what tests are there for brain stem death?
• confirmation of absent brainstem reflexes
- pupillary response (unresponsive pupils)
- corneal reflex (Stimulate the cornea with cotton wool, eyes dont blink if bad)
-motor responses within cranial nerve distributions
- gag reflex, cough reflex (Gag reflex stimulate pharynx with tongue depressor, Cough reflex stimulate carina with suction catheter, both stimulate cranial nerve nine and ten)
- vestibulo-ocular reflex (Look insight the ear, if bleed form ear then skull fracture. Then put in ice water. Normally you thinkg you would fall olver and move the eyes dowards the cold warter comign in. If intact, you move the eyes around and look around since you think you are fallling over. )
• confirmation of persistent apnoea (pre-oxygenate with 100% O2 for 10 minutes, and allow PaCO2 to rise to 5kPa; disconnect patient from ventilator while maintaining
adequate oxygenation and allow PaCO2 to rise above 6.65kPa; confirm no spontaneous
respiration and reconnect ventilator –> rapid breathing lowers CO2).
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