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Brain Death! and the Apnea Test

September 25, 2017

High Yield Review - Brain Death and the Apnea Test 

Case: A 60 year old male admitted to the ICU for

left sided intracerebral hemorrhage, you observe that there are  no spontaneous breaths  and you suspect brain death. 

 

You assess for clinical criteria:

- He has no spontaneous respirations

- Sedation has been stopped

- You review his CT Head and it shows a catastrophic CNS event

( Left Sided Intracerebral hemorrhage ) 

 

 

- You note his systolic blood pressure is > 100 mmhg 

- You note his core temperature is > 36C, 97F

- Review of toxicology show no drugs or poisons 

 

You perform a Neuro exam: 

- You feel for breath on your cheek and observe for chest rises and no spontaneous respirations noted 

- There is no response to voice, pain, or other stimuli 

- You see that the pupils are dilated and non reactive to light 

- You place Ice water in the ear and the eyes do not move

- You briskly turn his head side to side and his eyes remain centered 

- There is no corneal reflex 

 

You then perform the Apnea Test 

- After 10 minutes of observation you observe no spontaneous respirations 

- a repeat ABG shows PaCO2 of 60 mmhg 

You then Reassess Clinical Criteria and perform another Neuro Exam

- Then you can declare brain death 

Case Clues - Brain Death and the Apnea Test

- The patient has suffered an catastrophic CNS event ( Intracerebral hemorrhage) 

- No spontaneous respirations noted ( so now you are thinking of brain death)

- You asses clinical criteria --> Neuro Exam --> Perform the Apnea test --> Note the ABG Results -->  Repeat Clinical Criteria and Neuro exam ==> Declare Brain Death 

 

 

Notable Notes - Brain Death and the Apnea Test

(Click image to open PDF)

 

Know it for the Boards - Brain Death and the Apnea Test!

- Apnea test protocol is observation over 10 minutes 

- A positive apnea test: No respirations observed, a PaCO2 increase of 20 mmhg from baseline, or 60 mmhg

- A repeat clinical criteria and neuro assessment is needed to declare a patient brain dead 

 

Want to Know more ?

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