Brain death determination

Brain death determination

 

Brain Death Determination When the brain lacks oxygen, even for a few minutes, it could lead to loss of brain functions such as a gradual loss of consciousness or a complete loss of consciousness, causing the person to slip into a coma. In the most profound cases, irreversible brain damage and death occur. Oxygen deficiency can be caused by many things, such as; a brain injury, fall from height, traffic accidents, heart failure, stroke, or some neurological disease. That may cause irreversible loss of the brain cells’ performance.
The medical term for insufficient oxygenation to the brain is referral Anglia. Historically, before recent technology, scientists defined death only when the heartbeat and breathing stopped. Afterward, the idea of brain death was announced in 1959 by French neurologists Moldable and Gluon. They determined this state as “beyond coma” (D*mice et al., 2004). Then after around ten years, within the medical community, the development of many types of equipment became available, which aided in increasing the longevity of individuals with severe injuries to the brain.

How do doctors know if you are brain dead?

Some examples of these devices are ventilators to maintain respiration and heart monitors. These innovations in medicine made the concept of brain death clearer by closely showing the relationship between respirations or heartbeat and the brain. These innovations in the medical field guided the Harvard Medical School Committee to clarify that idea in 1968 (Sass, 2014). After that, it was medically defined as permanent loss of all brain functions, including cerebrum and brain stem, due to total death of brain neurons caused by the decrease of blood flow and oxygenation into the brain (ibid).

This essay will discuss the central brain regions that have an immediate cause of brain death and their functions, including the required tests of these regions, both clinical and confirmatory, for instance, the Electroencephalogram. The brain carries two significant parts, the cerebrum and the brain stem. When they have any cause of damage that might be a final result in brain death, each one has a primary role in a person’s life because they are responsible for the primary operations in human survival, especially the regulation of cardiac and respiratory functions.

 

Stages of brain death

The cerebrum is the most significant part of the brain and is divided into two hemispheres (Fall & Bergman, 1998). There are leading functions for the brain cerebrum. Without them, no human can live. It is essential to be concerned with the functional specialization of different regions of the cerebrum to guide the physician’s treatment and assist them in making the proper diagnosis. The cerebrum has a large primary sensory area responsible for general sensation, such as smell, vision, and hearing.
The motor area is responsible for controlling the skeletal muscles, and the association area of the cortex has operations similar to the sensory regions but more complicated such as behavior, communication, and intellect (ibid). Secondly, the brain stem is located in the posterior division of the brain and connected to the spinal cord. Besides that, it includes three significant parts; medulla obbligato, pens, and mandarin. Each one controls top performance, and it is the pathway of sending and receiving sensory information signals from the body to the brain.
It has other essential functions that significantly affect a person, such as regulating the respiratory system, consciousness, alertness, and awareness (Kiering & Barr, 2009). In general, both cerebrum and brain stem damage may end an arson’s life because they contain all the regulation centers for all of the most critical functions needed to sustain life. There are many criteria to diagnose brain death. Each country has its organization, but there are general rules and guidelines in determining brain death for patients worldwide.
There are essential tools to consider when deciding whether the patient is dead before the diagnosis of death by the criteria. A first tool is a person who is approaching the protocol of brain death qualified? For example, an ICC physician, an anesthesiologist, an internist, a neurosurgeon, or a neuron physician are allowed and equipped to perform the tests because they have studied and trained to diagnose brain death. Still, a dermatologist or an ophthalmologist they have not done training on that.

 

What is an ancillary test for brain death?

 

However, they need to know the patient’s state and be in a coma with ventilator support. The cause of their comatose condition must be rolled out, for instance, Head trauma, Cardiovascular hemorrhage, cerebral Anglia, or primary brain tumor. Next, the cause of brain damage must be clarified six hours before tarring brain functions evaluation. Finally, the patient should not be hypothermia and body temperature has to be above 34 C or 32 C in some countries protocol and the person should not be under sedatives, muscle relaxant, anticonvulsant… Etc Drugs for at least the previous five days. When these tools are completed correctly, the physician can start the diagnosis by the following exam steps. The first clinical examination is to confirm that the patient is in a coma and to make sure a patient is not having any seizure activity in the brain. Furthermore, the physician needs to test the absence of a motor response by painful stimulation for both hands and feet. It is required to do these evaluation exams on the standard method before starting the brain stem reflexes test because each exam depends on the previous one to give the correct final result.
Once the physician has done the previous evaluation, he will start the brain stem reflexes tests, the first clinical examination. These are five different exams and begin with a papillary response. The light stimulation tests the pupil response by a bright beam of light on both eyes, for example, a pen alights. Also, the corneal reflex is involuntary blinking and has to be tested via a wisp of cotton wool to touch the cornea. Thirdly, the cool-cephalic reflex does perform by moving the head in a different direction and monitoring the retina changes during the head movements.
Fourthly, the vestibule-ocular reflex is another test to activate eye movements by injecting both ears about 50 ml of ice-cold water or saline for adults, but children, less than 20 ml may be used. After all, upper and lower airways stimulation produces either gagging or coughing. Furthermore, this exam’s purpose or provoke the pharynx and trachea. For instance, using a catheter leads down to reach the pharynx and the trachea (Saudi center of organ transplantation, 2009). Accordingly, all those brain stem tests should result in absent responses to declare brain stem death.
After finalization of the first examination, it’s recommended to not start the second clinical test before 6 hours from the time of first exam end for an adult and after 12 hours for children (above one year),24 hours for infants (above 60 days-I years) and 48 hours for neonate (7 days-60 days). Therefore, to have enough mime to perform the confirmatory tests, such as Electroencephalogram (EGG), a machine with 21 electrodes connected to the skull to cover all the brain regions and measure the brain’s electrical activity (ibid).
The EGG and other confirmatory tests are optional in some countries. Still, it is often helpful for the physician to prove that the brain is permanently damaged by having more than one test that confirms his diagnosis and prognosis. The following clinical exam is apneas; it is done to indicate the failure of involuntary respiration. This exam has a specific rotator to perform, such as increasing the inspired fraction of oxygen without changing the ventilation rate, disconnecting the patient from the ventilator for 10 minutes, and supplying a continuous flow of humidified air.
These procedures are done to detect any attempt for the patient to breathe (ibid). Another test that is sensitive in analyzing the circulation in the brain is transitional Doppler (ETC). This examination detects the blood velocity that’s circulating in the blood vessels supplying oxygen-rich blood to the brain. It uses ultrasonic waves focused onto a beam directed at different depths and angles by an experienced operator. The technologist uses sites on the skull where the bone is relatively thin and close to the significant vessels whose blood flow velocities are critical.
One major vessel that supplies the brain is the Middle Cerebral Artery (MAC). When the blood flow circulation is compromised to the extent that survivability is impossible, the ETC shows reverberating waveforms as the blood ceases to flow in its average direction. Instead, it is ineffectually regurgitating back and forth without flow in espouse to the heart contraction. Later, systolic spikes indicate increased pressure in the vessel with heart contraction but without adequate blood flow through the vessel.
The last signal that is compatible with brain death is a loss of signal entirely, indicating no activity in the vessel and no recordable blood flow in the critical vessels of the brain. In conclusion, the concept of brain death has developed with a period of medical field improvements. The absence of a rich, uninterrupted oxygen supply is imperative to supply the brain and maintain unconsciousness and provide for the populations of neurons to continue to function correctly.
Trauma, disorders and diseases which impair circulation in the cerebral cortex and brain stem bring about a cascading assortment of symptoms that if not reversed results in death. The protocols and guidelines for brain death determination have been established for the patient’s safety to distinguish between patients who have suffered a life-threatening insult but who may recover and those unfortunate individuals in whom there is no hope for recovery.