Brain dead and bleeding

[Ronald Gross]

Absolutely correct - read my post again, and while not well stated you
will note that I was referring to the CT that was discussed.  Later on I
referred to a study that proved absence of blood flow, and clearly a 4
vessel angio is the radiologic test that serves to date as the "gold
standard", done if the patient is not stable enough to tolerate an apnea
test..........

>>> Ben Reynolds <aneurysm_42 at yahoo.com> 12/21/2006 1:53 PM >>>
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
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html 
> 
> Confidentiality Notice
> 
> This e-mail message, including any attachments, is
> for the sole use of
> the intended recipient(s) and may contain
> confidential or proprietary
> information which is legally privileged.  Any
> unauthorized review, use,
> disclosure, or distribution is prohibited.  If you
> are not the intended
> recipient, please promptly contact the sender by
> reply e-mail and
> destroy all copies of the original message.
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html 
> 

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/traumalist.html

Confidentiality Notice

This e-mail message, including any attachments, is for the sole use of
the intended recipient(s) and may contain confidential or proprietary
information which is legally privileged.  Any unauthorized review, use,
disclosure, or distribution is prohibited.  If you are not the intended
recipient, please promptly contact the sender by reply e-mail and
destroy all copies of the original message.