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Clinical Problems in the Use of Brain-Death Standards

Clinical Problems in the Use of Brain-Death Standards Abstract A 20-year-old woman is brought to the emergency room, after being found on the side of the road. She has fixed 8-mm pupils, no extraocular movements, no corneal response, no gag or cough reflex; she makes no response to any stimulus and is not breathing spontaneously. Her BP is palpable at 60 mm Hg, with a pulse rate of 40 beats per minute. In the emergency room, she is resuscitated with intubation, central venous line placement, and administration of volume and pressor agents. An emergency computed tomography (CT) scan shows early cerebral edema but no cerebral hematoma. Twenty-four and 48 hours later, there is no change in her neurologic findings. Her physician requests a neurologic consultation. The consultant establishes the absence of any brain-stem reflexes and asks for an EEG. This shows no activity; her barbiturate level is zero. The neurologic consultant wishes to declare the patient brain dead and References 1. Black PM: Brain death. N Engl J Med 1978;299:338-344, 393-401.Crossref 2. Veith FJ, Fein JM, Tendler MD, et al: Brain death: I A status report of medical and ethical considerations. JAMA 1977;239:1651-1655.Crossref 3. Becker DP, Robert CM, Nelson JR, et al: An evaluation of the definition of cerebral death. Neurology 1970;20:459-462.Crossref 4. Parisi JE, Kim RC, Collins GH, et al: Brain death with prolonged somatic survival. N Engl J Med 1982;306:14-16.Crossref 5. Diagnosis of brain death. Conference of Royal Colleges and Faculties of the United Kingdom. Lancet 1976;2:1069-1070. 6. Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President's Commission on the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA 1981;246:2184-2186.Crossref 7. An appraisal of the criteria of cerebral death: A summary statement. JAMA 1977;237:982-986.Crossref 8. Byrne PA, O'Reilly S, Quay PM: Brain death: An opposing viewpoint. JAMA 1979;242:1985-1990.Crossref 9. Veith FJ, Tendler MD: In response to an opposing viewpoint on brain death. JAMA 1979;243:180-189. 10. Jonsen AR, Siegler M, Winslade WJ: Clinical Ethics . New York, MacMillan Publishing Co Inc, 1982. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Clinical Problems in the Use of Brain-Death Standards

Archives of Internal Medicine , Volume 143 (1) – Jan 1, 1983

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References (11)

Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350010127021
Publisher site
See Article on Publisher Site

Abstract

Abstract A 20-year-old woman is brought to the emergency room, after being found on the side of the road. She has fixed 8-mm pupils, no extraocular movements, no corneal response, no gag or cough reflex; she makes no response to any stimulus and is not breathing spontaneously. Her BP is palpable at 60 mm Hg, with a pulse rate of 40 beats per minute. In the emergency room, she is resuscitated with intubation, central venous line placement, and administration of volume and pressor agents. An emergency computed tomography (CT) scan shows early cerebral edema but no cerebral hematoma. Twenty-four and 48 hours later, there is no change in her neurologic findings. Her physician requests a neurologic consultation. The consultant establishes the absence of any brain-stem reflexes and asks for an EEG. This shows no activity; her barbiturate level is zero. The neurologic consultant wishes to declare the patient brain dead and References 1. Black PM: Brain death. N Engl J Med 1978;299:338-344, 393-401.Crossref 2. Veith FJ, Fein JM, Tendler MD, et al: Brain death: I A status report of medical and ethical considerations. JAMA 1977;239:1651-1655.Crossref 3. Becker DP, Robert CM, Nelson JR, et al: An evaluation of the definition of cerebral death. Neurology 1970;20:459-462.Crossref 4. Parisi JE, Kim RC, Collins GH, et al: Brain death with prolonged somatic survival. N Engl J Med 1982;306:14-16.Crossref 5. Diagnosis of brain death. Conference of Royal Colleges and Faculties of the United Kingdom. Lancet 1976;2:1069-1070. 6. Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President's Commission on the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA 1981;246:2184-2186.Crossref 7. An appraisal of the criteria of cerebral death: A summary statement. JAMA 1977;237:982-986.Crossref 8. Byrne PA, O'Reilly S, Quay PM: Brain death: An opposing viewpoint. JAMA 1979;242:1985-1990.Crossref 9. Veith FJ, Tendler MD: In response to an opposing viewpoint on brain death. JAMA 1979;243:180-189. 10. Jonsen AR, Siegler M, Winslade WJ: Clinical Ethics . New York, MacMillan Publishing Co Inc, 1982.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1983

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