Critical Matters Neurologic Criteria for Death in Adults
Jun 12, 2019
Dr. Fred Rincon, an Associate Professor of Neurology and expert in neurocritical care, dives deep into the complex subject of brain death determination. He covers the historical context and legal foundations of brain death concepts from the 1960s. Learn about the crucial brainstem exams, the apnea test mechanics, and the role of drug considerations. Fred also emphasizes effective communication with families and the need for compassion in critical care, sharing insights on navigating the emotional complexities of these discussions.
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History And Legal Basis Of Brain Death
- Brain death emerged in the 1960s as ICU life support made cardiopulmonary criteria insufficient.
- The UDDA (1981) formalized death by neurologic or cardiopulmonary criteria but left clinical specifics to physicians.
Start With A Complete Clinical Exam
- Confirm a catastrophic brain injury, document coma and absent consciousness before testing further.
- Perform a thorough brainstem exam including pupils, corneal, oculocephalic, gag, and cough reflexes.
Exclude Reversible Confounders First
- Exclude confounders: correct hypothermia, hypotension, metabolic derangements, and drug effects before exam.
- Wait at least five half-lives for sedatives with normal organ function, longer if liver or kidney failure.
