GENERAL INTERNAL MEDICINE

Know the criteria for brain death in adults especially to know that a patient who is hypothermic (<90º F) or intoxicated cannot be certified dead until these are reversed.

Explanation: This consists of 3 components.

I. Cessation of all function of the entire brain- this critereon is mandatory

II.Irreversibility- this too is mandatory

III.Confirmatory investigations (this may be optional or required, depending on local practice)

I. Cessation of all function of the entire brain -mandatory-consisting of ALL the following because even if one of them is present- patient is not brain dead.

A. Unresponsive coma

B. Absent brainstem reflexes

    1. Pupillary light reflex

    2. Corneal reflex

    3. Cephalic (caloric) reflexes

    4. Oropharyngeal (gag) reflex

    5. Respiration (apnea testing)

II. Irreversibility-mandatory

A. Coma of known cause without potential for reversibility

B. Exclusion of contributory, reversible conditions

    1. Drug intoxication

    2. Neuromuscular blockade

    3. Hypothermia (<32.2 C, 90 F)

    4. Shock

    5. Major metabolic disturbance

C. Persistence for an appropriate period of observation (6-24 hours,

depending on the cause of coma and local practice)

III. Confirmatory investigations (may be optional or required, depending on local practice)

A. Electrocerebral silence (isoelectric EEG)

B. Absence of circulation to the brain