Flashcards in Death Deck (56)
Give five scenarios where prolonged resuscitation is very worthwhile?
Commonest example of somatic/clinical death?
Atherosclerotic coronary artery disease
After primary cardiac arrest and during cerebral hypoxia, how long does it take to deprive the cortex and then brainstem?
Cortex 2-3 minutes
Brainstem >4 minutes
Can brain be destroyed by hypoglycaemia?
What three systems does brainstem control?
Consciousness (RAS)-reticular activating system
Vasomotor centre (BP)
What is necessary component for whole brain death?
Cortical damage but brainstem is intact-spontaneous breathing and heartbeat?
Persistent Vegetative State
How long must PVS be going on for before diagnosis?
Greater than 6 months or 12 months
What does assessment of PVS include:
No spontaneous meaningful motor response inc voice
No language comprehension or expression
No sustained, reproducible, purposeful or voluntary behavioural response to normal or noxious visual, auditory or tactile stimulus
Is there moral dilema for BS death?
No - stop ventilating the corpse
When is someone legally dead?
When brainstem is destroyed
All sensory input from whole body travels through brainstem except what?
Smell and vision
What three CNs cannot be tested at bedside?
1, 11 and 12
Give three signs of brainstem activity?
Epileptic fit- cortical activity, motor nerves
Positive Doll's eye reflex- eyes remain fixed on moving head
What are the 3 pre conditions for diagnosing BS death?
1. Deeply comatose, requiring artifical ventilation
2. Cause of coma unknown
3. Reversible causes excluded: hypoxia, hypotension, SOL
Name some reversible causes that must be excluded for diagnosing brainstem death?
What cranial nerve tests must be done for diagnosing BS death?
1. Pupils do not react to light (2,3)
2. No corneal reflex (3,5,7)
3. No nystagmus upon ear irrigation (3, 4, 6, 8)
4. No grimace to pain (5, 7)
5. No gag reflex (9, 10)
Explain the apnoea test.
100% oxygen for 10 minutes
5% CO2 for 5 minutes
Disconnect from ventilator for 10 minutes
Rising CO2 fails to stimulate spontaneous breath
Once circulation stops, how long does it take for cellular death in the CNS?
Once circulation stops, how long does it take for cellular death in the peripheral NS?
Once circulation stops, how long does it take for cellular death in muscle?
Once circulation stops, how long does it take for cellular death in blood cells?
Once circulation stops, how long does it take for cellular death in the skin?
Once circulation stops, how long does it take for cellular death in bone/cornea?
What causes cells to die and degenerate?
Autolysis- intracellular enzymes
What year was most recent human tissue act installed?
Where does human tissue act 2004 apply to?
England and Wales- provisions relating to retention of material for DNA testing apply also to Scotland
“material that has come from a human body and consists of, or includes, human cells”
Who is the only person who can retain tissue?
Coroner to establish cause of death