Thursday, 2 December 2010

braın death - clinical case

12 year old boy felt from 4th floor while playing at their houses balcony. 112 emergency service arrived in time found child unconcious, entubation was done on sight. Physical findings upon arrival at emergencyl were: lost of conciousness, GCS:4, no spontaneous breathing and both pupil were fix dilated. Cranial CT scan showed generalised brain edema and large ventricular hemorrage. Neurosurgeon on charge found surgical intervention obsolete and the boy was admitted to ICU. 24 hr later GCS was found 3 and the possibility of a brain death was being considered.
No spontaneous movement some deep tendon reflex found No motor responce found upon painful stimulus No spontaneous respiration No brainstem reflexes apnea test was positive but some suspicous movement of extremity occured hyperthermia

Possible solutions:
1. 2 member declared brain death
2. one member refused brain death found hyperthermia a possibility for misinterpretation
3. one member found it neccessary for the apnea test be repeated due to spontaneous movement of arm and pectoris
4. last member stated the apnea as positive unvolunteer motor activity are due to spinal reflexes and does not negate the apnea test

two answers are correct- 2. and 4. Hyperthermia can be interprete as active ypothalamic input, and it is correct by our knowledge that there can be some movement due to spinal reflex durin apnea test