This man makes the hospitals look evil. As if the hospital staff and organ procurement agencies are hovering like vultures. The situation he implies is far from being the truth.
Where I work the families are given ample time to deal with the grief of losing a loved one. The conversation about brain death is not even considered for couple weeks. Even if the families ask about the long-term prognosis in the initial days, a doctor would be stupid to tell a family their loved one is brain dead without running a multitude of tests after the patient is stabilized.
There are clinical signs that can be seen upon admission that would indicate the patient has suffered an anoxic brain injury. Agonal respiration is seen with anyone who has suffered a brain injury due to insufficient oxygen supply. This type of respiration is initiated by the brain stem and is involuntary. Typically means severe brain injury. Also posturing with the arms and blown pupils. Lactate levels are also very high. High lactate levels (lactic acidosis) is caused by anaerobic metabolism, your body producing energy without oxygen.
Depending on the diagnosis, (gunshot wound to the head, SIDS, co-sleeping with a baby, trauma, shaken baby), most often intracranial pressures increase and prevents blood flow to the brain. It only takes 5 minutes for the brain to die when it is not being provided oxygen. Often, a craniotomy is performed to remove a section of the skull plate, allow the brain room to expand and reduce the pressure in the cranium cavity.
Cat scans and MRI can be done to look at the brain, over time you see what is called white matter differentiation or delineation of a gray-white matter
interface. An EEG is done to look at electrical activity in the brain. A flow study with contrast can look at brain perfusion or lack thereof.
The tests the man above was talking about is called Dolls eye test and Caloric reflex test. With Dolls eye test you move the patients head from side to side quickly. The eyes should move in the opposite direction the head is moving, if this does not happen the section of the brain controlling sight is not functioning. The caloric test, you entrain ice water in the patient's ear, the eyes should both point to the ear being entrained, if not brain death is presumed.
The last test is the apnea test. You have chemo receptors in your brain and heart that measure oxygen and CO2 levels that increase depth and rate of ventilation when oxygen gets low or CO2 gets high. See here:
The patient must have a normal CO2 level when this test starts (35-45). The patient is taken off the vent and blood gas samples are drawn every minute and CO2 levels are measured. The patient will remain unventilated till we measure a rise in the CO2 level of 20 above the initial number. If the patient does not attempt to breath with the elevated CO2 levels, the chemoreceptors in the brain are dead.
We recently had a braindead patient who was on the vent for 6 months, mother did not want to give up hope. This was a co-sleeping event, mother rolled on to the child and suffocated it. We give the families ample time to deal with the loss. Often the families will never give up hope and the hospital will seek a court order to terminally wean the patient. This is very rare.
If the patient wants to move their loved one to a rehab facility and keep them alive on ventilator, that is a option. Most often the patients are not stable enough to go to rehab. If they are on drugs to maintain blood pressure for instance, they are not a candidate.
So there are many steps that are taken before the last 3 tests that are done to sign the death certificate.
This man makes the hospitals look evil. As if the hospital staff and organ procurement agencies are hovering like vultures. The situation he implies is far from being the truth.
Where I work the families are given ample time to deal with the grief of losing a loved one. The conversation about brain death is not even considered for couple weeks. Even if the families ask about the long-term prognosis in the initial days, a doctor would be stupid to tell a family their loved one is brain dead without running a multitude of tests after the patient is stabilized.
There are clinical signs that can be seen upon admission that would indicate the patient has suffered an anoxic brain injury. Agonal respiration is seen with anyone who has suffered a brain injury due to insufficient oxygen supply. This type of respiration is initiated by the brain stem and is involuntary. Typically means severe brain injury. Also posturing with the arms and blown pupils. Lactate levels are also very high. High lactate levels (lactic acidosis) is caused by anaerobic metabolism, your body producing energy without oxygen.
Depending on the diagnosis, (gunshot wound to the head, SIDS, co-sleeping with a baby, trauma, shaken baby), most often intracranial pressures increase and prevents blood flow to the brain. It only takes 5 minutes for the brain to die when it is not being provided oxygen. Often, a craniotomy is performed to remove a section of the skull plate, allow the brain room to expand and reduce the pressure in the cranium cavity.
Cat scans and MRI can be done to look at the brain, over time you see what is called white matter differentiation or delineation of a gray-white matter interface. An EEG is done to look at electrical activity in the brain. A flow study with contrast can look at brain perfusion or lack thereof.
The tests the man above was talking about is called Dolls eye test and Caloric reflex test. With Dolls eye test you move the patients head from side to side quickly. The eyes should move in the opposite direction the head is moving, if this does not happen the section of the brain controlling sight is not functioning. The caloric test, you entrain ice water in the patient's ear, the eyes should both point to the ear being entrained, if not brain death is presumed.
The last test is the apnea test. You have chemo receptors in your brain and heart that measure oxygen and CO2 levels that increase depth and rate of ventilation when oxygen gets low or CO2 gets high. See here:
https://www.britannica.com/science/human-respiratory-system/Chemoreceptors
The patient must have a normal CO2 level when this test starts (35-45). The patient is taken off the vent and blood gas samples are drawn every minute and CO2 levels are measured. The patient will remain unventilated till we measure a rise in the CO2 level of 20 above the initial number. If the patient does not attempt to breath with the elevated CO2 levels, the chemoreceptors in the brain are dead.
We recently had a braindead patient who was on the vent for 6 months, mother did not want to give up hope. This was a co-sleeping event, mother rolled on to the child and suffocated it. We give the families ample time to deal with the loss. Often the families will never give up hope and the hospital will seek a court order to terminally wean the patient. This is very rare.
If the patient wants to move their loved one to a rehab facility and keep them alive on ventilator, that is a option. Most often the patients are not stable enough to go to rehab. If they are on drugs to maintain blood pressure for instance, they are not a candidate.
So there are many steps that are taken before the last 3 tests that are done to sign the death certificate.