condition that mimic brain death

5/20/2018 Condition That Mimic Brain Death

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Condition that Mimic Brain

Death


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Hypothermia

a state in which the body's mechanism fortemperature regulation is overwhelmed in theface of a cold stressor inadequate shelter for a homeless person,

someone caught in a winter storm or motor vehicleaccident

In the emergency department, core temperatureis best measured using a low-reading

temperature probe in the bladder or rectum oran esophageal probe.

Mild (32-35), moderate (28-32), severe (


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The response to light is lost at core

temperatures of 28C to 32C, and brain-stem

reflexes disappear when the core temperaturedrops below 28C.

These deficits are all potentially reversible,

even after extreme hypothermia. The diagnosis of brain death cannot be

reliably made until the core temperature has

reached 32C. (It has led to the dictum "apatient is not dead until the patient is warm

and dead.")


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Approach:

Rewarm the patient with heating blanket or:

If no perfusing cardiac rhythm is present,

rewarming through cardiopulmonary bypass

Neurologic examination can only be done when

the core temperature reach 32 degree celcius.


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Locked-In Syndrome (LIS)

a condition in which a patient is aware andawake but cannot move or communicateverbally due to complete paralysis of nearly all

voluntary muscles in the body except for theeyes (extra-ocular muscle)

Mute (lack coordination of breathing andvoice) and motionless

Sometimes able to perceive sensory andproprioception


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Lesion in the ventral pons- affect motor

pathway (corticospinal tract) but not reticular

formation (consciousness) Infarction (basilar artery embolism)

Bleeds

Tumor Central pontine myelinolysis


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Akinetic mutism

Patient awake, but remain silent and

motionless (not paralyzed)

Eye movement pick up sound stimulus

Due to injury at frontal lobe, thalamus and

ablation of cingulate gyrus (tx of psychosis).

Can also be due to Creutzfeldt-Jakob Disease

Frontal release sign might present


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Persistent Vegetative state

The vegetative state is a chronic or long-term conditionoccur after widespread severe damage to cerebralhemispheres.

Patients in a vegetative state may have awoken from acoma, but still have not regained awareness. In thevegetative state patients can open their eyelidsoccasionally and demonstrate sleep-wake cycles, butcompletely lack cognitive function.

Differ from a coma, state that lacks both awarenessand wakefulness.

Persistent: more than one month


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Psychogenic Unresponsiveness

Either due to schizophrenic somatoformdisorders or malingering

Patient often responds to painful stimuli

Normal vitals signs and neurological findings Resists eye opening, fast to close them (interfere

corneal and pupillary reflex)

Dropped hand avoids hitting face

Nystagmus on caloric testing , normal EEG Movements if present not stereotyped and

staged, but coordinated and purposive


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Drug and Substances

The effects of many sedative and anestheticagents can closely mimic brain death, butaspects of brain-stem function, particularlythe pupillary responses to light, remain intact.

Seen in reported in cases of intoxication withtricyclic antidepressants and barbiturates.

Screening tests for drugs may be helpful, but

some toxins (e.g., cyanide, lithium, andfentanyl) may not be detected by routinescreening tests.


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Metabolic disturbances

Severe metabolic disturbances such as:

severe electrolyte imbalances,

hyper or hypoglycemia,

severe pH disturbances,

severe hepatic dysfunction or

renal dysfunction

can cause reversible coma and interfere with the clinical

evaluation of brain death. These conditions should be identified and treated

before evaluation of brain death.


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OrganDonation


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Organ donation

Process of a person donating their organs for

transplant. These are given to someone with

2 types of donation:

Cadaveric donation

Donation after brain death

Donation after cardiac death

Living donation (family member) damaged organsthat need to be replaced.


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What Organ can be Donated?

Two kidney : save four lives; two who receives the kidneyand two more because now they have a place at thedialysis centre that has been vacated by the two who justreceived a kidney transplant.

Heart, lung and liver: three or four more will get a chanceto live longer.

Eye: save two blind men with a damaged cornea.

Bone: can improve up to 20-30 lives of patients who needa bone graft transfer.

Skin: is not life saving but it is a life altering moment. It willbe used to replace the damaged skin from burnt patients.It helps with the healing and minimizes the risk ofinfections.


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Declaration of brain death

Consent from family for potential organ

donor

The federal authorities of transplantation unit should be

informed

Lab test - what is still functioning, can be transferred

and free from HIV, Hepatitis and Syphilis

Organ harvesting

3-8 hours

depending on no.

of tissue and organ

to be donated

Corpse be returned to the family

All surgery cut will be sewn carefully and

perfectly.

Cotton balls will be placed in the eye

brackets and it will be sewn just like a normal

eye surgery.

For bone donation, a fake bone will be

replaced in return of the donated bone so

there will be no physical deformation can be

seen

Turn of ventilation

machine

After lab test results

out and surgery can

be carried out


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How to persuade bereaved family on

cadaveric donor?

1. Call the family or the next-of-kin to a quiet place/room.

2. Tell them about the patients condition, treatment and the

prognosis. Give time to them to accept the news. Explain and

inform them if have further questioning.3. Make sure that family demonstrates understanding of

patients prognosis and brain death before any mention of

donation.

4. Once the family understand and accept the news, donationpresentation can be proceed (what is their thought, what is

organ donor, how it was done, the benefits of organ donor to

help living people)


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Address the reasons why family against

donation (deceaseds wish, dispel any mythabout organ donation, act and religiousview)

It is important for the family to understand

that the deceaseds body will not be disfigured

and that donation will not affect funeral

arrangements or viewing of the body.

Give time to the family to make decision.

Respect their choice.


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Legislation and Ethic

Human Tissue Act 1974

This act allows using body parts of the dead for

medical, education and medical research purposes.

Requires discussion and approval from the next of kin. Malaysia Practices Opting-in Type Law

This allows a retrieval of organs from someone after

death if;

The deceased has made a written or verbal statement todonate his organ after death when he was still alive

Approved by the deceased family or next of kin


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Reference

DeJong's The Neurologic Examination

condition that mimic brain death

Documents

diagnosis of brain death

present5202018 condition

braindeath5202018 condition

month5202018 condition

purposive5202018 condition

persistent vegetative

malingering patient

thevegetative state