This document discusses brain death, including its historical definition, current diagnostic criteria, pathophysiology, and management of organ donors. Key points include:
- Brain death is defined as irreversible cessation of all functions of the entire brain, including the brain stem.
- Diagnosis requires two examinations at least 6 hours apart showing coma, absence of brainstem reflexes, and apnea during a standardized test. Ancillary tests like EEG can be used if clinical criteria are inconclusive.
- After brain death, pathophysiological changes occur like hypotension, diabetes insipidus, and coagulopathies due to loss of autonomic and endocrine functions regulated by the brain.
1. Brain death is defined as the irreversible loss of function of the brain, including the brainstem. It is diagnosed through clinical examinations demonstrating coma, absence of brainstem reflexes, and apnea.
2. The diagnosis of brain death requires meeting certain prerequisites, performing a neurological exam to demonstrate no response to stimuli and no brainstem reflexes, and conducting an apnea test to show the inability to breathe independently.
3. Confirmatory tests such as an EEG, angiogram, or nuclear scan may be used but are not required for the diagnosis of brain death. Proper documentation of meeting criteria is important.
Nurses as the primary care providers would be the immediate health care professional to assess the patient's response and to determine whether he is improving or deteriorating. Signs of brain death can be identified and reported early by a nurse with adequate knowledge.
This document discusses brain death and how it is defined. It explains that brain death is a legal definition of death that means the complete and irreversible cessation of all brain function. The brain has died due to blocked blood flow even though the heart may still be beating with the help of life support. Signs of brain death include the absence of reflexes and the inability to breathe without a ventilator. Tests like EEG can confirm no brain activity remains. The document provides details on clinical evaluations and confirmatory tests used to determine brain death.
This document discusses brain death and the criteria used to diagnose it. It begins by describing different states of consciousness including coma, persistent vegetative state, and locked-in syndrome. It then defines brain death as the total and irreversible loss of brain and brainstem function. The key criteria for determining brain death are the absence of cortical function, absence of brainstem reflexes, and apnea during a specific oxygen challenge. Confirmatory tests like angiography, EEG, transcranial Doppler, and nuclear medicine scans can also support the diagnosis. Precise clinical evaluations and testing are required to distinguish brain death from other severe neurological conditions.
This is a presentation on brain death, its background, definition, related neurological conditions, criteria of brain death, brain stem reflexes, causes of coma, confounding factors, observation compatible with brain death, ancillary test, medical record documentation, prognosis, Management of brain death patient.
You tube link of this presentation
https://www.youtube.com/watch?v=3MzE5lHfglI&t=38s
Brain Death and Preparation for Organ DonationRanjith Thampi
This document discusses brain death, including definitions, causes, mechanisms, diagnostic criteria and confirmatory tests. It provides details on:
- Loss of brainstem and cortical function constituting brain death
- Common causes like stroke, trauma, hypoxia
- Mechanism of increased intracranial pressure leading to circulatory arrest
- Clinical criteria including apnea testing over multiple examinations
- Confirmatory tests like EEG, evoked potentials, angiography and imaging to demonstrate lack of cerebral blood flow
This document discusses brain death, including its prerequisites, neurological exam criteria, ancillary tests, mimics, and prognosis. It notes that brain death is diagnosed through meeting specific criteria including deep coma, absence of brainstem reflexes on exam, and apnea test showing no respiratory effort and rising carbon dioxide levels. Ancillary tests like EEG, evoked potentials, and blood flow studies can help in certain cases. True brain death is considered irreversible, though very young patients may in rare cases survive longer with life support.
This presentation consist information about Brain death with special emphasis to differences between Indian and Western Guidelines. Also consist information about Organ transplantation and related act.
1. Brain death is defined as the irreversible loss of function of the brain, including the brainstem. It is diagnosed through clinical examinations demonstrating coma, absence of brainstem reflexes, and apnea.
2. The diagnosis of brain death requires meeting certain prerequisites, performing a neurological exam to demonstrate no response to stimuli and no brainstem reflexes, and conducting an apnea test to show the inability to breathe independently.
3. Confirmatory tests such as an EEG, angiogram, or nuclear scan may be used but are not required for the diagnosis of brain death. Proper documentation of meeting criteria is important.
Nurses as the primary care providers would be the immediate health care professional to assess the patient's response and to determine whether he is improving or deteriorating. Signs of brain death can be identified and reported early by a nurse with adequate knowledge.
This document discusses brain death and how it is defined. It explains that brain death is a legal definition of death that means the complete and irreversible cessation of all brain function. The brain has died due to blocked blood flow even though the heart may still be beating with the help of life support. Signs of brain death include the absence of reflexes and the inability to breathe without a ventilator. Tests like EEG can confirm no brain activity remains. The document provides details on clinical evaluations and confirmatory tests used to determine brain death.
This document discusses brain death and the criteria used to diagnose it. It begins by describing different states of consciousness including coma, persistent vegetative state, and locked-in syndrome. It then defines brain death as the total and irreversible loss of brain and brainstem function. The key criteria for determining brain death are the absence of cortical function, absence of brainstem reflexes, and apnea during a specific oxygen challenge. Confirmatory tests like angiography, EEG, transcranial Doppler, and nuclear medicine scans can also support the diagnosis. Precise clinical evaluations and testing are required to distinguish brain death from other severe neurological conditions.
This is a presentation on brain death, its background, definition, related neurological conditions, criteria of brain death, brain stem reflexes, causes of coma, confounding factors, observation compatible with brain death, ancillary test, medical record documentation, prognosis, Management of brain death patient.
You tube link of this presentation
https://www.youtube.com/watch?v=3MzE5lHfglI&t=38s
Brain Death and Preparation for Organ DonationRanjith Thampi
This document discusses brain death, including definitions, causes, mechanisms, diagnostic criteria and confirmatory tests. It provides details on:
- Loss of brainstem and cortical function constituting brain death
- Common causes like stroke, trauma, hypoxia
- Mechanism of increased intracranial pressure leading to circulatory arrest
- Clinical criteria including apnea testing over multiple examinations
- Confirmatory tests like EEG, evoked potentials, angiography and imaging to demonstrate lack of cerebral blood flow
This document discusses brain death, including its prerequisites, neurological exam criteria, ancillary tests, mimics, and prognosis. It notes that brain death is diagnosed through meeting specific criteria including deep coma, absence of brainstem reflexes on exam, and apnea test showing no respiratory effort and rising carbon dioxide levels. Ancillary tests like EEG, evoked potentials, and blood flow studies can help in certain cases. True brain death is considered irreversible, though very young patients may in rare cases survive longer with life support.
This presentation consist information about Brain death with special emphasis to differences between Indian and Western Guidelines. Also consist information about Organ transplantation and related act.
This document discusses cerebral blood flow and its regulation. It begins with an introduction to the components inside the skull and the Monro-Kellie doctrine. It then covers the anatomy of brain circulation discovered by Willis in 1664, including the anterior and posterior circulations and collateral pathways. Regulation of cerebral blood flow is achieved through hemodynamic autoregulation, metabolic and chemical mediators, neural control, and circulatory peptides. Clinical measurement techniques include laser Doppler flowmetry, transcranial Doppler, and imaging modalities like CT, MRI, PET, and SPECT. Factors like age, hypertension, and failure of autoregulation can impact cerebral blood flow and its regulation.
The document discusses the anesthetic management of patients undergoing treatment for cerebral aneurysms, including definitions, epidemiology, presentation, diagnosis, management of vasospasm, intracranial pressure, pre-operative assessment and testing, and radiological procedures such as coiling of aneurysms. Precise management of hemodynamics, fluid balance, and respiratory status is important due to the risks of re-bleeding, cerebral ischemia, and impaired autoregulation in these patients.
Brain death is a clinical diagnosis based on the absence of neurologic function and irreversible coma. A complete neurologic examination is required to determine brain death, which must show no brainstem reflexes, no response to stimuli, apnea on testing, and flaccid muscle tone. Ancillary tests like EEG or angiography can assist in diagnosis but are not required. Special considerations are needed for diagnosing brain death in newborns and preterm infants due to the potential for reversible conditions and lack of brain development. Death is declared after two examinations show no changes confirming an irreversible condition.
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Management of patient with increased intracranial pressuresalman habeeb
This document discusses the management of increased intracranial pressure. It defines intracranial pressure and its normal compensatory mechanisms. Common causes of increased ICP including brain edema are explained. Signs and symptoms as well as diagnostic tests and methods for measuring ICP are covered. Goals and approaches for medical and surgical management to reduce ICP are outlined.
1. The document discusses the history and techniques of intracranial pressure (ICP) monitoring. It describes historical figures who contributed to the understanding of ICP and various monitoring methods that have been developed over time.
2. The current gold standard for ICP monitoring is an external ventricular drain, though fiberoptic and strain gauge monitors provide alternatives. Newer methods like optic nerve sheath ultrasound provide noninvasive options.
3. Careful analysis of ICP waveforms can provide insights into intracranial compliance and dynamics that help guide management of conditions with elevated ICP like traumatic brain injury.
The document discusses intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury. There are invasive and non-invasive methods for measuring ICP. Invasive methods include intraventricular catheters and subarachnoid bolts to directly measure pressure. Non-invasive methods attempt to indirectly measure ICP through techniques like transcranial Doppler ultrasonography and tympanic membrane displacement. Nursing care for patients with increased ICP focuses on airway maintenance, ventilation, fluid balance, positioning, and environmental control to reduce intracranial pressure.
Brain death current concepts and legal issues in indiaNeurologyKota
This document discusses the history and criteria for determining brain death. It begins by outlining the historical definitions of death from the 1960s onwards, which evolved from cardiopulmonary criteria to brain-based criteria with the development of life-support technologies. The document then examines the anatomical basis of brainstem death and causes that can lead to it. It provides details on the clinical evaluation process for determining brain death in both adults and children based on guidelines from the US and UK. The document also discusses legal aspects of brain death certification in India according to the Transplantation of Human Organs Act.
The document discusses the diagnosis of brain death through neurological criteria. It begins by describing the main parts of the brain and their functions. It then discusses the concepts, laws, and types of brain death in India. The key components of determining brain death are described, including establishing the cause of coma, achieving normal temperature and blood pressure, performing neurological examinations to check for absence of brainstem reflexes and response to stimuli, and conducting an apnea test. Potential mimics of brain death and pitfalls in the clinical evaluation are outlined. Confirmatory ancillary tests like cerebral angiography and EEG are also discussed.
The document discusses intracranial pressure (ICP), providing definitions and normal values. It describes cerebrospinal fluid (CSF) and autoregulation of cerebral blood flow. It covers evaluation of raised ICP including Monro-Kellie doctrine, Cushing's triad, and changes in the cranium. It discusses types of cerebral edema and causes of raised ICP. Clinical features, investigations, and general treatment protocols are outlined. Specific conditions like normal pressure hydrocephalus and idiopathic intracranial hypertension are briefly mentioned. Prognosis is also covered.
This document provides information on assessing and managing patients with altered consciousness such as coma. It defines key terms like coma, delirium, and vegetative state. It describes how to perform a neurological examination to evaluate a patient's level of consciousness and determine if deficits are focal or diffuse. The examination should assess motor response, brainstem reflexes, respiratory pattern, and reflexes. Admission to the ICU is recommended for patients with a Glasgow Coma Scale of 8 or less or a deteriorating level of consciousness.
Burr hole surgery involves drilling small holes in the skull to access the brain for procedures like draining blood or fluid. It costs $6,500 and requires a 2-4 day hospital stay. The package arranged by Surgerica includes second opinions, travel assistance, hospital care, follow-ups and more to facilitate affordable brain surgery overseas.
Current strategies for cerebral protection during planned cerebral ischemia include hypothermia, colloidal volume expansion, induced hypertension, and barbiturate coma. Hypothermia between 34-35°C is an effective cerebral protector. Colloidal volume expanders are preferable to crystalloids. Induced hypertension can be achieved short-term with phenylephrine or long-term with dopamine. Barbiturate coma decreases cerebral metabolism and intracranial pressure, but carries risks of hemodynamic and respiratory depression that require intensive monitoring. The goal is to maintain intracranial pressure below 20mmHg and cerebral perfusion pressure above 70mmHg.
70% of RTA patients have head injury(HI).
One of the most important public health problems of today.
70% of deaths in RTA are due to HI.
At Risk population
Males 15-24
Infants
Young Children
Elderly
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
The document discusses autoregulation of cerebral blood flow. It notes that the brain receives about 15-20% of cardiac output despite being only 2% of body weight. Cerebral blood flow is tightly regulated between 50-130 mmHg mean arterial pressure through three mechanisms: metabolic regulation which balances supply and demand, myogenic regulation where blood vessel muscles sense pressure changes, and neurogenic regulation involving the sympathetic nervous system and astrocytes. Together these maintain stable blood flow despite fluctuations in blood pressure through the autoregulation phenomenon.
This document discusses the anesthetic management of patients with traumatic brain injury (TBI). It covers the pathophysiology of primary and secondary brain injuries following TBI. Evaluation involves a neurological exam including Glasgow Coma Scale. The goals of airway management and ventilation are to prevent hypoxia and hypercarbia which can worsen outcomes. Intraoperative monitoring such as ICP monitoring aims to maintain cerebral perfusion pressure and reduce intracranial pressure. Blood pressure and ventilation are carefully managed to optimize oxygen delivery and avoid elevating ICP.
The document discusses brain death, its diagnosis and pathophysiology. It defines brain death as the complete and irreversible loss of brain function. The diagnosis involves meeting strict clinical criteria demonstrating the absence of brainstem reflexes as well as confirmatory tests like EEG. Brain death results in no prospect of survival without life support or recovery of brain function. Proper diagnosis is important for organ donation where brain death constitutes legal death.
1) Brain death is the irreversible loss of all brain and brainstem functions and is diagnosed clinically through examination of coma, absent brainstem reflexes, and apnea on testing.
2) The role of the intensivist is to determine if the patient meets criteria for brain death through clinical examination and ancillary testing, and to prepare potential organ donors.
3) Brain death results from severe brain injury or lack of oxygen that causes raised intracranial pressure, cessation of cerebral blood flow, and ultimately complete necrosis of brain tissue.
This document discusses brain death and its determination. It begins by introducing the concept of brain death and how advances in medicine led to its development. It then covers the anatomical and physiological basis of brain death, focusing on the brainstem and its role in consciousness and vital functions. Several sections define the criteria for determining brain death, including clinical assessments and tests to confirm the diagnosis. Complicating factors and observation periods are also outlined. The document concludes by noting guidelines for determining brain death in children.
This document discusses cerebral blood flow and its regulation. It begins with an introduction to the components inside the skull and the Monro-Kellie doctrine. It then covers the anatomy of brain circulation discovered by Willis in 1664, including the anterior and posterior circulations and collateral pathways. Regulation of cerebral blood flow is achieved through hemodynamic autoregulation, metabolic and chemical mediators, neural control, and circulatory peptides. Clinical measurement techniques include laser Doppler flowmetry, transcranial Doppler, and imaging modalities like CT, MRI, PET, and SPECT. Factors like age, hypertension, and failure of autoregulation can impact cerebral blood flow and its regulation.
The document discusses the anesthetic management of patients undergoing treatment for cerebral aneurysms, including definitions, epidemiology, presentation, diagnosis, management of vasospasm, intracranial pressure, pre-operative assessment and testing, and radiological procedures such as coiling of aneurysms. Precise management of hemodynamics, fluid balance, and respiratory status is important due to the risks of re-bleeding, cerebral ischemia, and impaired autoregulation in these patients.
Brain death is a clinical diagnosis based on the absence of neurologic function and irreversible coma. A complete neurologic examination is required to determine brain death, which must show no brainstem reflexes, no response to stimuli, apnea on testing, and flaccid muscle tone. Ancillary tests like EEG or angiography can assist in diagnosis but are not required. Special considerations are needed for diagnosing brain death in newborns and preterm infants due to the potential for reversible conditions and lack of brain development. Death is declared after two examinations show no changes confirming an irreversible condition.
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Management of patient with increased intracranial pressuresalman habeeb
This document discusses the management of increased intracranial pressure. It defines intracranial pressure and its normal compensatory mechanisms. Common causes of increased ICP including brain edema are explained. Signs and symptoms as well as diagnostic tests and methods for measuring ICP are covered. Goals and approaches for medical and surgical management to reduce ICP are outlined.
1. The document discusses the history and techniques of intracranial pressure (ICP) monitoring. It describes historical figures who contributed to the understanding of ICP and various monitoring methods that have been developed over time.
2. The current gold standard for ICP monitoring is an external ventricular drain, though fiberoptic and strain gauge monitors provide alternatives. Newer methods like optic nerve sheath ultrasound provide noninvasive options.
3. Careful analysis of ICP waveforms can provide insights into intracranial compliance and dynamics that help guide management of conditions with elevated ICP like traumatic brain injury.
The document discusses intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury. There are invasive and non-invasive methods for measuring ICP. Invasive methods include intraventricular catheters and subarachnoid bolts to directly measure pressure. Non-invasive methods attempt to indirectly measure ICP through techniques like transcranial Doppler ultrasonography and tympanic membrane displacement. Nursing care for patients with increased ICP focuses on airway maintenance, ventilation, fluid balance, positioning, and environmental control to reduce intracranial pressure.
Brain death current concepts and legal issues in indiaNeurologyKota
This document discusses the history and criteria for determining brain death. It begins by outlining the historical definitions of death from the 1960s onwards, which evolved from cardiopulmonary criteria to brain-based criteria with the development of life-support technologies. The document then examines the anatomical basis of brainstem death and causes that can lead to it. It provides details on the clinical evaluation process for determining brain death in both adults and children based on guidelines from the US and UK. The document also discusses legal aspects of brain death certification in India according to the Transplantation of Human Organs Act.
The document discusses the diagnosis of brain death through neurological criteria. It begins by describing the main parts of the brain and their functions. It then discusses the concepts, laws, and types of brain death in India. The key components of determining brain death are described, including establishing the cause of coma, achieving normal temperature and blood pressure, performing neurological examinations to check for absence of brainstem reflexes and response to stimuli, and conducting an apnea test. Potential mimics of brain death and pitfalls in the clinical evaluation are outlined. Confirmatory ancillary tests like cerebral angiography and EEG are also discussed.
The document discusses intracranial pressure (ICP), providing definitions and normal values. It describes cerebrospinal fluid (CSF) and autoregulation of cerebral blood flow. It covers evaluation of raised ICP including Monro-Kellie doctrine, Cushing's triad, and changes in the cranium. It discusses types of cerebral edema and causes of raised ICP. Clinical features, investigations, and general treatment protocols are outlined. Specific conditions like normal pressure hydrocephalus and idiopathic intracranial hypertension are briefly mentioned. Prognosis is also covered.
This document provides information on assessing and managing patients with altered consciousness such as coma. It defines key terms like coma, delirium, and vegetative state. It describes how to perform a neurological examination to evaluate a patient's level of consciousness and determine if deficits are focal or diffuse. The examination should assess motor response, brainstem reflexes, respiratory pattern, and reflexes. Admission to the ICU is recommended for patients with a Glasgow Coma Scale of 8 or less or a deteriorating level of consciousness.
Burr hole surgery involves drilling small holes in the skull to access the brain for procedures like draining blood or fluid. It costs $6,500 and requires a 2-4 day hospital stay. The package arranged by Surgerica includes second opinions, travel assistance, hospital care, follow-ups and more to facilitate affordable brain surgery overseas.
Current strategies for cerebral protection during planned cerebral ischemia include hypothermia, colloidal volume expansion, induced hypertension, and barbiturate coma. Hypothermia between 34-35°C is an effective cerebral protector. Colloidal volume expanders are preferable to crystalloids. Induced hypertension can be achieved short-term with phenylephrine or long-term with dopamine. Barbiturate coma decreases cerebral metabolism and intracranial pressure, but carries risks of hemodynamic and respiratory depression that require intensive monitoring. The goal is to maintain intracranial pressure below 20mmHg and cerebral perfusion pressure above 70mmHg.
70% of RTA patients have head injury(HI).
One of the most important public health problems of today.
70% of deaths in RTA are due to HI.
At Risk population
Males 15-24
Infants
Young Children
Elderly
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
The document discusses autoregulation of cerebral blood flow. It notes that the brain receives about 15-20% of cardiac output despite being only 2% of body weight. Cerebral blood flow is tightly regulated between 50-130 mmHg mean arterial pressure through three mechanisms: metabolic regulation which balances supply and demand, myogenic regulation where blood vessel muscles sense pressure changes, and neurogenic regulation involving the sympathetic nervous system and astrocytes. Together these maintain stable blood flow despite fluctuations in blood pressure through the autoregulation phenomenon.
This document discusses the anesthetic management of patients with traumatic brain injury (TBI). It covers the pathophysiology of primary and secondary brain injuries following TBI. Evaluation involves a neurological exam including Glasgow Coma Scale. The goals of airway management and ventilation are to prevent hypoxia and hypercarbia which can worsen outcomes. Intraoperative monitoring such as ICP monitoring aims to maintain cerebral perfusion pressure and reduce intracranial pressure. Blood pressure and ventilation are carefully managed to optimize oxygen delivery and avoid elevating ICP.
The document discusses brain death, its diagnosis and pathophysiology. It defines brain death as the complete and irreversible loss of brain function. The diagnosis involves meeting strict clinical criteria demonstrating the absence of brainstem reflexes as well as confirmatory tests like EEG. Brain death results in no prospect of survival without life support or recovery of brain function. Proper diagnosis is important for organ donation where brain death constitutes legal death.
1) Brain death is the irreversible loss of all brain and brainstem functions and is diagnosed clinically through examination of coma, absent brainstem reflexes, and apnea on testing.
2) The role of the intensivist is to determine if the patient meets criteria for brain death through clinical examination and ancillary testing, and to prepare potential organ donors.
3) Brain death results from severe brain injury or lack of oxygen that causes raised intracranial pressure, cessation of cerebral blood flow, and ultimately complete necrosis of brain tissue.
This document discusses brain death and its determination. It begins by introducing the concept of brain death and how advances in medicine led to its development. It then covers the anatomical and physiological basis of brain death, focusing on the brainstem and its role in consciousness and vital functions. Several sections define the criteria for determining brain death, including clinical assessments and tests to confirm the diagnosis. Complicating factors and observation periods are also outlined. The document concludes by noting guidelines for determining brain death in children.
This document discusses brain death, including its definition, criteria, and controversies. It begins by explaining how advances in medicine led to the development of neurological criteria for determining death. It then covers the anatomical and physiological basis of brain death, focusing on damage to the brainstem and reticular formation. The document outlines the clinical criteria for diagnosing brain death, including the absence of brainstem reflexes and apnea testing. It notes complicating factors and observation periods. The history and acceptance of brain death criteria internationally is reviewed. Some bioethical controversies are also presented, such as debates around the definition of death and higher brain formulations.
Brain death and care for cadaveric organ donarKrishna R
The document discusses the history and criteria for determining brain death. It begins by outlining the evolution of the concept of brain death from the 1960s onwards. Key events included distinguishing brain death from cardiac death with the advent of life support technologies. The document then discusses the anatomy and functions of the brainstem and how brainstem death criteria focus on irreversible loss of brainstem function. It provides details on the tests and criteria used in India to determine brain death, including loss of consciousness, absence of brainstem reflexes, apnea testing, and rule out of confounding factors. Spinal cord reflexes that can occur after brain death are also addressed.
Brain Death concepts, Its changes and life after brain death, is the body still alive?? what are the determinants of brain death and who can declare it, bio ethical dimensions of nursing care in BD
The document provides guidance on effective donor management following brain death declaration. It discusses [1] stabilizing the donor through brain death examination and managing physiology, [2] addressing complex issues like hemodynamics, electrolytes, gas exchange and more through protocols, and [3] coordinating with transplant teams to evaluate organ function and arrange recovery. The goal is optimizing organ viability and function through vigilance and collaboration between critical care staff and transplant professionals.
Final [CH13] NOTES ppt, Neurological Problems.pptTristanBabaylan1
This document provides an overview of rapid neurologic assessment techniques including the Glasgow Coma Scale and assessment of level of consciousness. It also discusses conditions such as migraines, seizures, meningitis, increased intracranial pressure, strokes, Parkinson's disease, and Alzheimer's disease. For each condition, it outlines signs and symptoms, diagnostic testing, treatment options, nursing considerations, and interventions.
1. Coma is defined as a state of unconsciousness from which the patient cannot be aroused. It results from diffuse or focal injuries to the brain.
2. The document discusses the pathophysiology, etiology, examination, investigations, management, and diagnosis of brain death in patients presenting with coma.
3. Key points include differentiating structural from metabolic comas, evaluating for reversible causes, monitoring vital signs and neurological exam including brain stem reflexes, treating increased intracranial pressure, and confirming brain death through apnea testing and clinical criteria.
General approach and differential diagnosis of comaAn Chang
This document provides guidance on evaluating and managing comatose patients. It outlines the following key steps:
1. Ensure airway, breathing and circulation are stabilized. Treat any rapidly reversible causes of coma like hypoglycemia.
2. Use the Glasgow Coma Scale to assess the level of consciousness. Common causes of coma include head injuries, strokes, infections, tumors, and metabolic derangements.
3. Perform a full neurological exam including pupil size and response, motor function, and posture. Request diagnostic tests like bloodwork and CT or MRI as indicated.
4. Manage increased intracranial pressure with osmotic diuretics if present. Treat any identifiable structural or metabolic causes. Monitor
1. Brain death is defined as the irreversible loss of all brain function, including the brainstem. The three essential findings are coma, absence of brainstem reflexes, and apnea on testing.
2. Common causes of brain death include traumatic brain injury, intracerebral hemorrhage, hypoxic-ischemic injury from cardiopulmonary arrest. A thorough exam is required to determine the cause and rule out potential confounders.
3. Evaluation of brain death involves assessing for coma, absence of brainstem reflexes on exam, and a positive apnea test showing lack of respiratory drive and rising CO2 levels. Ancillary tests like angiography or EEG can also be
Respiratory tract obstruction in an unconscious patient and its management.pptxSUTACADEMYOFMEDICALS
Sree Uthradom Thirunal (SUT) Academy of Medical Sciences is one of the best hospital and top college located in Thiruvananthapuram, the capital of Kerala state, India. The Academy was founded in 2006 based in 30 acres of beautiful landscaped grounds with an annual admission of 100 Students. The college aims to provide quality professional medical education to every student who joins the institute and the campus and the hospital lie on Vattappara to Nedumangad road, at Vencod Junction. SUTAMS is recognized by MEDICAL COUNCIL OF INDIA, Government of India and affiliated to KERALA UNIVERSITY OF HEALTH SCIENCES, Thrissur, Kerala, India
Stroke or Cerebrovascular incident, is defined as an abrupt onset of a neurological deficit that is attributable to a focal vascular cause.
The clinical manifestations of stroke are highly variable because of the complex anatomy of the brain
The document discusses guidelines for determining brain death. It begins with historical context for defining death and the need for brain death criteria. Key points include:
- Brain death is the irreversible loss of all brain function, including the brain stem. It allows for legal death even if other organs are functioning.
- Tests to determine brain death include examining for the absence of brain stem reflexes and apnea testing to check for respiratory drive.
- If full criteria are met, including examinations showing no brain activity, the time of death is determined to be when respiratory criteria were met on tests.
Stroke is a leading cause of death and disability globally. The presentation summarizes key aspects of stroke management. It describes the epidemiology, pathophysiology, clinical features, diagnosis and management of both ischemic and hemorrhagic strokes. Prevention of initial and recurrent strokes is emphasized through control of risk factors and use of anticoagulants or antiplatelets depending on the patient's risk profile. Early diagnosis and treatment including thrombolysis are important to minimize brain damage from acute strokes.
Anaesthesia for posterior fossa surgery/NEUROANAESTHESIAZIKRULLAH MALLICK
This document discusses the anatomy, contents, clinical presentation, and anesthetic considerations for posterior fossa surgery. The posterior fossa is bounded by bones and contains the cerebellum, brainstem, and cranial nerves. Common tumors present with non-specific symptoms like headache but can also cause neurological deficits depending on the location of the lesion. Anesthetic goals are to facilitate surgery while minimizing brain trauma and maintaining stability. Important considerations include patient positioning, monitoring, induction technique, and maintenance with low-dose inhalational agents and ventilation to reduce intracranial pressure.
Benign intracranial hypertension (BIH), also known as idiopathic intracranial hypertension or pseudotumor cerebri, is characterized by increased intracranial pressure without a tumor or other identifiable cause. Common symptoms include headache, nausea, visual disturbances, and papilledema which can cause vision loss if untreated. While the exact cause is unknown, theories include excess CSF production, increased blood flow to the brain, or impaired venous drainage from the brain. Treatment involves weight loss, medications like acetazolamide, and sometimes surgical procedures to relieve pressure like optic nerve sheath fenestration or CSF shunting.
Benign intracranial hypertension (BIH), also known as idiopathic intracranial hypertension or pseudotumor cerebri, is characterized by increased intracranial pressure without a tumor or other identifiable cause. Common symptoms include headache, nausea, visual disturbances, and papilledema which can cause vision loss if untreated. While the exact cause is unknown, theories include excess CSF production, increased blood flow to the brain, or impaired venous drainage from the brain. Treatment involves weight loss, medications like acetazolamide, and sometimes surgical procedures to relieve pressure like optic nerve sheath fenestration or CSF shunting.
lucid interval and its importance in trauma and mental healthsreya paul
1) A 38-year old cricket player was hit on the temple by a cricket ball while fielding without a helmet. He initially seemed fine but later lost consciousness and was found to have a brain hemorrhage.
2) The document discusses lucid intervals which is a period of temporary consciousness that can occur between initial unconsciousness from head trauma and delayed worsening of symptoms from a brain injury like an epidural hematoma.
3) Recognizing lucid intervals is important to prevent delays in treating expanding brain injuries. The cricket player discussed experienced a lucid interval but ultimately died after surgery failed to control his brain hemorrhage.
This document discusses brain death, including its definition as the irreversible cessation of all brain functions including the brainstem. It outlines the diagnostic guidelines for determining brain death in children and adults. The clinical diagnosis involves demonstrating irreversible coma, absence of brainstem reflexes, and apnea. It also discusses the apnea test procedure, observation period requirements, confirmatory tests like EEG and cerebral blood flow scans, documentation standards, and providing supportive care after the diagnosis.
This document provides information about brain death. It begins with definitions of death and introduces brain death as an irreversible form of unconsciousness characterized by loss of brain function while other organs may still be functioning. The document then discusses the history of how brain death was recognized and defined. It outlines the criteria for determining brain death, including assessing brain stem reflexes and performing an apnea test. The document notes that Indian law recognizes brain death and defines a deceased person. It emphasizes the importance of establishing the cause of brain dysfunction and ruling out potential confounders before determining brain death.
Myasthenia gravis is an autoimmune disorder characterized by fatigable weakness of skeletal muscles due to antibodies attacking acetylcholine receptors at the neuromuscular junction. Clinical presentation includes fluctuating muscle weakness that worsens with exertion and improves with rest, often starting with ocular or bulbar muscles. Anesthetic management aims to prevent prolonged effects on respiratory muscles and allow rapid recovery, often using potent inhaled anesthetics, propofol, or remifentanil without neuromuscular blockers when possible. Reversal agents like sugammadex are preferred over neostigmine to avoid cholinergic crisis. Careful extubation is important to avoid myasthenic crisis.
This document discusses anaesthesia for electroconvulsive therapy (ECT). It describes ECT as the artificial induction of a grand mal seizure through electrical stimulation of the brain to treat severe mental illnesses. It notes the common indications for ECT and outlines the anaesthetic considerations and techniques used to control physiological responses and complications during the procedure, including preoxygenation, induction agents like methohexital or propofol, and muscle relaxants like succinylcholine to prevent injury during seizures. Risks associated with ECT like increased intracranial pressure, blood pressure changes, and memory loss are also summarized.
This document discusses various methods of labor analgesia. It begins by outlining the objectives and introducing the stages of labor and physiology of pain. It then summarizes non-pharmacological methods like psychoprophylaxis and TENS. Various pharmacological methods are discussed including inhalational analgesia, systemic opioids, and regional techniques like epidural analgesia, combined spinal epidural, and walking epidural. Epidural analgesia is described as the gold standard, and optimal epidural regimens, administration techniques, and monitoring are outlined.
Paediatric anatomy and physiology for AnaesthesiaKundan Ghimire
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3. Historical Perspective
•Historically death defined as “permanent cessation of
circulatory and respiratory function.”
•However, in 1968 a committee at Harvard Medical School
decided to redefine death by using “irreversible coma” as
a new criterion.
4. • advancements in CPR techniques and widespread
mechanical ventilators use, number of patients could be
kept temporarily ‘alive.
• Consequently, Harvard criteria was developed and formed
the basis for all brain death guidelines.
5. BRAIN DEATH
Uniform Determination of Death
Act(UDDA) 1981
•An individual who has sustained either
•Irreversible cessation of circulatory and
respiratory functions, or
•Irreversible cessation of all functions of the entire
brain, including the brain stem
6. American Academy of
Neurology(1995)
Published practice parameter to
describe medical standards for
the determination of brain death
•essential findings necessary to
confirm irreversible cessation
of all functions of the entire
brain, including brain stem.
8. cerebral hypoxia, traumatic head
injury, subarachnoid or intracerebral
hemorrhage and bacterial meningitis.
primary brainstem pathology
or conditions causing cerebral
edema. E.g DKA, HE, Water
intoxication, eclampsia,
Aspirin overdose, Malignant
hypertension.
irreversible rise
in ICP
increased ICP compresses the
entire brain including the
brainstem
total brain infract
9. •Rise in ICP ➡️ massive release of catecholamine stores
➡️ increased systemic arterial blood pressure, sometimes
associated with reflex bradycardia, bradyarrhythmia, or
both.
•Decreased cardiac output, pulmonary edema, and cardiac
ischemia may be encountered.
10. •Once total brain infarction has occurred ➡️ catecholamines
depletion ➡️ loss of sympathetic output ➡️ peripheral
vasodilation and systemic hypotension.
•Other common problems after brain death include diabetes
insipidus, hypothermia, metabolic acidosis and cardiac
arrest.
11. Physiological change after brain
death
Neurological Changes:-
• temperature regulation center in hypothalamus is impaired.
• patient becomes poikilothermic and hypothermic.
Cardiovascular Changes:-
• Raised ICP may cause rise in catecholamines, leading to
'sympathetic storm', responsible for the increased blood pressure,
cardiac dysrhythmias, ECG abnormalities, myocardial damage
and renal impairment.
12. Pulmonary Changes:-
• During the sympathetic storm, rapid rise in left atrial pressure
exceeds pulmonary artery pressure may result in capillary
disruption, protein-rich pulmonary edema and interstitial
hemorrhage.
Endocrine Changes:-
• Neurogenic diabetes insipidus.
• Electrolyte disturbances: hypernatremia, hypokalemia,
hypocalcaemia, hypophosphatemia and hypomagnesemia occur
rapidly without treatment.
13. •Interrupt hypothalamic-pituitary axis leading to
serum hormone depletion.
• Hypothyroidism & adrenal insufficiency
•Fall in insulin levels
Leads to systemic hyperglycemia with severe
osmotic diuresis and profound hypovolemia.
16. DIAGNOSTIC CRITERIA
•Two examinations, separated by at least 6
hours
•Done by 2 or 3 physicians independent of the
transplant team
•At least one physician should be a specialist
in neurology/neurosurgery/neuroanesthesia
18. PREREQUISITES:
Inclusion criteria
•patient must be totally unresponsive and ventilator
dependent.
•Irreversible cause of brain death of known etiology:
evidence of brain injury-clinical, radiological.
19. PREREQUISITES:
Exclusion criteria
•No drug intoxication or poisoning
•Recent administration or continued presence of
neuromuscular blockers.
•Guillain-Barré or the locked-in syndrome
21. Demonstration of clinical signs of brain death
1. Coma or unresponsiveness
•GCS of 3
•No cerebral motor response in all extremities or
facial muscles to painful nail-bed pressure or
supraorbital ridge pressure.
22. 2. Absence of brainstem reflexes
A. Pupils
a) No response to bright light
b) Size: midposition (4 mm) to dilated (9 mm)
B. Facial sensation and facial motor response
a) No corneal reflex to touch with a cotton swab
b) No jaw reflex
c) No grimacing to deep pressure on nail bed,
supraorbital ridge, or temporomandibular joint
23. C . Pharyngeal(gag) and tracheal(cough) reflexes
a) No response after stimulation of the posterior
pharynx with tongue blade
b) No cough response to tracheal suctioning
D. Ocular movement
a) No oculocephalic reflex (testing only when no
fracture or instability of the cervical spine is
apparent)
b) No occulo-vestibular reflex
26. 3. Apnea test:
considered as most important test.
• main components
• Prevent hypoxemia
• Ensure an adequate PaCO2
• Observe that spontaneous respiratory effort is
absent
28. Procedure
•Adjust vasopressors to a systolic blood pressure 100
mm Hg
•Pre-oxygenate with 100% oxygen for at least 10
minutes to PaO2 of 200 mm Hg.
•Reduce ventilation frequency to 10 breath to eucapnia
•Reduce PEEP to 5 cm H2O.
•If oxygen saturation remains 95%, obtain baseline
ABG
29. •Disconnect the patient from the ventilator.
•Deliver 100% O2
•4-6 L/m via a insufflation catheter inserted at the
level of carina.
•6 L/m by T piece attached to the ETT tube
•Look closely for the respiratory effort for 8-10 mins.
•If no respiratory drive observed after 8 min draw
blood for blood gas analysis and reconnect ventilator
30. Apnea test- Positive
•respiratory movements- absent
•and arterial PaCO2 is ≥ 60 mm Hg or 20 mm Hg
increase in PaCO2 over a baseline
Apnea test- Indeterminate
•Respiratory movement-absent
•PaCO2<60 mm Hg.
Apnea test- Negative
•respiratory movements-present.
31. Criteria to abort test
•Presence of respiratory movements
•systolic blood pressure becomes < 90 mm Hg.
•significant oxygen desaturation.
•New cardiac arrhythmias.
32. Factors that can interfere the clinical
diagnosis of brain death
•Severe facial or cervical spine trauma
•Preexisting pupillary abnormalities
•Toxic levels of any sedative drugs, aminoglycosides,
TCA, anticholinergics, antiepileptic drugs,
chemotherapeutic agents, or neuromuscular blocking
agents
•Sleep apnea or severe pulmonary disease resulting in
chronic retention of CO2
33. Ancillary Testing
Recommended when
•cause of coma is not known
•Apnea testing inconclusive or aborted
•confounding clinical conditions limit the
clinical examination.
•Skull or cervical injuries
•Cardiovascular instability
•To reassure family member and medical staff
34. Choice of test
•Ideal ancillary test should meet all of the
following criteria:
• no false positives results
• sufficient on its own to establish is or is not present.
• not susceptible to ”confounders” such as drug effect
or metabolic disturbances.
•standardized in technology, technique and
classification of results
•available, safe and readily applied in all medical
centers with ICUs,
35. Ancillary test for brain death
•Electroencephalography
•Cerebral Angiography
•Nuclear brain scanning
•Transcranial doppler ultrasonography
•CT Scan
•MRI/ MRI-angiography
•SSEP
36.
37. Spinal reflex
•Movements originating from the spinal cord or
peripheral nerve.
•Common(33-75%), triggered by tactile stimuli or
spontaneously.
•Examples include:
• Undulating toe flexion response- planter tactile
stimulation
• Triple flexion response with flexion at the hip, knee and
ankle.
• Pronator extensor reflex- head turning.
• Facial myokymia, repetitive twitching of facial muscles.
• Lazarus sign
• truncal movements including asymmetrical opisthotonic
posturing of the trunk and preservation of superficial and
deep abdominal reflexes.
38. Brain death in child
•Most commonly occurs as a result of trauma and
anoxic encephalopathy.
•Anatomic neurodevelopment continues by 2 years of
age or beyond the first dacade of life.
•Presence of open fontanelles and open sutures makes
the skull an expandable chamber.
•ICP may not exceed MAP and cerebral blood flow
continues.
39. History: determination of the proximate cause of
coma to ensure absence of remediable or reversible
conditions.
Physical examination criteria:
1. coma and apnea
2. absence of brainstem function
• Midposition or fully dilated pupils
• Absence of spontaneous eye movements.
• Absence of movement of bulbar musculature and
corneal, gag, cough, sucking and rooting reflexes.
• Absence of respiratory movements with standardized
testing for apnea.
40. 3. patient must not be hypothermic or hypotensive for
age.
4. Flaccid tone and absence of spontaneous or induced
movements, excluding spinal cord events.
5. Examination results should remain consistent with
brain death throughout the observation and testing
period.
41. •Exclusion of preterm infants younger than 37 weeks
of gestational age.
•Observational period:
•24 hours: neonates (37 weeks of gestation to term
infants 30 days of age)
•12 hours: Infants and children (>30 days to 18 years)
42. Management of organ Donors
•Consent from family for organ donation can be
obtained after the diagnosis of brain death is
established.
•primary goal:
•preserve organ viability.
•best achieved by ensuring oxygenation and
ventilation, maintaining homodynamic stability, and
correcting electrolyte problems and acid-base
abnormalities.
46. Conditions Distinct From Brain Death
•Deep coma
•Persistent Vegetative State
•Minimally Responsive State
•Locked in syndrome
47. Deep coma
•Non-responsive to external stimuli
•Dysfunctional cerebrum
• Brain stem intact spontaneous breathing and
heartbeat
48. Vegetative state
•Appears to be wakeful with cycles of eyes
closure and opening.
•Normal Sleep-Wake Cycles
•No Response to Environmental Stimuli
•Can ventilate themselves
•Lack of higher brain function to control
emotions, consciousness and cognition.
•Hypoxic brain injury.
49. Minimally Responsive State
•Unlike vegetative state, patients with MCS have
partial preservation of conscious awareness.
•Diffuse or Multi-Focal Brain Injury
50. Locked in syndrome
• Lesion to the brainstem, most frequently an ischemic
pontine lesion.
•complete disruption of the motor pathways
• face, trunk and limb movements, including
breathing, swallowing and phonation.
• Consciousness and cortical functions are preserved.
51. References
• Miller’s Anesthesia, 8th Edition
• ICU book.
• American Academy of Neurology guidelines for brain death
determination.
• Textbook of Neuroanaesthesia and Critical Care.
Decreased cardiac output, pulmonary edema, and cardiac ischemia may be encountered while brain death is evolving.
Neural connection between temperature-regulating centre and peripheral body tissue is lost and the pt becomes poikilothermic.
Hypothalamic pituitary and endocrine- preserved to a certain degree for a certain period after onset of brain death. Thyroid hormones and vasopressin levels are markedly reduced after brain death.
Release from damaged brain tissue
Steps in determining brain death- clinical evaluation, neurological assessment, ancillary test and documentation
Cause of coma- severe traumatic brain injury, subarachnoid or intracerebral hemorrhage, extensive ischemic strokes, cerebral edema secondary to fulminant hepatic failure and hypoxic ischemic brain injury.
CNS depressants- anesthetic agents, BDZs,barbiturates, opiates, and tricyclic antidepressant.
Conditions mimicking coma- GBS, locked in syndrome and severe hypothyroidism.
Medical conditions confounding clinical assessment- no severe electrolyte, acid base, endocrine or circulatory(shock) disturbance.
Hypothermia- depresses CNS function and can misdx brain death, also delays PaCO2 increase necessary for apnea testing.
Thyroid dysfunction and Addisonian crisis can affect muscle function or result in coma. Na:115-160mmol/l, glucose 3-20mmol/l, Mg/PO4: 0.5-3mmol/l, K:1-2mmol/l, O2:>10kPa, CO2<6kpa, MAP>60mm Hg
Clinically can be tested by knee/ ankle jerk. Or use PNS
Brain originating motor response, including response to pain stimulus above the neck or other brain originating movements- seizures, decrebrate or decorticate.
Lazarus sign can occur spontaneously during apnea testing and are considered to have spinal origin during hypoxic or hypotensive episodes.
Pupil shape- round, oval or irregular. Pupil- CNs-II and III, corneal reflex- V and VII, no motor response- CNs V and VII.
Cough or gag- CNs IX and X, Oculo-vestibular-CNs III, VI and VIII,
Pharyngeal(gag) reflex, tracheal(cough) reflex
Movement of the eye should be absent during 1 min of observation. Both sides are tsted, with an interval of several minutes.
Mechanical/gravitational forces stimulate vestibular responses.
On brisk rotatation of head from side to side. Intact lower brainstem with impaired cerebral hemisphere- eye will deviate away from the direction of rotation and maintain an forward field of view.
Lower brainstem damaged- eye will follow direction of head rotation.
Thermal energy stimulates vestibular responses.
After injection of 50 ml of cold saline, intact brainstem- both eye will deviate slowly towards the irrigated ear, and horizontal nystagmus in opposite ear. Conjugate eye movement is lost when lower brainstem is damaged.
PaCO2 >60mm Hg produces maximum stimulation of brainstem
Prevent hypoxemia- so preoxygenate with 100% FiO2 for 10 mins to increase PaO2>200 mm Hg
Hypotension may result in compromised cerebral perfusion leading to loss of electroencephalographic activity causing a SPURIOUS dx.
Pre-oxygenate with 100% O2 for at least 10 mins. To PaO2 of 200 mm Hg
Respirations- abdominal or chest excursions and may include a brief gasp.
If the test is inconclusive but the patient is hemodynamically stable during procedure, it may be repeated for a longer period of time (10-15 minutes) after the patient is again adequately pre-oxygenated.
Abort the test if pt becomes unstable at any point during apnea test.
SpO2 <85% for longer than 30 s.
Ancillary- an alternative test to one that otherwise, for any reason cannot be conducted.
In adults, ancillary tests are not needed for the clinical diagnosis of brain death and cannot replace a neurologic examination.
No false positive- when the test confirms brain death there should be none that recover or have the potential to recover.
Sufficient-wheather there is total and irreversible destruction of brainstem or the entire brain
Unfortunately no currently available test meets all of these criteria.
Undulating- alternating flexion-extension of toes with passive displacement of foot
Lazarus sign- bilateral arm flexion, shoulder adduction, hand raising to chest/neck, triggered by head flexion and sternal stimulation. Opisthotonic posture- backward arching of head, neck and spine
Associated with sweating, flushing, tachycardia
Preterm- brainstem reflexes may not be completely developed.
Sleep like state from which patient cannot be aroused
No response to environmental stimuli- not aware of surroundings