This document discusses brain death, its diagnosis, and organ donation. It provides definitions of brain death standards in the U.S. and U.K. Diagnosing brain death requires demonstrating irreversible loss of brain and brainstem functions through clinical exams and tests like apnea testing. Key findings that must be absent are brainstem reflexes, response to pain, and spontaneous breathing. The process of declaring brain death should be separate from discussing organ donation with family.
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 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.
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 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 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
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
I am a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany.
I am presently working in Columbia asia hospitals, Bangalore.
My areas of interest are Vascular Neurosurgery, Stroke specialist, interventional neuroradiology,
Auditory brainstem responses are generated by the
activity in structures of the ascending auditory
pathways that occurs during the first 8–10 ms
after a transient sound such as a click sound has
been applied to the ear.
Epilepsy can occur after stroke, and is more common in elderly population. This talk looks at classification, epidemiology, pathogenesis, clinical presentation and treatment of post-stroke seizures and epilepsy. The risk factors for the development of post-stroke seizures have also been looked at.
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
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
I am a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany.
I am presently working in Columbia asia hospitals, Bangalore.
My areas of interest are Vascular Neurosurgery, Stroke specialist, interventional neuroradiology,
Auditory brainstem responses are generated by the
activity in structures of the ascending auditory
pathways that occurs during the first 8–10 ms
after a transient sound such as a click sound has
been applied to the ear.
Epilepsy can occur after stroke, and is more common in elderly population. This talk looks at classification, epidemiology, pathogenesis, clinical presentation and treatment of post-stroke seizures and epilepsy. The risk factors for the development of post-stroke seizures have also been looked at.
Death by Neurological Criteria and Organ Donation: Bill KnightSMACC Conference
Bill Knight explains the concept of death by neurological criteria and the complexities surrounding organ donation in such situations.
Bill discusses the process of dying, the definition of death, how to approach the neurologically dead patient and how to consider organ donation.
Death is a complex topic.
Due to advancements in medical technology and processes, the definition of death is a challenging one.
Bill talks at length about the definition of death by the neurological criteria. Dying is an active process, whereas death is an event.
The acceptance of death by the neurological criteria is often challenging as Bill will highlight. Bill talks about the care of the dying or dead patient.
There is a point at which care will transition from supporting the patient to supporting the organs. This is still good care.
There is an alignment of parallel intentions – first and foremost resuscitation of patients and then failing that, proceeding to considering and actioning organ donation. This is important due to the shortage of viable donor organ worldwide.
The donation process itself is complex. Bill provides his thoughts. He insists that an intensivist be involved as this has been shown to increase the number of viable and healthy organs made available.
The timing is also important. Available evidence does not support the need for immediate procurement after brain death. Taking time to optimise perfusion and allow recovery and cardiac function is appropriate and should be done.
Bill also discusses other treatment options at the time of death such as optimising endocrine function.
Finally, Bill will provide some practical considerations when communicating with the dead patient’s family. This involves being clear on your messaging. You are supporting organs, not life.
To reinforce this point, Bill suggests not examining or talking to the patient. He also recommends using all of the available hospital support services.
Similarly, it is best to not introduce the topic of organ donation to the family yourself as the treating clinician. Utilise the Organ Procurement Organisations (or similar services) and get them involved early to speak with the family.
Join Bill Knight in his talk on the North American perspective on Organ Donation, brain death and management of the brain dead donor prior to organ donation.
For more like this, head to our podcast page. #CodaPodcast
A detailed presentation on Brain Death and Ongan transplantation.
Criteria for Brain Death are explained in detail. Legislative laws regarding the organ transplant, organ preservation are also explained.
INTRODUCTION
HISTORY
MECHANISM OF ACTION
INDICATION OF ECT
TYPES OF ECT
ELECTRIC STIMULUS
DURATION OF THERAPY
PRE TREATMENT EVALUATION
CONTRAINDICATION
SIDE EFFECT
ELECTROD REPLACEMENT
ROLE OF NURSES
DOCUMENTATION
SUMMARY
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Definition
U.S. standard U.K. standard
Complete and irreversible
loss of entire brain and
brainstem activity.
Complete and irreversible
loss of brainstem function.
3. Legally,
British physician only needs to document loss of brain
stem function.
U.S. physician must document loss of brain (cerebral)
and brainstem functions.
4. No one has ever recovered from such case. In other
words, till now there is no cure or treatment found
for brain dead patient.
5. “Published studies of patients meeting the criteria for brain stem
death or whole brain death – the American standard which includes
brain stem death diagnosed by similar means – record that even if
ventilation is continued after diagnosis, the heart stops beating within
only a few hours or days”
6. Adapted from Smith M. Physiologic changes during brain stem death-lessons for
management of the organ donor. J Heart Lung Transplant 2004;23:S217-22.
7. The concept of brain death is specific.
It does not apply to patients existing in a
Persistent vegetative state
other severe degrees of brain damage from causes such
as metabolic derangements, drug intoxication etc.
8. Difference between brain death
and a persistent vegetative state
Brain death Persistent vegetative state
Irreversible coma
Complete loss of brainstem
function
Brain dead = Dead
Brainstem function
unaffected
Sleep-wake cycle (RAS)
PVS may recover
9. Difference between persistent vegetative state
and Minimal responsive state
Persistent vegetative state Minimal responsive state
Sleep-wake cycle (RAS)
Brainstem function
unaffected
No response to
environmental stimuli
Sleep-wake cycle (RAS)
Brainstem function
unaffected
Variable interaction with
environmental stimuli
10. Resolution of the Council of Islamic Jurisprudence on
Resuscitation Apparatus
Decision No. (5) D 3/07/86
The council of Islamic Jurisprudence in its third meeting held in Amman, capital of
Jordan from 8 to 13 Safar 1407 H corresponding to 11 to 16 October 1986 and after
discussing all relevant aspects of resuscitation apparatus and after hearing the detailed
explanation from specialist doctors, decide the following:
A person is pronounced legally dead and consequently, all dispositions of the Islamic law
in case of death apply if one of the two following conditions has been established:
There is total cessation of cardiac and respiratory functions, and doctors have ruled that
such cessation is irreversible.
There is total cessation of all cerebral functions and experienced specialized doctors have
ruled that such cessation is irreversible and that brain has started to undergo autolysins.
In this case, it is permissible to take the person off resuscitation apparatus, even if the
function of some organs e.g., heart are still artificially maintained.
11. Saudi Center for Organ Transplantation
Who is responsible for the diagnosis
of brain death?
It is mandatory that a
Neurologist,
Neuro-surgeon,
Internist,
ICU physician,
Anesthesiologist,
Pediatrician
consultant physician with experience
in evaluation of brain-dead patients
performs the examinations.
Neither a nephrologist nor a transplant
surgeon should be involved in the
establishment of diagnosis of brain
death.
Who is responsible for the care of
patients with brain death?
The following professionals are
responsible for the care of the brain-
dead patient:
ICU physician,
Anesthesiologist,
Internist,
Neurosurgeon
Neurophysician in cooperation with-a
nephrologist
12. Diagnosis
Is a clinical diagnosis
Three cardinal findings necessary for brain death:
Irreversible coma
Absence of brainstem reflexes
Apnea
13. who and how ? When ?
2 Neurological tests
1 Apnea test
2 Physicians and 1 should be
a consultant
Non of them from transplant
team
Adults :
30 min – 12 hr
Children :
12 - 48 hrs
14. Irreversible coma :
Evidence of an “acute CNS
catastrophe” that is compatible with
the clinical diagnosis of brain death
Exclusion of complicating medical
conditions that may confound the
clinical assessment
No severe electyrolyte, acid-
base, or endocrine disturbance
No drug intoxication or
poisoning
Core temperature >35 degrees
celsius
15. Absent Brainstem reflexes
No grimace to pain
No Pupillary responses
No corneal reflex
No ocular movement to
OCR or caloric testing
No gag or cough response
16. Pupils response
Brain dead: Mid-size (4-6mm), unreactive pupils (affecting both
sympathetic and parasympathetic)
Pre-existing pupilary abnormality Cataract ,eye surgery. limit the test
17. • No corneal reflex
lack of eyelid movement after
touching the cornea (not
conjunctiva) with a cotton
swab or tissue
18. Oculocephalic reflex (“Doll’s eye”) Technique:
Check No C-spine injury
Use both hands
Turn head to one side and
observe for both eyes movement
Turn head to other side and
observe for both eyes movement
Can be done vertically and
horizontally
Normal response: both Eyes move
contralateral to direction of head
turn
Brain dead show no eye movement
19. Vestibulo-oculogyric reflex (Caloric test)
Technique :
No wax ,TM intact
Elevate the HOB 30°
Irrigate tympanic membranes with
50ml iced water
Observe both eyes movement for 1
minute after ear irrigation,
Wait 5 minute before testing the other
ear
Normal response: both eyes deviates
towards the cold ice ear
Brain death: no Eye movement
Facial trauma involving the auditory
canal and petrous bone can also inhibit
these reflexes
20. No grimace to pain
Pressure on supra-orbital
ridge (to rule out any spinal
cord injury or spinal-
mediated reflexive motor
responses)
Absent Gag reflex
Tunge depressor
Absent coughing reflex
Insertion of suction tube
through the ETT
Minimal movement of the
ETT
21. Apnea Testing
Prerequisites are required:
The core temperature needs to be > 35
Systolic BP > 90 mmHg
Patient should be euvolemic
PaCO2 ~ 40-45 mmHg
PaO2 ~ 200 mmHg (to guard against desaturation
during apnea)
22. Technique:
Pre-oxygenate with 100% oxygen for several min till pO2 ~
200mmHg baseline PaCO2 to be ~40 mmHg
Disconnected from the ventilator and Advance a cannula 1-2
cm beyond the end of the ETT with 8-12 L/min humidified
O2
Observe for respiratory effort for ~6-10 minutes
Get ABG to determine PaCO2
• Result is positive if PaCO2 levels greater than 60 mmHg, or ≥20
mmHg over baseline and there is no respiratory effort
• Reconnect patient to Mechanical ventilator and document the
test.
23. • Stop the test at any time and
reconnect to MV if the patient
develops:
Arrythmias,
Hypotention,
Desaturation
Confirmatory tests are necessary
for patients who do not achieve
adequate levels of hypercarbia
prior to becoming unstable.
24. Ancillary Testing
Not necessary to establish brain death in the vast majority of cases
Not a substitute for clinical exam
Tests not 100% sensitive or specific
Reserve for cases where entire exam can’t be done, for example:
Severe facial trauma
Preexisting pupillary abnormalities (cataract,eye surgery)
unstable patient intended for organ donation
Children under 1 yr
25. Ancillary Testing for Brain Death
Cerebral angiography
EEG
TCD
Technecium scan
SEP’s
26. Brain death in children
7 days of age to 2 mo:
two examinations + EEGs separated by 48 hr
2 mo to 1 yr of age:
two examinations + EEGs separated by at least 24 hrs
initial examination + isoelectric EEG followed by nuclear
medicine study confirming no cerebral blood flow
> 1 yr of age:
two examinations at least 12 hrs apart, with EEG and cerebral
nuclear medicine blood flow studies optional but
recommended
27. Delivering the news
Most families have a better understanding of the organ
donation process if the ICU staff entirely separates the
declaration of brain death from discussions about organ
donation.
Thus, the determination of brain death is performed first
and presented to the family who are given time to digest
the information.
Before support is withdrawn ,a request for organ donation
is made by a representative of the Organ Procurement
Organization (OPO).
28. Say “Dead” not “brain dead”
Say “Artificial or mechanical ventilation” not “life support”
Time of death = Time of 1st neurological examination
Not when ventilation removed
Not when heart beats stop
Don’t say ”kept alive” for organ donation
Don’t talk as if he/she’s still alive
29. Other than for potential organ donation, there is no
legal or medical rationale to oxygenate the cadaver.
No family permission is required to cease ventilation
of the corpse; none should be requested.
Physician should inform the family that the patient is
dead.
Physician should request organ donation.
If declined, the physician should inform ”not ask” the
family that all medical interventions will be withdrawn.
Fallow Local hospital policy
30. Decoupling of the process of brain death declaration from
the request for organ donation has resulted in an increase
in next of kin authorizing organ donations.
31.
32. Question 1
What is the posture of a brain dead patient ?
Decerebrate
Decorticate
None of the above
33. Question 2
Which of the fallowing is present in brain dead:
Biceps reflex
Triceps reflex
Jaw reflex
Knee reflex
Superficial Abdominal reflex
34. Question 3
Which part of the brain has the thermoregulation
center ?
Cortex
Thalamus
Hypothalamus
Midbrain
Medulla
35. Question 4
If thermoregulation center is in the hypothalamus
and the patient is brain dead how to maintain core
body temperature >35 ?