BrainDeath.pptVIP

Clinical Pearls and Pitfalls Damage to the base of the pons, typically from a basilar artery embolism, can result in the development of the so-called locked-in syndrome, where the patient loses all voluntary movements with the exception of blinking and vertical eye movements. Guillain-Barre syndrome can involve all peripheral and cranial nerves and mimic brain death, but can be differentiated from it by the time course of the development of the disease which evolves over several days and by electrical and blood flow examinations. Clinical Pearls and Pitfalls Hypothermia must be reversed prior to performance of the clinical examination to eliminate the confounding effects on the clinical examination. A variety of drugs including narcotics, benzodiazepines, tricyclic antidepressants, anticholinergics, and barbiturates can mimic brain death. It is prudent to administer reversal agents where the cause of coma is unknown and the agents are available (ie, naloxone, flumazenil). Alternatively, where drug levels are available, brain death should not be declared until the levels of these agents are subtherapeutic. If the serum level of a drug cannot be determined, declaration of brain death should not be done until several elimination half-lives have passed without change in the patients examination. Clinical Pearls and Pitfalls The cold-caloric oculocephalic examination can be confounded by wax or blood in the ear canal. Dolls eyes examination should not be performed if the cervical spine is unstable. Chronic obstructive pulmonary disease or sleep apnea may result in elevated baseline CO2 retention, confounding the apnea examination. Certain spinal reflexes including spontaneous movements of the torso, arms, or toes may mimic volitional movements, but should be ignored if the clinical brain stem examination is consistent with brain death or confirmatory examinations are positive. Common misconceptions Since there is a heartbeat, he is alive Brain dead pts have perm