Which of the following is not a diagnostic criteria for declaring brainstem death?
Correct Answer: Absence of stretch reflex from all extremities is essential
Description: Ans. d. Absence of stretch reflex from all extremities is essential (Ref: Harrison 19/e 442e-2, 1735. 1776, 18/e p2252)Absence of stretch reflex from all extremities is not a diagnostic criteria for declaring brainstem death.Criteria for Brain Death Brainstem deathThe definition of Brain stem death requires simultaneous demonstration that the patient has irreversibly lost the capacity of consciousness (Coma) and the capacity to breathe (Apnea), both of which are dependent on intact brainstemQ.Clinical assessment of the integrity of Brainstem has two components including assessment of the integrity of brainstem mediated cranial nerve reflexes and the Apnea testQ.Brainstem deathDeep Unresponsive ComaAbsence of all Brainstem Cranial ReflexesComplete Apnea in presence of hypercarbia (Absence of Brainstem Respiratory Reflex)* Patients with brain death show the deepest comaQ possible with total unresponsiveness to all stimuli.* No spontaneous movementQ* No response to external stimuliQ (Verbal/Deep pain)* All reflexes mediated by cranial nerve must be absentQ* Absent Pupillary Light reflex (CN II, III)Q* (Pupils are usually midsized but may be enlarged but they should not be small)* Absent Corneal Reflex (CNV, VII)* Absent Vestibulocochlear ReflexQ (CN III, IV, VI, VIII) (No eye movement in response to caloric irrigation of ears)* Absent Oculocephalic Reflex: (Absent Doll's eye reflexQ) Eyes wilt move with the head (No ocular movements on rapid turning of head).* Absent Gag ReflexQ (CN IX, X)* Absent Tracheal Cough ReflexQ (CN X)* Absent Central Motor Response to PainQ (CN V, VII)* (No response to deep somatic stimulation).* No respiratory effort in response to hypercarbia needs to be demonstrated to show that aponea is due to brainstem (medullary) damageQ* Absent respiratory movement during disconnection from the ventilator with the PaCO2 > 60 mm Hg is required for the test to be validQ.
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