Evolution of Brain Death Determination Guidelines
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The document discusses the history and criteria for determining brain death. It outlines the 1959 definition of brain death and subsequent guidelines from 1968, 1981, 1994, and 2005. Brain death is defined as the absence of cerebral and brainstem function, and apnea. The document describes tests to assess brainstem reflexes and the requirement of confirming irreversible brain injury before declaring brain death.
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Evolution of Brain Death Determination Guidelines
- 1. By Kamalakar Ambati Reference From: Pubmed, HOD.org, Nueurostudy online. By Kamalakar Ambati 1
- 2. Prior to the advent of mechanical respiration, death was defined as the cessation of circulation and breathing By Kamalakar Ambati 2
- 3. 1959 Coma de’passe’ Mollaret and Goulon 1968 Irreversible Coma/Brain Death Harvard Medical School Ad Hoc Committee 1981 Uniform Determination of Death Act - President’s Commission for the Study of Ethical Problems in Medicine 1994 American Academy of Neurology Guidelines for the determination of Brain Death 2005 NYS Guidelines for Determining Brain Death By Kamalakar Ambati 3
- 4. Absent Cerebral Function Absent Brainstem Function Apnea By Kamalakar Ambati 4
- 5. By Kamalakar Ambati 5
- 6. Cerebral Cortex Reticular Activating Brain Stem System By Kamalakar Ambati 6
- 7. Cognition Voluntary Movement Sensation By Kamalakar Ambati 7
- 8. By Kamalakar Ambati 8
- 9. Midbrain Cranial Nerve III pupillary function eye movement By Kamalakar Ambati 9
- 10. Pons Cranial Nerves IV, V, VI conjugate eye movement corneal reflex By Kamalakar Ambati 10
- 11. Medulla Cranial Nerves IX, X Pharyngeal (Gag) Reflex Tracheal (Cough) Reflex Respiration By Kamalakar Ambati 11
- 12. Receives multiple sensory inputs Mediates wakefulness By Kamalakar Ambati 12
- 13. Normal Cerebral Anoxia By Kamalakar Ambati 13
- 14. Normal Cerebral Hemorrhage By Kamalakar Ambati 14
- 15. Normal Subarachnoid Hemorrhage By Kamalakar Ambati 15
- 16. Normal Trauma By Kamalakar Ambati 16
- 17. Normal Meningitis By Kamalakar Ambati 17
- 18. g ellin l Sw rona Neu ICP>MAP is incompatible with life ury l Inj Flow ranial Increased Intracranial rona Pressure c Intra Neu By Kamalakar Ambati 18
- 19. Persistent Vegetative State Locked-in Syndrome Minimally Responsive State By Kamalakar Ambati 19
- 20. Normal Sleep-Wake Cycles No Response to Environmental Stimuli Diffuse Brain Injury with Preservation of Brain Stem Function By Kamalakar Ambati 20
- 21. Ventral Pontine Infarct Complete Paralysis Preserved Consciousness Preserved Eye Movement By Kamalakar Ambati 21
- 22. Static Encephalopathy Diffuse or Multi-Focal Brain Injury Preserved Brain Stem Function Variable Interaction with Environmental Stimuli By Kamalakar Ambati 22
- 23. Clinical Prerequisites: Known Irreversible Cause Exclusion of Potentially Reversible Conditions Drug Intoxication or Poisoning Electrolyte or Acid-Base Imbalance Endocrine Disturbances Core Body temperature > 32° C By Kamalakar Ambati 23
- 24. Coma Absent Brain Stem Reflexes Apnea By Kamalakar Ambati 24
- 25. No Response to Noxious Stimuli Nail Bed Pressure Sternal Rub Supra-Orbital Ridge Pressure By Kamalakar Ambati 25
- 26. Pupillary Reflex Eye Movements Facial Sensation and Motor Response Pharyngeal (Gag) Reflex Tracheal (Cough) Reflex By Kamalakar Ambati 26
- 27. Pupils dilated with no constriction to bright light By Kamalakar Ambati 27
- 28. Occulo-Cephalic Response “Doll’s Eyes Maneuver” By Kamalakar Ambati 28
- 29. Oculo-Vestibular Response “Cold Caloric Testing” By Kamalakar Ambati 29
- 30. Corneal Reflex Jaw Reflex Grimace to Supraorbital or Temporo-Mandibular Pressure By Kamalakar Ambati 30
- 31. Prerequisites Core Body Temperature > 32° C Systolic Blood Pressure ≥ 90 mm Hg Normal Electrolytes Normal PCO2 By Kamalakar Ambati 31
- 32. 1. Pre-Oxygenation 100% Oxygen via Tracheal Cannula PO2 = 200 mm Hg 2. Monitor PCO2 and PO2 with pulse oximetry 3. Disconnect Ventilator 4. Observe for Respiratory Movement until PCO2 = 60 mm Hg 5. Discontinue Testing if BP < 90, PO2 saturation decreases, or cardiac dysrhythmia observed By Kamalakar Ambati 32
- 33. Facial Trauma Pupillary Abnormalities CNS Sedatives or Neuromuscular Blockers Hepatic Failure Pulmonary Disease By Kamalakar Ambati 33
- 34. Sweating, Blushing Deep Tendon Reflexes Spontaneous Spinal Reflexes- Triple Flexion Babinski Sign By Kamalakar Ambati 34
- 35. Recommended when the proximate cause of coma is not known or when confounding clinical conditions limit the clinical examination By Kamalakar Ambati 35
- 36. EE G Normal Electrocerebral Silence By Kamalakar Ambati 36
- 37. Cerebral Angiography Normal No Intracranial Flow By Kamalakar Ambati 37
- 38. Technetium-99 Isotope Brain Scan By Kamalakar Ambati 38
- 39. MR- Angiography By Kamalakar Ambati 39
- 40. Transcranial Ultrasonography By Kamalakar Ambati 40
- 41. Somatosensory Evoked Potentials By Kamalakar Ambati 41
- 42. Concern for man and his fate must always form the chief interest of all technical endeavors. Never forget this in the midst of your diagrams and equations. Albert Einstein By Kamalakar Ambati 42