Jul 7, 2025
seen from United States
seen from Canada
seen from Spain
seen from Indonesia
seen from Brazil
seen from Greece
seen from Canada
seen from United States
seen from United States
seen from United States
seen from Canada
seen from Slovakia
seen from Brazil
seen from China
seen from Canada
seen from Indonesia
seen from Türkiye
seen from United States
seen from United States
seen from United Kingdom
Nuclear Assault - Brain Death
KENTUCKY
FRIED
GALLUS
ALL GRAINS, NO BRAINS
if a person goes into cardiac arrest and early resuscitation efforts were given but it lasted for 30 minutes until ECMO was initiated and ROSC was achieved, how is brain death determined if therapeutic hypothermia and deep sedation was given?
It's just not something they can determine initially.
The sedation and paralytics are given to prevent the person from shivering when the therapeutic hypothermia is initiated. Therapeutic hypothermia is usually only used for about 24 hours, after which the person is warmed back up to normal temps. At this time, every 24 hours or so the person undergoes a "sedation vacation" where the sedation is withdrawn to see if the person can wake up and breathe on their own. It would be during this time when an EEG or other determinations of brain death, like cold calorics, would be used.
Hundreds of Chinese doctors and other medical workers have been acting as “executioners” for the state to sustain ...
Life After Death
When a person dies, their cells don't all stop functioning simultaneously. In fact some, like the large cells in this tissue from a human brain, even start growing and activating genes. These so-called 'zombie cells' are a type of immune cell called glia, and researchers have discovered that, for many hours after death – defined in this experiment as the point when a section of living brain tissue was removed during surgery – the cells ramp up gene activity, grow in size and extend protrusions into surrounding tissue. While it’s not entirely surprising that immune cells, whose job it is to clear up tissue damage, become activated in this way, the specific details and time-frames of such postmortem changes had not previously been recorded. For neurologists studying brain pathologies, the data is likely to be a valuable resource for helping to distinguish normal postmortem events from those caused by a disease.
Written by Ruth Williams
Image from work by Fabien Dachet and colleagues, Dr Jeffrey Loeb's lab, University of Illinois
University of Illinois at Chicago, Chicago, IL, USA
Image copyright held by the original authors
Research published in Scientific Reports, March 2021
You can also follow BPoD on Instagram, Twitter and Facebook
The surgeon is letting students pick their three topics for our oral exam DAYS prior to test day. This is ludicrous on so many levels, I don’t even want to go into it.
I was told I had to choose topics, or else my classmate would choose them for me... so, fine. Sighs. I chose three and thus am now extra-reading up on:
symptoms and surgical treatment of chronic pancreatitis
classification of skull fractures
determination of brain death
I chose this last one because two weeks ago, I stood beside a paramedic as she went through the steps for a fresh ED admit ... and I realized I didn’t even know what things to check before someone could be declared brain dead. In fact, I always confused the ideas of comatose, brain death and persistent vegetative state. So I’ll clear it up for myself (and perhaps others?):
BRAIN DEATH: a state of irreversible unconsciousness (GCS 1-1-1) which meets very strict criteria. Importantly, there is an absence of brainstem reflexes, motor response, and respiratory drive. There are many other criteria as well, but for starters, the reflexes to check are the following:
1. corneal reflex (CN V1 + CN VII) 2. oculocephalic reflex (CN VIII + CN III and CN VI) 3. gag reflex (CN IX + CN X) 4. pupillary light reflex (CN II + CN III) 5. cough reflex (CN X + CN X) 6. pain reflex (CN V + CN VII)
Because the determination of brain death is so crucial to get right, there are other criteria as well, which are explained really well on teachmesurgery.com (linked the article here). These include that the patient not be on sedatives, be apneic, have no reversible causes in the background, and many more.
Brain death differs from persistent vegetative state, although both are in an irreversible unconscious state. A patient who is brain dead cannot breathe on their own. A person in a vegetative state actually does breathe on their own. A comatose patient is also unconscious, with no reflexes, but they may be awakened -- it depends on the cause of the coma.
--------------------
In the case of the patient on that fateful day, the presentation was GCS 1-1-1, and she was intubated in the field. The husband called the ambulance because the patient had a seizure while sitting on the toilet. The toilet... yes, you guessed right. When we did a CT of her head, there was a very large subarachnoid hemorrhage. It’s a textbook case: undiagnosed cerebral aneurysm ruptures in the background of straining (i.e. being on the toilet), and if the bleed is large enough, it can be fatal.
In her case, it was. However, you need to wait 5-6 hours to declare someone braindead, so we observed her in our ED while the family came to say goodbye. She was young... 50-something? ... and no significant medical history except smoking.
--------------------
In medicine, you learn best by seeing, then doing. I saw my first case, and one day in the future, I’ll have to do it myself.
Looks like I’m in for another week of taking care of the brain dead baby I had the last time I worked. He’s worse off than before. They tried to extubating him on Monday... it didn’t last. They’re going to try again this Monday and I predict he’ll stay extubated for an even shorter period this time. His little fingers are contracting, his pupils are tiny and nonreactive, and besides some random movements at times, his tone is essentially flaccid. He also hardly ever overbreathes the set vent rate besides when stimulated, otherwise he rides it. Not great. According to the note I read the dad thinks he looks better. He needs to get glasses because this baby is deteriorating at quite a fast rate. I truly hope he just declares himself. It’ll be easier on the family so they don’t have to feel like they’re killing their baby (they’re not, they’re just letting nature take its course... though they don’t see it that way... yet, hopefully). The attending brought up a trach being necessary if he fails this extubation and I don’t know why on earth he even brought such a thing up. This child should not be trached. Sure, he can’t live without the vent, but he can’t do anything else either. We should not be torturing his body with a surgery that will not improve his quality of life, only prolong it.
Anyway, look at the cute new mask I made.
