Brain death

Criteria

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

Brain Stem Reflexes

1. Pupils
   1. no response to light (fixed and mid-dialated)
2. Ocular movement
   1. no oculocephalic reflex (+Doll's Eyes)
   2. no vestibulocochlear (deviation of eyes to irrigation w/ 50mL cold water to ears - allow 1 min after and 5 min b/t)
3. Facial motor response/sensation
   1. jaw reflex (grimacing to deep facial pressure)
   2. corneal reflex (touch eye w/ swab)
4. Paryngeal/tracheal
   1. gag (tounge blade)

Apnea Testing

1. Prerequisites:
   1. Core temp >36.5 C (97 F)
   2. SBP >90
   3. Corrected DI
   4. Nl PCO2 (>40)
   5. Nl PO2 (preoxiginate >200)
2. 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

See Also

• ACLS (Main)
• Post Cardiac Arrest
• Coma

Source

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