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  #1  
Old 12-13-2012
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Default Diagnosis of brain death

After a sailing accident in which a man falls overboard, he arrives at the ED with a temperature of 25°C (77.0°F), no spontaneous respirations or cardiac activity, and a depressed skull fracture. Rewarming is begun, the man is intubated and mechanically ventilated, and cardiotropic medications are administered, resulting in a faint, palpable, pulse. The “doll’seyes” reflex is absent. There is no deviation of the eyes in response to irrigation of the ear canal with ice water. His Glasgow Coma Scale score is 3/15. Body temperature after CT is 28.1°C (82.5°F). Which of the following characteristics would prevent brain death from being declared in this patient at this time?

(A) Artificial ventilation
(B) Body temperature
(C) Cardiac activity
(D) Glasgow Coma Scale score 3/15
(E) Skull fracture
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Old 12-13-2012
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Quote:
Originally Posted by heartbeat View Post
After a sailing accident in which a man falls overboard, he arrives at the ED with a temperature of 25°C (77.0°F), no spontaneous respirations or cardiac activity, and a depressed skull fracture. Rewarming is begun, the man is intubated and mechanically ventilated, and cardiotropic medications are administered, resulting in a faint, palpable, pulse. The “doll’seyes” reflex is absent. There is no deviation of the eyes in response to irrigation of the ear canal with ice water. His Glasgow Coma Scale score is 3/15. Body temperature after CT is 28.1°C (82.5°F). Which of the following characteristics would prevent brain death from being declared in this patient at this time?

(A) Artificial ventilation
(B) Body temperature
(C) Cardiac activity
(D) Glasgow Coma Scale score 3/15
(E) Skull fracture
the answer is B which the only one that make sense. in order to declare pt brain death the body temperature should be normal and in this context hypothermia specifically should be corrected. also don't forget that u can have SC reflexes in a brain dead pt
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Old 12-15-2012
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Originally Posted by the_emperor View Post
the answer is B which the only one that make sense. in order to declare pt brain death the body temperature should be normal and in this context hypothermia specifically should be corrected. also don't forget that u can have SC reflexes in a brain dead pt
Yup the correct answer is B.
A diagnosis of brain death requires a core body temperature of at least 32.2°C (90.0°F). Lower temperatures exhibit a neuroprotective effect via enzyme inhibition, and patients have been successfully resuscitated with neurologic recovery even after long periods of cardiac arrest, if the patient’s core body temperature was low at the time of arrest. Other requirements include the absence of intoxication or poisoning, the absence of metabolic or endocrine derangements, evidence of a catastrophic cerebral event, and the absence of brain stem reflexes, such as the “doll’s-eyes” (oculocephalic) reflex and the vestibulo-ocular reflex (response to caloric stimulation).
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Old 12-15-2012
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Quote:
Originally Posted by heartbeat View Post
After a sailing accident in which a man falls overboard, he arrives at the ED with a temperature of 25°C (77.0°F), no spontaneous respirations or cardiac activity, and a depressed skull fracture. Rewarming is begun, the man is intubated and mechanically ventilated, and cardiotropic medications are administered, resulting in a faint, palpable, pulse. The “doll’seyes” reflex is absent. There is no deviation of the eyes in response to irrigation of the ear canal with ice water. His Glasgow Coma Scale score is 3/15. Body temperature after CT is 28.1°C (82.5°F). Which of the following characteristics would prevent brain death from being declared in this patient at this time?

(A) Artificial ventilation
(B) Body temperature
(C) Cardiac activity
(D) Glasgow Coma Scale score 3/15
(E) Skull fracture
B. body temperature.
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Old 12-15-2012
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(B) Body temperature
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