W7_03 Neurologic Determination of Death

Question 1

definition of neurologically determined death?

Answer 1

irreversible loss for capacity of consciousness, along with loss of all brainstem functions, including breating

Question 2

minimal clinical criteria for NDD?

Answer 2

absent brainstem reflexes;
absent respiratory effort baed on apnea test;
absent confounding factors (i.e. unresuscitated shock, hypothermia, metabolic disorder)

Question 3

thresholds for apnea testing?

Answer 3

paCO2 ≥ 60mmHg and ≥20 mmHg above baseline;

pH ≤ 7.28

Question 4

example of an ancillary test for when minimal criteria are impossible to attain?

Answer 4

imaging the brain - absence of all intracranial blood flow

Question 5

steps of the apnea test?

Answer 5

preoxygenate with 100% O2;
normalize acid-base;
disconnect from ventilator;
100% O2 via catheter;
observe for respiration;
if CO2 and pH thresholds reached, then reflex determined to be absent

Question 6

differences of NDD vs vegetative patient?

Answer 6

spontaneous ventilation in vegetative patients;
CV stability in vegetative patients;
sleep/wake cycles present in vegetatives