Death,Diagnosing Death,Brain Death

Diagnosing Death:-Pulseless,apnoeic,fixed pupils,no heart sounds,If on a Ventilator Brain death may be diagonsed even if the heart is still beating.


Brain Death:-  British Criteria Definition:- Brain Death is death of the brainstem,which is recognized by establishing:
:- Deep Coma with absent respirations(Hence on ventilator)
:- The absence of drug intoxication and hypothermia(<35*c)
:-The absence of hypoglycaemia,acidosis, and U&E imbalance

Tests:- All Brainstem reflexes should be absent
:-Fixed,unreacting pupils,absent corneal response.
:-No vestibulo-ocular reflexes,ie no eye movement occurs after or during slow injection of 20 ml of ice cold water into each external auditory meatus in turn.Visualize the tympanic membrane first to eliminate false negative tests.
:-No motor response within the cranial nerve distribution should be elicited by adequate stimulation.
:-No gag reflex or response to bronchial stimulation.
:-No respiratory effort on stopping the ventilator and allowing Paco2 to rise to 6.7 kPa.

Other considerations:- Repeat the test after a suitable interval usually 24 hours.spinal reflexes are not relevent to the diagnosis of brain death .An EEG recording is not required,nor is a neurologist.The doctor diagonising brain death must be a consultant(or his deputy registered for>five years).The opinion of one other doctor (any) should also be sought.

The USA criteria For Brain death are slightly different from those for the UK eg an EEG is required to confirm the absense of cerebral activity of brain death is to be diagnosed within six hours of apparent cessation of brain activity.Diagnosis of brain death is permitted in cases of intoxication if isotope angiography shows absent cerebral circulation,or if the intoxicant has been metabolized.

After Death:- Inform the Relatives,GP and Consultant.see the relatives,Death certificate.IF the cause of death is doubt (violence,injury,surgery) inform the coroner or Procurator fiscal