This in turn contributes towards the secondary brain injury that neuro-critical care aims to limit. The consequent rise in intra-cranial pressure opposes cerebral perfusion pressure and limits cerebral oxygen delivery. Swelling may occur in the injured brain and the effects of this in a fixed-volume container such as the skull are well known. It has a high metabolic requirement, comprising 20% of the body’s oxygen consumption and receiving 15% of the total cardiac output. The brain is particularly susceptible to injury. PHYSIOLOGY AND PATHOLOGY OF BRAIN INJURY: In addition – and of particular relevance to this article – the pons contains the reticular activating system that is vital for cortical arousal and conscious awareness, whilst the medulla contains centres that control cardio-respiratory function. Most of the cranial nerve nuclei are contained here. The brainstem is the physical link between the cerebral cortex and the spinal cord and it consists of the midbrain, the pons and the medulla. Pons, medulla oblongata, cerebellar hemispheres. Cerebral hemispheres, thalamus and hypothalamus The brain is made up of three main embryological segments. This article describes the basic science behind brainstem death, the methods of testing for brainstem death and discusses the management of these patients. These would allow futile treatments to be withdrawn and organs to be donated if appropriate, safe in the knowledge that there would be no chance of a recovery. There has never been an actual statutory definition of death in the United Kingdom, unlike in the United States of America, and this was one factor that led to the development of brainstem death criteria. Absent vestibulo-ocular reflexes bilaterallyĪs intensive care practices and facilities improved and became more widely available, it became a more common occurrence for severely brain damaged patients to be supported with mechanical ventilation.Two sets of tests separated by 24 hours.Testing for apnoea with an arterial CO 2 of greater than 7.0 kPa.The following are contra-indications to organ donation:.Two doctors with at least 3 years of medical registration.The following are required for brainstem death testing:.The following can be associated with brainstem death:.
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