المستجدات الطبية في موت الدماغ ياسر مندورة

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تقديم د. ياسر مندورة عن المستجدات الطبية في موت الدماغ من منظور طبي وشرعي
Yasser Mandourah, MD, FRCP(C), FCCP,ABIM
Director, Department of Intensive Care Services (RMH)
Director, Center of Intensive Care Science and Research(RMH)
Vice President Saudi Critical Care Society (SCCS

Published in: Health & Medicine
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المستجدات الطبية في موت الدماغ ياسر مندورة

  1. 1. ‫المستجدات الطبية في موت الدماغ‬ Yasser Mandourah, MD, FRCP(C), FCCP,ABIM Director, Department of Intensive Care Services (RMH) Director, Center of Intensive Care Science and Research(RMH) Vice President Saudi Critical Care Society (SCCS) Riyadh Armed Forces Hospital Riyadh, Saudi Arabia yasser.mandourah@rmh.med.sa
  2. 2. ‫المفهوم العلمي لموت الدماغ‬
  3. 3. Intracranial compensation
  4. 4. Concepts of Brain Injury • Primary injury: area of maximum neuronal damage • Penumbra: area of less injured and potentially recoverable neuronal tissue • Secondary injury: follows primary injury and causes further neuronal damage
  5. 5. Primary Brain Injury • Trauma: concussion, contusion, shear injury • Ischemia: global, regional • Inflammation • Compression: tumor, edema, hematoma • Metabolic insults
  6. 6. Secondary Brain Injury • Hypoperfusion: high intracranial pressure, edema, vasospasm • Hypoxia: hypoxemia, hypoperfusion, high O2 consumption • Harmful mediators: reperfusion, inflammation • Electrolyte or acid-base changes
  7. 7. Intracranial pressure volume
  8. 8. Elevated ICP head CT
  9. 9. Pathological A waves (also called plateau waves) • • • • • are abrupt, marked elevations in ICP of 50 to 100 mmHg which usually last for minutes to hours. The presence of A waves signifies a loss of intracranial compliance heralds imminent decompensation of autoregulatory mechanisms the presence of A waves should suggest the need for urgent intervention to help control ICP.
  10. 10. ‫آلية تشخيص موت الدماغ وكيفيته‬
  11. 11. ‫النظام المعمول به في المملكة‬ ‫العربية السعودية‬
  12. 12. ‫الفرق بين الحياة النباتية وموت الدماغ.‬
  13. 13. Size is the most important predictor for patient outcome 38 ml 43 ml • A patient with a haemorrhage the size of a ping pong ball is likely to have a better outcome than a patient with a haemorrhage the size of golf ball:  mortality on ’ping pong’ size: app. 40%  mortality on ’golf ball’ size: app. 70%

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