstem reflexes 4) absence of ventilatory drive
*** How is ventilatory drive tested? When should the test be ended prematurely and resujlts considered inconclusive?1) apnea test (once pt is hemodynamically stable, including use of vasopressure to maintain SBP > 100 mm Hg) and normal core them (including use of external warming), an apnea test can be undertaken. After providing 100% oxygenation for 10 minutes, ventilator support is reduced to 10 respirations/min and a positive end expiratory pressure (PEEP) of 5 cm H20. If the SpO2 is > 95%, the pt is disconnected from the ventilator and observed for 8-10 minutes to determine whether spontaneous respirations occur. A blood gas is obtained at the end of the test to determine CO2 level. If the PCO2 is > 60 mm Hg and there are no spontaneous respiratory movements, the apnea tests is considered positive and highly suggestive of brain death 2) if pt becomes hypotensive (SBP < 90 mm Hg) OR hypotxic (O2 sat < 85%) before the test is completed
This dx should NOT be determined unless what 2 parameters are met by the patient?1) SBP stable (even if vasopressors are needed) 2) temperature is stable (even if add'l measures are required like heated blankets)
What 2 signs are used to confirm if coma is presence?1) absence of eye opening 2) physical response to noxious stimuli
Evaluation for reversible causes of coma are done, list 3?1) removal of sedating medicaitons 2) assessment for electrolyte abnormalities 3) cessation of neuromuscular blocking agents that may supopress pt response to stimuli
Lists 6 evaluations of brainstem reflexes?1) pupillary response 2) oculomotor reflexes (oculovestibular and oculocephalic) 3) corneal reflex 3) facial muscle movement to noxious stimuli 4) gag reflexes 5) trachea reflexes
What 2 ancillary tests are not necessary to confirm this dx but may be helpful in identifying reversible causes of coma or in evaluating pts where the neuro exam or apnea tests is equivocal?1) cerebral angiogram 2) electroencephologram (EEG)
The American Academy of Neurology does not require more than one neurological exam in the evaluation of this dx, although some states may required ___ separate examinations?two
What should be recorded based on the clinical determination of brain death?time of death
What is often reflected as the time of death?time of a positive apnea test (time of elevated CO2 on a blood gas) as this is often the final test after patient stabilization, neurological examination and confirmation of irreversible coma
*** SUMMARY = This dx should NOT be determined unless the patient's ____ ____ ____ and ____ are stable, even if additional measures are required (vasopressors or heating blankets?1) systolic blood pressure 2) temperature
*** SUMMARY = Ancillary tests including ____ ____ or ____ are NOT necessary to confirm this dx?1) cerebral angiogram 2) electroencephalogram (EEG)
*** SUMMARY = The American Academy of Neurology _____ (does vs. doesn't) require more than one neurological exam in the evaluation of this dx, any licensed physician may perform the neurological exam, not only a neurologist?doesn't