Brain death
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
- no response to light (fixed and mid-dialated)
- 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)
- 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)
- SBP >90
- Corrected DI
- 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
See Also
Source
2/8/07 DONALDSON (adapted from One-Legacy)