ASPEK MEDIKOLEGAL PELEPASAN ALAT BANTU PERNAFASAN PADA PASIEN MATI BATANG OTAK

MEDICO LEGAL ASPECT IN WITHDRAWAL OF VENTILATOR ON BRAIN DEATH PATIENTS

Fachri Setiawan (UNDIP)Marcellinus Triyuono D (UNDIP)Sylvia Wahyu R (UPN)Aprillia Tri Noorharsanti (UNDIP)Che Wan Nur Hajar binti Saimi (UKRIDA)

Dewi Yulianti (UPN)Melissa Elperide Damery (UPN)Oktavianus Gilbert (UPN)Elsa Alamanda (UNDIP)Muhammad Syafiq (UKRIDA)

(ASPEK MEDIKOLEGAL PELEPASAN ALAT BANTU PERNAFASAN PADA PASIEN MATI BATANG OTAK)

Dosen penguji:dr. Arif Rahman Sadad, Sp.F, S.H, Msi.Med, DHM

Residen pembimbing:dr. Suryo Wijoyo, MH (Kes)In the modern era, the determination of death became indefinite.

Advanced development of medical technologiesWithdrawal of life-support devices e.g. Ventilator presumed as euthanasiaBACKGROUND

?BRAIN DEATHDefinitions of Brain DeathHarvard Criteria- Harvard ad hoc group defined cerebral or brain death in 1968

Uniform Determination of Death Act, 1980

An individual who has sustained either (1)irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead. A determination of death must be made in accordance with accepted medical standards.

Allows for determination at the discretion of the physician.

American Academy of Neurology Guideline for Brain Death Determination -Neurology 1995;45:10121014.

American A

Automaticity of the heart , pacemaker. Lacks oxygen.

4Clinical Criteria for Brain Death in Adults and ChildrenComaAbsence of motor responseAbsence of pupillary responses to light and pupils at midposition.Absence of corneal reflexesAbsence of caloric responses

Absence of gag reflexAbsence of coughing in response to tracheal suctioningAbsence of respiratory drive at PaCo2 that is 60mmHg or 20mmHg above normal baseline

Diagnosis Brain Stem DeathNeurologi ExaminationClinical Prerequisites:

Known Irreversible Cause

Exclusion of Potentially Reversible Conditions

Core Body temperature > 32 C

Evaluation ComaAbsent Brain Stem ReflexesApnea TestConfirmatory TestCOMANo Response to Painful Stimulus

Nail Bed Pressure

Sternal Rub

Supra-Orbital Ridge Pressure

Absence of Brain Stem ReflexesPupillary Reflex

Eye Movements

Facial Sensation and Motor Response

Pharyngeal (Gag) Reflex

Tracheal (Cough) Reflex

1. Pupillary Refleks

2. Eye movements

3. Facial sensory & motor responses

Corneal Reflex

Jaw Reflex

Grimace to Supraorbital or Temporo-Mandibular Pressure

Pharyngeal and tracheal reflexes

APNEA TEST(American Academy of Neurology)Pre-requisiteCore body tempeature > 32CSystolic Blood Pressure 90 mm HgNormal ElectrolytesNormalize PO2,PCO2 if possible

1. Pre-Oxygenation100% Oxygen via Tracheal Cannula PO2 = 200 mm Hg2. Monitor PCO2 and PO2 with pulse oximetry3. Disconnect Ventilator4. Observe for Respiratory Movement until PCO2 = 60 mm Hg5. Discontinue Testing if BP < 90, PO2 saturation decreases, or cardiac dysrhythmia observed

Confirmatory Testing

EEGElectrocerebral SilenceCerebral Angiography

No Intracranial FlowTranscranial Ultrasonography

Technetium-99 Isotope Brain Scan

Step Determination of Brain Stem Death DiagnosisNeurological examination to determine whether a person has suffered brain death or not can be made only if the following requirements are metSteps determination of brain stem death include the following:Evaluation of cases of comaProvide an explanation to the patient's family about the current stateThe initial clinical assessment of brain stem reflexesThe period of observation intervalsUp to the age of 2 months, the period of observation intervals of 48 hoursAge more than 2 months -