Criteria for Brainstem death includes -
Ans. is 'b' i.e., Absent pupillary ligh reflex and dilated pupils o Brainstem death is characterized bv absence o f all brainstem mediated cranial re flexes Pupillary reflex - o Pupils do not react to light, they are fixed and dialated. Occulocephalic reflex - o It is tested by holding the eye open and rotating the head from side to side or up and down. The reflex is positive or present if the eyes move in the opposite direction of the head movement and it is therefore sometimes called doll s eve reflex. The diagnosis of brain death is usually made bv neurological examination provided certain prerequisites are met. o The underlying cause is understood. o Etiology is capable of producing neuronal death and confounding from drug intoxication or poisoning. o Metabolic derangements and hypothermia have been ruled out. o The neurological examination must demonstrate coma, no brain generated response to external stimuli and absent brainstem reflexes. o An apnea test should be performed in all patients meeting all other brain death criteria Brain Death | | | | | Deep Coma Absent brainstem reflexes Apnea Vital signs & general criteria o Absent pupillary light reflex o Absent occulo cephalic reflex o Absent jaw jerk o Absent gag, sucking or rooting reflex o Absent cough with tracheal suctioning o Absent sucking or rooting reflex o Apnea with arterial PCO, > 60 mm Hg o Coretemp > 32.2degC o SBP > 90 mm Hg o No drugs that could simulate brain death The apnea test o A person breathe's for two reasons # To rid the body of carbon dioxide # Take in oxygen o The primary drive to breathe is actually a build up of carbon dioxide which rises quickly without breathing. o If carbon dioxide levels reach a certain level and there is no attempt made to breathe, it suggests those centres of the brainstem are not functioning. o To test this, the ventilator is turned off and the patient is watched to see if any attempt to breathe are made. o Blood tests are taken to ensure that the level of CO2 has reached levels that would normally stimulate breathing (more than 20% of the patient baseline carbon dioxide level). o In order to avoid the body becoming hypoxemic the patient is given 100% 0, for 15 minutes before the apnea test.
Positive Doll's eye Reflex
Absent pupillary light reflex and dilated pupils
Pinpoint pupils
Positive vestibulo-ocular reflex
Miscellaneous (C.N.S.)