Brain stem death (patient information): Difference between revisions

	Brain stem death
Overview
What are the symptoms?
What are the causes?
Diagnosis
Diseases with similar symptoms
Where to find medical care for Brain stem death?
Brain stem death On the Web
Ongoing Trials at Clinical Trials.gov
Images of Brain stem death
Videos on Brain stem death
FDA on Brain stem death
CDC on Brain stem death
Brain stem death in the news
Blogs on Brain stem death
Directions to Hospitals Treating Brain stem death
Risk calculators and risk factors for Brain stem death

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Latest revision as of 18:40, 4 February 2013

For the WikiDoc page for this topic, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview

Brain stem is the inner part of the brain that is connected to the spinal cord. It is responsible for regulating most of the automatic functions of the body that are essential for life, including breathing, heartbeat, blood pressure and swallowing. Further more, the brain stem plays a vital role in core functions such as consciousness, awareness and movement. Brain stem death means that the brain stem stops working, not sending messages to the body to control such core functions, at the same time, not receiving messages back from the body. Once brain stem occurs, there is no chance to recover.

What are the symptoms of Brain stem death?

No pupillary response to light
No blanking on corneal touch
No eye movement on caloric testing
No grimacing on paiful stimuli
No cough reflex or gag reflex
No vestibulo-ocular reponse

What causes Brain stem death?

Severe brain swelling after a serious fall or traffic accident or trauma
Massive cerebral hemorrhage
Severe or long time of anoxia

Diagnosis

A series of strict tests need to be carried out by two senior doctors who are not members of transplant team. The tests are done at the patient's bedside. These tests are frequently repeated to confirm that the patient's brain stem has stopped working. All the following criteria need to be met before brain stem death can be pronounced.

Clinical tests for absent brain stem reflexes

No pupillary response to light
No blanking on corneal touch
No eye movement on caloric testing
No grimacing on paiful stimuli
No cough reflex or gag reflex
No vestibulo-ocular reponse

Test for confirmation of persistent apnoea. The procedure is the following:

Preoxygenation with 100% oxygen for 10 minutes
Allow PaCO2 to rise above 5.0 kPa before test
Disconnect from ventilator
Maintain adequate oxygenation during test
Allow PaCO2 to climb above 6.65 kPa
Confirm no spontaneous respiration
Reconnect ventilator

Diseases with similar symptoms

Persistent vegetative state (PVS): Patients in a PVS has no feeling mental distress, or physical pain, or awareness of the surroundings. The difference between PVS and brain stem death is whether the core functions are affected. For patients with PVS, there is a slim chance to recover.But for the patients with brain stem death, there is no chance once their brain stem has died. All of the core functions of the body have stopped working and can never be restarted.

Where to find medical care for Brain stem death?

Directions to Hospitals Treating Brain stem death Template:WH Template:WS

@@ Line 1: / Line 1: @@
+__NOTOC__
 '''For the WikiDoc page for this topic, click [[Brain stem death|here]]'''
-{{SI}}
+{{Brain stem death (patient information)}}
-{{CMG}};  Jinhui Wu, MD
+{{CMG}}; '''Associate Editor(s)-In-Chief:''' Jinhui Wu, M.D.
-{{EJ}}
+==Overview==
+[[Brain stem]] is the inner part of the brain that is connected to the spinal cord. It is responsible for regulating most of the automatic functions of the body that are essential for life, including breathing, heartbeat, blood pressure and swallowing. Further more, the brain stem plays a vital role in core functions such as consciousness, awareness and movement. Brain stem death means that the brain stem stops working, not sending messages to the body to control such core functions, at the same time, not receiving messages back from the body. Once brain stem occurs, there is no chance to recover.
-==What is brain stem death?==
+==What are the symptoms of Brain stem death?==
+*No pupillary response to light
+*No blanking on corneal touch
+*No eye movement on caloric testing
+*No grimacing on paiful stimuli
+*No [[cough reflex]] or [[gag reflex]]
+*No [[vestibulo-ocular reponse]]
-==How do I know if I have brain stem death and what are the symptoms of brain stem death?==
+==What causes Brain stem death?==
+*Severe [[brain swelling]] after a serious fall or traffic accident or [[trauma]]
+*Massive [[cerebral hemorrhage]]
+*Severe or long time of [[anoxia]]
-==Who is at risk for brain stem death?==
+==Diagnosis==
+A series of strict tests need to be carried out by two senior doctors who are not members of transplant team. The tests are done at the patient's bedside. These tests are frequently repeated to confirm that the patient's brain stem has stopped working. All the following criteria need to be met before brain stem death can be pronounced.
-==How to know you have brain stem death?==
+*Clinical tests for absent brain stem reflexes
+:*No pupillary response to light
-==When to seek urgent medical care?==
+:*No blanking on corneal touch
+:*No eye movement on caloric testing
-==Treatment options==
+:*No grimacing on paiful stimuli
+:*No [[cough reflex]] or [[gag reflex]]
+:*No [[vestibulo-ocular reponse]]
+*Test for confirmation of persistent [[apnoea]]. The procedure is the following:
+:*Preoxygenation with 100% oxygen for 10 minutes
+:*Allow [[PaCO2]] to rise above 5.0 kPa before test
+:*Disconnect from ventilator
+:*Maintain adequate oxygenation during test
+:*Allow PaCO2 to climb above 6.65 kPa
+:*Confirm no spontaneous respiration
+:*Reconnect ventilator
 ==Diseases with similar symptoms==
+:*[[Persistent vegetative state]] ([[PVS]]): Patients in a PVS has no feeling mental distress, or physical pain, or awareness of the surroundings. The difference between PVS and brain stem death is whether the core functions are affected. For patients with PVS, there is a slim chance to recover.But for the patients with brain stem death, there is no chance once their brain stem has died. All of the core functions of the body have stopped working and can never be restarted.
-==Where to find medical care for brain stem death?==
+==Where to find medical care for Brain stem death?==
-[http://maps.google.com/maps?f=q&amp;hl=en&amp;geocode=&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|brain stem death}}}}&amp;sll=37.0625,-95.677068&amp;sspn=65.008093,112.148438&amp;ie=UTF8&amp;ll=37.0625,-95.677068&amp;spn=91.690419,149.414063&amp;z=2&amp;source=embed Directions to Hospitals Treating brain stem death]
+[http://maps.google.com/maps?q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|map+top+hospital+Brain stem death}}}}&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&sa=N&hl=en&tab=wl Directions to Hospitals Treating Brain stem death]
-==Prevention of brain stem death==
-==What to expect (Outlook/Prognosis)?==
-==Copyleft Sources==
-http://www.surgical-tutor.org.uk/default-home.htm?core/trauma/head_brain.htm~right
-http://www.uktransplant.org.uk/ukt/how_to_become_a_donor/questions/answers/further_info/brain_stem/the_brain_stem_more.jsp
-http://www.bartsandthelondon.nhs.uk/docs/brain_stem_death_2009_gmandersloot.pdf
-http://www.ich.ucl.ac.uk/gosh_families/information_sheets/death_brain_stem/death_brain_stem_families.html
-http://www.nhs.uk/conditions/Brain-death/Pages/Introduction.aspx
+[[Category:Patient information]]
+[[Category:Medical ethics]]
+[[Category:Neurology]]
+[[Category:Emergency medicine]]
+[[Category:Intensive care medicine]]
+[[Category:Mature chapter]]
 {{WH}}
 {{WS}}
-[[Category:Patient Information]]