Identifying Organismal Integration In Tk
I propose that there are at least three bodily functions described in TK’s autopsy report that demonstrate that he is still an integrated whole: blood pressure homeostasis, a robust immune response, and proportionate growth. Significantly, both defenders and critics of the neurological criteria for death agree that the first two functions are indicative of organismal integration. Tonti-Filippini, a defender of the TBD criterion for death, argues that integration is mediated in the human body by the hormonal, i.e., endocrine, system:
The transfer of information merely between one part of the body and another is insufficient to establish that the soul has not separated from the body. For instance, circulation in itself is not a transfer of information that integrates the body. Rather it is a means by which information might be transferred such as happens through the endocrine system.
In brief, my argument is the following: If TK had retained his integration after total brain failure, then we would expect that his three organismal functions would be comparable pre- and post-brain death. In contrast, if TK had lost his integration, then we would expect that his three organismal functions, after the tragic destruction of his brain, would be defective or unreliable or faulty in some way.
On Approaching Life After Death
“All I want to accomplish in life is to have fun and make other people’s lives better as best as I can.
“No personal achievement will matter to me once I’m dead, the only thing that will live on after my death will be my impact on the people that are still alive. And hopefully my impact will be positive!”
Thoughts From Families Who Have Been There
Family members who have a loved one in a minimally conscious or vegetative state have identified a number of important issues:
It might not be possible to find someone who knows everything about how to access these various services and programs. The key is to keep asking questions and following up to make sure that you and your loved one get all the benefits that are available. People who may be helpful to you are social workers, therapists, case managers, the local social security office, your state brain injury association chapter, family members or friends who are disabled or who have family who are disabled, or the human resources department at your loved ones employer.
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Care During Coma Or Vs
People in a coma or a VS need a lot of care. This care may include:
- Feeding with a feeding tube.
- Turning the person while he or she is in bed to prevent pressure injuries .
- Helping with bowel and bladder relief. This may include using a catheter or diapers.
- Managing breathing. This may include removing mucus from the airway. It may also include cleaning a tracheostomy tube.
- Managing muscle tone. This includes helping to relieve extremely tight muscles with positioning and range of motion exercises.
- Using special equipment. This may include a wheelchair. It could also include special bedding to help with proper posture, decrease muscle tightness, and prevent pressure sores.
- Treating infections such as pneumonia or urinary tract infections.
- Managing other health problems such as fevers or seizures.
What Does It Mean To Be Brain Dead
“It’s complicated,” Lewis Nelson, MD, the chair of emergency medicine at Rutgers New Jersey Medical School, tells Health. There are two major parts of the brain, he explains: The cortex, which is the part that helps you think, and the brain stem, which controls things like your breathing.
When someone is brain dead, “both your cortex and brain stem have deactivatedthey’re not functional,” Dr. Nelson says.
A person’s heart will continue to beat when they’re brain dead and receiving medical careprovided they’re put on a ventilator to restore their breathing, which is what typically happens, Dr. Nelson says. “But if someone is brain dead and you turn off the ventilator, they will die,” he says.
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What Happens After Coma And Vegetative State
When people start to regain consciousness, they may:
- follow simple instructions from others such as, Open your eyes, Squeeze my hand, Say your name, etc.
- communicate by speaking words or by indicating yes or no by head nods or gestures and/or
- use a common object in a normal way such as brushing hair with a brush, using a straw to drink, holding a phone to the ear, etc.
Persons with brain injury transition through the period of unconsciousness and subsequent stages of recovery at a slower or faster rate, largely depending on the severity of injury. Those with less severe injuries may transition through these stages more rapidly and some of the stages described here may be poorly recognized or not occur at all. Those with very severe injuries may stall at one or another stage and not be able to make the transition to a higher level of recovery.
For persons with more prolonged periods of unconsciousness, emergence from unconsciousness is a gradual process. Coma rarely lasts more than 4 weeks. Some patients move from coma to the vegetative state but others may move from coma to a period of partial consciousness. It would be very rare for a person to move directly from coma, or vegetative state, to a state of full consciousness.
Persons who have shorter periods of unconsciousness likely had less severe brain injuries initially. Consequently, they are likely to go on to make better recoveries than persons who had longer periods of unconsciousness.
Characteristics Of The Vegetative State
- Return of a sleep-wake cycle with periods of eye opening and eye closing
- May moan or make other sounds especially when tight muscles are stretched
- May cry or smile or make other facial expressions without apparent cause
- May briefly move eyes toward persons or objects
- May react to a loud sound with a startle
- Unable to follow instructions
- No speech or other forms of communication
- No purposeful movement
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Recovering From The Mcs
When a person can correctly answer simple yes and no questions or use at least two objects such as a comb or pencil consistently, they are no longer in the MCS. Some people stay in the MCS indefinitely, but many improve and regain independence. The longer a person remains in the MCS, the more permanent impairments he or she is likely to have. Both the VS and the MCS are caused by severe damage to areas of the brain that are important for consciousness. After improving from the MCS, people are usually confused. Some people move directly from coma to this confused state.
Was It Really Brain Death
Twenty-one-year-old Zack Dunlap from Oklahoma appeared on NBC’s Today Show in 2008 to tell an incredible story of hearing a physician telling his parents that a PET scan confirmed that he was brain dead after a catastrophic brain injury. While he was being prepared for organ donation, however, he moved his arm purposely in response to stimuli. Dunlap recovered, went to a rehabilitation hospital, and ultimately went home 48 days later, very much alive.
Earlier this year, 13-year-old Trenton McKinley from Alabama and his parents hit the media circuit to talk about the miracle of Trenton awakening after being declared brain dead from a vehicle accident1 day before his organs were scheduled to be harvested.
The likely explanation for such “recoveries” from brain death, according to experts, is that these individuals were never brain dead in the first place. “Errors have been made where people declared brain dead were later found to have spontaneous movement that should not have been possible,” says Robert M. Sade, MD, professor of surgery and director of the Institute of Human Values in Health Care at the Medical University of South Carolina in Charleston. “In virtually all those cases, brain-death determination was not done correctly. If you don’t go through the exact protocol for brain-death determination, you’re likely to have patients diagnosed as being dead by neurologic criteria who are, in fact, not brain dead.”
- Was It Really Brain Death?
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Symptoms Of Vegetative State
People in a vegetative state can do some things because some parts of the brain are functioning:
They can open their eyes.
They have relatively regular sleeping and waking patterns .
They can breathe, suck, chew, cough, gag, swallow, and make guttural sounds.
They may even be startled by loud noises and appear to smile or frown.
Because of these responses, they may appear to be aware of their surroundings. However, they have no awareness of themselves or their environment. Their apparent responses to their surroundings result from automatic basic reflexes and not from a conscious action. For example, they may instinctively grasp an object when it touches their hand, as a baby does.
People in a vegetative state cannot do things that require thought or conscious intention. They cannot speak, follow commands, move their limbs purposefully, or move to avoid a painful stimulus.
People in a vegetative state have no control over urination and bowel movements .
Establishing The Irreversibility And Cause Of The Coma
Before a doctor can determine whether the coma is irreversible, he or she must find if there is any way to reverse it. To do so, the medical team must first pinpoint the cause of the coma.
Moreover, the team must exclude any condition that could potentially mimic brain death, such as hypothermia, drug toxification or poisoning, metabolic abnormalities, or neuromuscular agents that can cause “death-like” paralysis. All of these, by varying degrees, are potentially reversible.
Establishing the irreversibility of a coma requires that the doctor wait an appropriate amount of time based on the known or proximate cause. The determination that must meet both medical and legal standards. From this perspective, the term “proximate” indicates that the cause must be sufficiently established and supported if it is not already known.
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How To Interact With A Loved One Who Is Unconscious Or At A Low Level Of Responsiveness
The most natural way of interacting is to talk to your loved one, even though he or she may not respond or understand. Telling him or her about recent events in your life, whats going on in your family or neighborhood, or the latest news may make you feel connected. Talking with your loved one about what you are doing as you provide care can increase your comfort with caregiving. For example, telling your loved one that you are going to move his or her arms and legs to help prevent joint tightness might make you feel more comfortable with this task. Only do these range of motion exercises if you have been instructed to do so by a doctor, nurse, or therapist.
Touch is another way to feel connected. Some family members have said that giving a massage or putting lotion on the hands or face of their loved one helps them to feel close to them. Its also important to give your loved one time for quiet and rest, such as by turning the TV off. You should also avoid overstimulation as this may cause rapid breathing, muscle tightening, teeth grinding, restlessness, and fatigue.
What Happens When Someone Is In A Coma
Someone who is in a coma is unconscious and will not respond to voices, other sounds, or any sort of activity going on nearby. The person is still alive, but the brain is functioning at its lowest stage of alertness. You can’t shake and wake up someone who is in a coma like you can someone who has just fallen asleep.
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Establishing The Absence Of Respiratory Function
The final step in establishing brain death is the apnea test. Apnea is the medical term for the suspension of breathing and is used in this instance to ascertain whether the suspension is permanent.
To perform an apnea test, the doctor would take the following steps:
If there is no respiratory movement and the PaCO2 has increased to over 60meaning that there has been no exchange of oxygen and carbon dioxide in the lungsthe person will be declared brain-dead.
If on the other hand, a respiratory movement is observed, then the person cannot be considered brain-dead. Further investigations would then be performed to identify what, if anything, can be done to reverse the condition.
How Long Will It Take For Someone To Awaken From Coma After Brain Injury
Every brain injury is unique and as a result, every individual will regain consciousness from a coma at a different rate. Generally, the more severe the brain damage, the longer it will take for the individual to recover.
Sometimes, a patient may suddenly lose consciousness after being fully alert. Other times, unconscious individuals may gradually regain consciousness. Due to the unpredictable nature of consciousness in the early stages of traumatic brain injury, it is nearly impossible to predict when a patient will awaken from a coma in the first 24 hours after a traumatic brain injury.
However, a coma rarely lasts over a month. Instead, individuals who remain unconscious for prolonged periods typically progress to a wakeful but unconscious state called post-coma unresponsiveness. In the next section, we will discuss post-coma unresponsiveness and additional states of consciousness that may occur after a coma.
What Is A Coma
Someone who is in a coma is unconscious and has minimal brain activity. They’re alive, but can’t be woken up and show no signs of being aware.
The person’s eyes will be closed and they’ll appear to be unresponsive to their environment. They won’t normally respond to sound or pain, or be able to communicate or move voluntarily.
Someone in a coma will also have very reduced basic reflexes such as coughing and swallowing. They may be able to breathe on their own, although some people require a machine to help them breathe.
Over time, the person may start to gradually regain consciousness and become more aware. Some people will wake up after a few weeks, while others may go into a vegetative state or minimally conscious state .
How Do Doctors Know Someone Is Brain Dead
Doctors will put a patient through a number of tests to determine if they’re brain dead, George Teitelbaum, MD, interventional neuroradiologist and director of the Pacific Stroke and Aneurysm Center at Providence Saint John’s Health Center in Santa Monica, California, tells Health. One is by measuring electrical activity of the brain. “When someone has basically flatlined activity, they’re considered to be brain dead,” he says.
Doctors will also typically do tests to determine if there is any blood flow to the brain, along with several physical exams. “When you move the head from side to side, normally the eyeswith a little delaywill track the direction that you turn the head,” Dr. Teitelbaum says. “When they just sort of follow the head, it’s called doll’s eyes.” Doctors may also touch the surface of the eyeball and the back of the throat, which would normally cause some kind of physical reaction, he says.
“If someone is not on medication like barbiturates, these tests are highly suggestive of somebody being brain dead,” Dr. Teitelbaum says.
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Left Ventricular Assist Device
An LVAD is used in cases of heart failure. Its a mechanical device that assists the left ventricle in pumping blood to the body.
Sometimes an LVAD becomes necessary when a person is awaiting a heart transplant. It doesnt replace the heart. It just helps the heart pump.
LVADs can have significant side effects, so a person on the heart transplant list might opt against having one implanted after evaluating their likely wait time and risk with their doctor.
What Is Life Support
The term life support refers to any combination of machines and medication that keeps a persons body alive when their organs would otherwise stop working.
Usually people use the words life support to refer to a mechanical ventilation machine that helps you breathe even if youre too injured or sick for your lungs to keep working.
Another cause for the need of a ventilator is a brain injury that doesnt allow the person to protect their airway or initiate breaths effectively.
Life support is what gives doctors the ability to perform complicated surgeries. It can also prolong life for people who are recovering from traumatic injuries. Life support can also become a permanent necessity for some people to stay alive.
There are many people who have portable ventilators and continue to live a relatively normal life. However, people who are using a life-support device dont always recover. They may not regain the ability to breathe and function on their own.
If a person on a ventilator is in a long-term state of unconsciousness, this can put family members in the difficult situation of choosing whether their loved one should continue to live in an unconscious state with the help of the machine.
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