Critical Matters Neurologic Criteria for Death in Adults
Jun 12, 2019
Dr. Fred Rincon, an Associate Professor of Neurology and expert in neurocritical care, dives deep into the complex subject of brain death determination. He covers the historical context and legal foundations of brain death concepts from the 1960s. Learn about the crucial brainstem exams, the apnea test mechanics, and the role of drug considerations. Fred also emphasizes effective communication with families and the need for compassion in critical care, sharing insights on navigating the emotional complexities of these discussions.
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Exclude Reversible Confounders First
- Exclude confounders: correct hypothermia, hypotension, metabolic derangements, and drug effects before exam.
- Wait at least five half-lives for sedatives with normal organ function, longer if liver or kidney failure.
Test Horizontal And Vertical Eye Movements
- Test oculocephalic reflexes both horizontally and vertically when safe to move the head.
- Check responses above and below the foramen magnum to exclude preserved brainstem or spinal-mediated reflexes.
Apnea Test As Central Confirmation
- The apnea test proves absence of brain-driven respiration by CO2 stimulation of the brainstem.
- The CO2 rise >20 mmHg or PaCO2 ≥60 mmHg with no respirations confirms the test per guidelines.
