Introduction: Coma and Brain Death: Current Guidelines, Ethical Issues, & Clinical Challenges (09:16)
This video will differentiate discrepancies of a vegetative, minimally conscious, and akinetic mutism, abulic, or catatonic states. A coma is not arousable even with vigorous stimulation; afflicted individuals will exhibit brain stem function. Causes include traumatic brain injury, cerebral injury, metabolic issues, or a subdural hematoma.
States of Coma (14:58)
A vegetative state has a severely impaired cortical function; eyes will open spontaneously. In a minimally conscious state (MCS) patients may visually track and may have purposeful responses. In akinetic mutism, abulia, and catatonia individuals experience profound apathy, but responds to stimuli at times.
Assessment: Brain Death (09:26)
The person is comatose, experiences no brainstem function, and is on a ventilator. Upon first examination examine the airway, breathing, and circulation. Provide Dextrose, Naloxone, or Thiamine as needed.
Diagnosing Brain Death (23:05)
Brain death is irreversible cessation of the brain stem; most common causes include traumatic brain injury (TBI) and subarachnoid hemorrhage. Institutions follow different protocols. Diagnostic criteria for determining brain death include finding cause of coma, discontinuing any drug that could be causing a depressed state, maintaining a normal temperature and blood pressure, and performing a clinical evaluation.
Challenges and Controversy (09:54)
Sometimes ancillary tests are required due to swollen eyes or multiple co-founders such as organ failure. Nuclear medicine can help families understand their loved one is gone. Unconfirmed diagnoses can occur when there is severe facial trauma, pupillary injury, toxic level drugs, and sleep apnea; spontaneous movements and auto triggering of mechanical ventilator can occur with people who are brain dead.
Accepting Brain Death (08:16)
Promote the well-being of the patient and use appropriate communication. Consider saying "organ support" instead of "life support." Jahi McMath is currently ventilated and provided tube feedings after moving to New Jersey to ensure treatment.
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