An 80 ,vear-old man is adn.itted to the hospital with a massive intracranial bleed.
He has been placed on a ventilator because of tbe respiratory failure associated witlr
intracranial herniation, When you try to remove the ventilato5 there are no respirations. The patient makes no purposeful moventents. There is no pupilary reaction
when you shine a light in his eyes. There is no nystagmus on cold caloric question
testing. Oculocephalic and corneal reflexes are absent. Hc left no specific wishes for
his care.
Which of the following is the most appropriate action regarding this patent?
Remove the ventilator.
Make the patient DNR.
Place a nasogastric tube to prevent aspiration.
Get a court order authorizing you to remove the ventilator.
Do an EEG (electroencephalogram) three times separated by slr hours each
trme.
exp:
The patient meets the criteria for brain cleath. These are: negative corneal reflex, no nvstagmus rn response to caloric stimulation of the tympanic membranes, negative pupilary and oculocephalic reflexes, and the absence of ,ponon.o., respiration when the ventilator is held. Ifthere are no brainsten reflexes an.1 the patient will not spontaneously breathe, then the patient is brain dead. There is no hope ol recovery in this circumstance. An EEG is no consistent with b,ai, deuth. s.nitJffif ll,l’…;‘fi H*:::1:::il",:T:;1,*
States. Although the heart has contr.nued to beat, it is the same as taking the heart out of the chest and seeing it beat in a specimen pan simply because of the automaticity of the hearti intrinsic conduction path*oy. Wh.n n pntient is brain dead, you do not need to seek court or cthics corl
a patient is brain dead, . ",r"ilil;’ jt"t":il::il:H Tiil:i:: :lifir#i: patient. The brain-dead patient is dead. Thisrvool.t b. "s illogi."l as placing a naso_ gastric feeding tube in a cadaver on the autopsy table.
Remember, although you have legal right tnlurn off the ventilator immediately on a persor who is brain dead, you sh9yl4 talk to tl-re–family first. Ifthere is an answer that says “discuss,” “conference,’
o, arriy iiiii “iJi ird"ti"g ,n”, y.u lv"", to always achieve consensus first, then that discuss the maer -,r.,. 0,’,”,i’ifii:;’,:,ffi:::tJ:J,jr,1T:i: jj:i]if…"l
tube.