–Observation of patient suffering with terminal illness
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Author: Dr. Sesha sai Chittajallu
Genre: medical
Release: 2018
Page(Chapter): 267 pages
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Declaration of death:

1.Death and the Brain Clinical Tests : loss of consciousness # absence of spontaneous movements (excluding spinal reflexes) # absence of motor responses in cranial distribution # loss of brainstem reflexes → absent pupillary light reflex-pupils mid-position or greater (‘fixed dilated pupils’) → corneal → gag/pharyngeal → cough/tracheal → vestibuloocular (‘cold caloric’) → oculo-cephalic (‘dolls eye’) → loss of capacity to breathe. Laboratory Tests : isoelectric EEG # absent brain blood flow # absence of brain perfusion # absence of cerebral metabolic activity # absent brainstem evoked potentials after wave 1 # evidence of tonsillar herniation by neuro-imaging (Spinal Reflexes : in brain death* spinal-mediated reflexes include- plantar flexion and triple flexion responses, muscle stretch reflexes, abdominal contractions, sitting up posturing and respiratory-like movements .Brain death requires the use of a supplementary or confirmatory test. The most commonly recommended supplemental tests are EEG, 4 vessel cerebral angiography or radionuclide testing.

*Newer tests – inconsistently recommended – include CT angiography, CT
perfusion, MR angiography and transcranial Doppler) (Function should be
distinguished from activities. Brain function such as the capacity for consciousness or ability for unassisted breathing is distinguished by examples of brain activity such as posterior pituitary antidiuretic hormone release or residual nests of neuronal
electrical function)( performance of apnea testing should be reserved as the last test
of brainstem function).

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