brain death and organ donation jessica hammond, rn, bsn, srna
TRANSCRIPT
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Brain Death and Organ Donation
Jessica Hammond, RN, BSN, SRNA
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Topics for DiscussionHistory of the determination of death
Assessment and testing of the potential brain dead patient
Medical management of the brain dead organ donor
Organ procurement surgery
Anesthesia management for organ procurement surgery
Organ procurement as portrayed by the media
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Determining Death- The Historical Perspective
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American Academy of Neurology Practice Parameter of 1995
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So what is the process of determining brain death?
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Clinical Evaluation:Prerequisites
Establish irreversible and proximate cause of coma
Achieve normal core temperature
Achieve normal systolic blood pressure
Perform one neurologic examination
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Clinical Evaluation: Neurologic Assessment
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Clinical Evaluation: Apnea Test
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Confirmatory Testing:Nuclear Brain Scanning
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Confirmatory Testing:Angiography
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Confirmatory Testing:Transcranial Doppler Ultrasonography
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Confirmatory Testing:Electroencephalography (EEG)
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Certification of DeathThe medical record must indicate:
etiology and irreversibility of coma / unresponsiveness
absence of motor response to painabsence of brainstem reflexes during two separate
examinations separated by at least 6 hoursabsence of respiration with pCO2 ≥ 60 mm hg justification for, and result of, confirmatory tests if
used
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AAN Practice Parameter 2010 Update
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Medical Management of the Brain Dead Donor
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Physiologic Changes Following Brain Death
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Shift in Care
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Goals of Donor
Management
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Timing and Coordination
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Surgical Procedure-
Organ Procurement
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Surgery for Organ Procurement:
Current Anesthesia Recommendations
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Do volatile anesthetics have a place in procurement surgeries??
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Life is pleasant.Death is peaceful.
It’s the transition that’s troublesome.
Isaac Asimov