Brain dead and bleeding

[Ben Reynolds]

A four vessel angiogram showing a cutoff sign at the
skull base for all four vessels without any
intracranial reconstitution or collateralization of
contrast is the conditio sine qua non radiographic
image of a brain dead individual, assuming a GCS of 3.

You'd be hard pressed to find a clinical exam for
brain death which could refute that.

Ben Reynolds, PA-C
Pittsburgh, PA
--- Ronald Gross <Rgross at harthosp.org> wrote:

> Dean,
> 
> The determination of brain death CANNOT be made
> radiologically, and
> therefore a CT that shows injuries that are
> supposedly not compatable
> with life does not mean that the patient is brain
> dead.  Brain death is
> a clinical determination that depends on the absence
> of any and all
> brain stem function and apnea in the presence of
> profound hypercarbia
> and high PO2, or proof that there is no blood flow
> to the brain. 
> 
> In my opinion, there is no question in my mind that
> the patient you
> referenced should have been operated on.  The
> physician that was
> "roundly criticized" got off easy, as I see it.
> 
> Ron
> 
> >>> "Dean Lutrin" <deanlutrin at gmail.com> 12/21/2006
> 12:11 PM >>>
> Dear list
> 
> A quick question. What are your feelings on
> operating on a patient who
> comes
> into your ER brain dead with intraabdominal
> bleeding? Do you treat the
> abdomen on its own merits assuming that some of the
> low GCS may be
> attributable to hypovolaemia etc...
> 
> I am of course assuming that the patient has been
> intubated without
> drugs,
> there is no drug history etc etc...
> 
> We debated this a bit today where one of the
> surgeons did not operate
> on a
> case because the CT brain showed unsurvivable
> injuries and was roundly
> criticised.
> 
> Is this a matter of opinion or are there good
> answers?
> 
> Thanks 
> 
> Dean Lutrin
> JHB, SA
> 
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