2. What is the difference between
an anatomic coma and a
metabolic coma? Examples.
1a
Dr. Sherif
Badrawy
Digitally signed by Dr.
Sherif Badrawy
DN: cn=Dr. Sherif Badrawy,
o=KKUH, ou=Critical Care,
email=sherif_badrawy@ya
hoo.com, c=SA
Date: 2015.07.15 05:30:04
+03'00'
3. -An anatomic coma involves 【mechanical
destruction】 of the brainstem or cerebral
cortex (i.e.: hemorrhagic stroke, car
accident)
-A metabolic coma is 【global disruption
of metabolic processes】 (i.e.: electrolyte
imbalance)
1b
4. What are the requirements
under the state *regulations for
determining brain death? Name
5
2a
5. - 【a QUALIFIED PHYSICIAN】
-Physician acts in good faith (【not part of
transplant team】 imposing a conflict of
interest)
-【Number of physicians (at least 2)】
-Religious exemption
-Medical standards
2b
6. Although there is no gold
standard about what constitutes
brain death, how is it generally
determined.
3a
12. What is the hospital policy for
brain death? *
6a
13. -Requires 2 independent exams
-A neurologist or neurosurgeon
must perform one of the exams
-Document exam in medical record
-Determination is made in ICU
6b
24. What are the steps taken in
diagnosis a brain stem function?
12a
25. -Fixed, nonreactive pupils
-Absence of spontaneous eye movement
-Absence of oculovestibular reflex &
oculocephalic response (CN 3, 6, 8)
-Absent gag reflex (CN 9 & 10)
-Absent cough reflex
-Absent corneal reflex (5 & 7)
-Absence of respiratory function
12b
26. How is the oculovestibular reflex
performed? Interpretation of
results?
13a
27. ice h20 placed in eardrum. If there
is a brainstem injury, the eyes would
stay midline and if the brainstem is
intact, the eyes will go the opposite
way
【cOld = Opposite, Warm = With】
13b
33. Core Body Temp ≥ 36.5°C or 97°F
SBP ≥90 mmHg
DI under control (positive fluid balance for past
6 hours)
pCO2 must be normal (arterial ≥40 mmHg)
Pre-oxygenation up to arterial pO2 ≥ 200 mmHg
16b
34. How is the absence of respiratory
function determined? STEPS.
17a
35. -Apnea test
1. Preoxygenate (100%)
2. Baseline ABG (to see what the CO2 is)
3. Disconnect ventilator (but do not take oxygen away)
4. Administer oxygen
5. Observe respirations
6. Draw ABG (8-10 min)
7. A pCO2 of ≥ 60 mmHg or an increase of ≥ 20 mmHg over
a normal baseline with no respiratory effort supports a
positive apnea test and is consistent with brain death.
17b
43. -Ensure the option of anatomical donation is
presented to the family on all deaths
-Hospital must notify OPO of individuals whose
death is imminent or who have died in the
hospital
-OPO determines medical suitability
-Hospital and OPO will work collaboratively
21b
55. If the pCO2 rises to greater than 60mmHg or
20mmHg higher than the pretest pCO2 and the
patient has no respiratory effort, the test
supports the diagnosis of death by neurological
criteria.
27b