Brain death is the complete and irreversible loss of all brain function. It is legally considered death. Three essential findings confirm brain death: coma, absence of brain stem reflexes like breathing, and apnea. Brain stem death is the irreversible loss of brain stem function, which controls vital automatic functions. Causes include head trauma, stroke, hemorrhage or lack of oxygen. Determining brain death requires the patient to be unresponsive to stimuli, have no movements or breathing even if the ventilator is removed, and lack all reflexes after thorough examination and confirmatory EEG showing no brain activity.

1. BRAIN DEATH/ BRAIN STEM DEATH
Prepared by
Nursing Instructor
Mrs. Safoora Qureshi
CON, PIMS

2. A vegetative state of alter consciousness
• Is a state of alter consciousness, when a person is awake but is
showing no signs of awareness. A person in vegetative state may
present following characteristics
• Eye opening
• wake up & fall asleep at regular intervals
• Cannot speak, follow commands & move to limbs
• Have basic reflexes
• Blinking on loud noise
• Withdrawal reflex on hand squeezing, or pain/pinch
• EEG show some brain activities
• Cause: head injury, brain hypoxia, metabolic or degenerative
disorders

3. Brain stem
• Brain stem is the lower part of the brain that’s connected to the
spinal cord
• The brain stem is responsible for regulating most of the body
automatic functions that are essential for life such as;
• Breathing
• Heart beat
• Blood pressure
• Swallowing

4. Define The Terms:
Brain death:
• Is defined as complete and irreversible cessation of brain activity
• A person on an artificial life support machine, no longer has any
brain functions, is legally confirmed as dead.
• The three essential findings in brain death are coma, absence of brain
stem reflexes, and apnea. An evaluation for brain death should be
considered in A patient properly determined to be brain dead is legally
and clinically dead.
Brain Stem Death:
• Is irreversible cessation of brain and brain stem function
• Is a clinical syndrome, defined by the absence of reflexes with pathways
through the brain stem, which connect the spinal cord to the mid brain, and
cerebral hemisphere
Cardiac Death:
• Heart beat and respiration stop

5. Causes of Brain Death
• Occurs when blood and/or oxygen supply to the brain is stopped
• Caused by;
• Cardiac arrest
• Heart attack
• Stroke
• Severe head injury
• Brain hemorrhage
• Tumors

6. Criteria For Determining Brain Stem Death
1. Unreceptivity & Responsivity;
• Total unawareness to external stimuli & internal need
• Complete unresponsiveness to even most intense painful stimuli
2. No movement;
• No spontaneous muscular movements in response to stimuli such as
• Pain, Touch, Sound, Light
3. Apnea;
• Absence of complete breathing for one hour
• If a pt is on ventilator, total absence of spontaneous breathing is established
by turning off the respirator for 03 minutes, and observe for any effort from
the subject to breath spontaneously

7. 4. Absence of elicitable reflexes
• Pupils are fixed and dilated, does not response to light
• Ocular movement and blinking absent
• Corneal and pharyngeal/ gag reflexes absence
• Stretch tendon reflex also lost
5. Cold Caloric;
• The ocular vestibular reflex is an excellent tool to assess the vestibular
pathways in the patient with an uncleared cervical spine

9. Pupillary Reaction To Light

10. Doll’s Eye Movements

11. Cold Caloric Test

12. Neurological Assessment

13. Bran Death Confirmatory Test
EEG
• An electroencephalogram is a
test that measures electrical
activities of brain
• Electroencephalography
(EEG): Brain death is
confirmed by documenting
the absence of electrical
activity during at least 30
minutes of recording

14. What is brain death and brain dead
Brain death:
• A patient who is in a coma or persistent vegetative state
typically has some brain stem function (which controls
breathing) and possibly other brain function.
Brain dead:
• When a person is brain dead, no part of the brain is functioning
any longer