Brain death

First of all, rule out confounding factors: major endocrine and electrolyte disturbances, drug intoxication, hemodynamic instability (core body temperature should be greater than 36 degrees C, Systolic BP more than 100 mm Hg)

apnea test: disconnect the ventilator for 10 minutes and let PaCo2 rise to 60mm Hg (or above 20mm Hg from baseline) and pH fall to less than 7.28, if the patient is not able to initiate their own breath, then the apnea test is positive.

absence of brainstem and cerebral reflexes e.g. pupil, gag, tracheal suction reflex, caloric reflex, dolls eye reflex,  extensor posturing




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