The Internet Book of Critical Care Podcast IBCC Episode 66 - Brain Death
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Nov 28, 2019 Exploring the diagnosis and irreversibility of brain death, focusing on clinical signs, reflex responses, and standardized apnea test procedures. The discussion includes the importance of transparent communication, specialized team involvement for organ donation talks, critical care management, neuro hormonal deficits, and pitfalls in accurate assessment of brain dead patients.
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Brain Death Definition and Physiology
- Brain death is defined by irreversible loss of all cerebral and brainstem function, marked by coma, no cranial nerve reflexes, and apnea.
- The underlying physiology involves critical intracranial pressure leading to zero brain perfusion and loss of electrical activity on EEG.
Spinal Reflexes in Brain Death
- Brain death patients can exhibit spinal reflexes like triple flexion, which may mimic responses.
- These reflexes originate from loss of brain inhibition over spinal circuits and do not contradict brain death diagnosis.
Common Causes and Approach
- The most common causes of brain death include anoxic brain injury and intracranial hemorrhage, all causing brain swelling and pressure.
- Starting with understanding the underlying disease process is critical before suspecting brain death.