Coming Back From The Dead
Accurately diagnosing those with severe brain injuries is crucial to the individuals long-term care and potential recovery. Misdiagnosis can result in the denial of care and treatment that can otherwise restore the individuals brain functions and improve their quality of life. In the worst case scenario, those patients who are aware but whose life-support systems are turned off by family members or physicians can suffer a at the hands of those responsible for caring for them.;
Should A Brain Dead Person Be Kept Alive
Here is the issue in its simplest form: if you are brain dead, you cannot be alive on life support. It is true that your organs may be kept viable through mechanical ventilation and other means, but a person with no functioning brain activity is as dead as dead is. They cannot be brought back to life.
The Doctors Thought I Was Brain Dead Then I Woke Up From The Coma
When doctors use the term brain dead, its usually a sign that they believe the patient has no hope of recovery and is basically dead.
But the diagnosis can be widely controversial. Brain dead diagnoses have launched public legal battles between hospitals and families over whether the patient really is brain dead and whether they deserve medical care. In many cases, the patients have died; but in others, they have lived or recovered.
A Reno, Nevada student is celebrating her 21st birthday this January five months after doctors thought she was brain dead from alcohol poisoning.
Hanna Lottritz, a journalism student at the University of Nevada, Reno, shared her story at The Huffington Post to encourage young adults to drink responsibly, but her story also points to the potentially life-threatening dangers of a brain death misdiagnosis.
Lottritz collapsed on July 26, 2015, at a music festival in Nevada after agreeing to a drinking competition with a male friend, according to the report. The 20-year-old student, who calls herself competitive, said they played to see who could take the longest chug from a bottle of whiskey. Friends said she collapsed several minutes later, after taking another drink of alcohol.
Not breathing, Lottritz was flown to the hospital by helicopter. When she arrived, her blood alcohol concentration was five times over the legal limit at .41, she said.
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A Dogged Quest To Fix Broken Spinal Cords Pays Off With New Hope For The Paralyzed
But the scientific literature scarce as it is seems to show that even several magic bullets are unlikely to accomplish what Bioquark hopes it;will.
This isnt the first start for the trial. The study launched in Rudrapur, India, in April 2016 ;but it never enrolled any patients, according to Pastor. Regulators shut the study down in November;2016 because, according to Science, Indias;Drug Controller General hadnt cleared it.
Now, Pastor said, the company is in the final stages of finding a new location to host trials. The company will;announce a trial in Latin America in coming months, Pastor told STAT.
If that trial mirrors the protocol for the halted Indian one, itll aim to enroll 20 patients wholl receive a barrage of treatments. First theres the injection of stem cells isolated;from the individuals own fat or blood. Second, theres a peptide formula injected into the spinal cord, purported to help nurture new neurons growth. Third, theres a regimen of nerve stimulation and laser therapy;over 15 days to spur the neurons to form connections. Researchers;will;look to behavior and EEG for signs that the treatment is working.
But the process is fraught with questions. How do researchers complete trial paperwork when the person participating is, legally, dead? If the person did regain brain activity, what kind of functional abilities would he or she have? Are families getting their hopes up for an incredibly long-shot cure?
Can You Recover From Brain Death
No, a patient who is brain dead will not be able to recover. The body may continue to breathe with mechanical support but eventually, both the breathing and heart will stop even with continued support.
Being brain dead is not the same as being in a coma or a prolonged vegetative state. The latter two are medical states where one may be unconscious;but still show brain function.
The media and Hollywood often use these terms interchangeably. But both medically and legally, brain death is its;own distinguishable diagnosis;that one cannot recover from.
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Problems With The Apnea Test
According to the published guidelines, the apnea test is the cornerstone procedure for declaring a patient brain-dead. This procedure, just like all the other clinical test-criteria put forth by the Harvard Committee, has never been validated. A recent review of current-practice apnea testing reveals that it still lacks consensus standardization regarding the actual procedure, monitored parameters, and evidence-based safety measures that may be used to prevent complications . A close look at the apnea test in light of the neuro-intensive care requirements for SBI demonstrates that this procedure does not take into account the pathophysiology of brain injury and coma, namely those factors which can worsen cerebral ischemia, brain edema, and cerebral hypertension .
In the apnea test, the patient is disconnected from the ventilator to let the PaCO2 rise above a certain threshold or at least 20 mmHg above the baseline, while oxygenation is preserved via a catheter down the endotracheal tube delivering 100 percent O2 . Given the above information regarding the effect of CO2, the harmful effect of the apnea test, which induces hypercarbia in comatose patients with SBI is self-evident. The apnea-induced hypercarbia can easily push CBF to below the critical level of 1015ml/100g/min, below which cellular membrane depolarization and disruption of ionic homeostasis occur .
Shocking Number Of Patients Not Really Brain Dead
Studies from Canada indicate that approximately 20% of patients misdiagnosed as brain-dead are in fact conscious and have the potential to recover from traumatic brain injuries. This misdiagnosis can have fatal consequences that can result when physicians and loved ones pull the plug on life support systems that are keeping patients alive. New technology that detects brain activity could be the answer.
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How Is Someone Declared Brain Dead
In California, two separate doctors will independently run a series of standardized exams that test whether or not the brain is functioning at any level.
If both doctors find the patient absent of any responses, the patient is then declared dead. This is the point when the time of death takes place.
Recovery From Brain Death
It is taught that when a brain cell dies, it will not be replaced. The brain cells you are born with will need to last a life-time as new cells will not replace cells that die for whatever reason. Actually, there is now data which supports neurogenesis, a process where new brain cells can be made; but that is a story for another day. The belief that a brain that has died will not ever recover led to the Brain Death statutes which allowed for a legal declaration of death for a person who meets certain clinical and laboratory findings indicative of brain death. These statutes allowed for the harvesting of organs for transplant purposes from donors who still had a functioning cardiopulmonary system. Previously, a person had to lose the heart activity in order to be declared dead. This meant that many otherwise useful organs were lost for transplant purposes.
The case of Jahi McMath is still winding its way through the California legal system and it will force a new look at the brain death statute. Unfortunately, this decision will be placed in the hands of a jury which may not have the knowledge, training, experience, or education to competently make this fateful decision.
Judge Pulido has ruled that there is a disputed issue of material fact-is Jahi McMath brain dead under the Uniform Determination of Death Act? Since it is a disputed fact, it will be up to a jury to make this decision. With the denial of the motion, the case is now likely to proceed to a jury trial.
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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.
Other Brain Death Testing
After completing the physical assessment, the physician may elect to order additional testing. While it is typical for both a physical assessment and an apnea test to be done, some people who are not brain dead cannot tolerate apnea testing. Often, in those cases, a flow study will be done. These studies are done to see if blood is traveling to the brain through the bloodstream. If the study shows that no blood is reaching the brain, the test is consistent with brain death.
Some physicians will use an EEG, or electroencephalogram, which is a test that measures brain waves. A person who is brain dead will have a “flat” EEG, as brain waves will be absent.
Atropine, a prescription medication that causes the heart rate to increase, an also be administered as an ancillary test for brain death because it is not effective in brain dead individuals. If the heart rate increases notably after the medication is given, this suggests that a person is not brain dead.
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Ethical Foundations Of Patient Careprimum Non Nocere
In recent decades, scientific progress, sociocultural changes, and moral pluralism have altered the practice of the medical profession. Besides a weakening of the moral fabric in the medical community, there has been also a transformation of the physician into a variety of roles , much to the detriment of the doctorpatient relationship. Yet, it is this very relationship that constitutes the essence of the medical profession. It is a relationship in which the very sick person finds him- or herself in a most vulnerable and exploitable condition; his or her welfare thus depends not just on the knowledge and skills of his or her doctor, but also on the latter’s ethical outlook. This is why medicine is an inherently moral practice , in which the role of the physician as a moral agent is of central importance. Thus, despite the dominance of principle-based ethics, introduced by , the truth remains that in medicine, we are dealing with a sick human being, rather than with abstract principles. The telos of the medical profession thus rests on the telos of the doctorpatient relationship. This, in turn, means that the physician’s moral attitude, and consequently, his or her clinical acts must be directed to what is necessary to heal and to help this patient .
When The Brain Is Injured It Responds Like Other Injuriesit Swells However The Brain Is Confined In The Skull And Has No Room To Swell This Leads To Brain Death
To avoid even the smallest chance of mistake, most hospitals require that two physicians sometimes hours apart each conduct a range of tests in search of even the slightest indication of brain activity.
None of these physicians can have anything to do with organ donation and transplantation; they probably do not even know whether the patient is a would-be donor or how the family feels about donation. Physicians, however, often let family members watch as they perform some of these tests because the tests visually demonstrate that, appearances notwithstanding, the person they love is indeed dead.
No One Pulls the Plug
Once a person is declared brain dead, families are not asked to “pull the plug” or to take someone “off of life support” because such actions would be impossible: the person they love has already died.
Debates about whether to “pull the plug” or discontinue support on someone who is in a coma or in a persistent vegetative state have nothing to do with organ donation; such people still have brain function, and are not dead.
Organ and Tissue Donation after Cardiac Death
Typically when a person suffers a cardiac death, the heart stops beating. The vital organs quickly become unusable for transplantation. But their tissues such as bone, skin, heart valves and corneas can be donated within the first 24 hours of death.
Brain Death Can Be Confusing For Families Who Are Confronted With The Sudden Death Of Someone They Love
When this happens, some families expect that the person they love can simply be kept on the ventilator in hopes that their condition will improve. But to be brain dead is to be dead, and no improvement or recovery is possible. Defibrillators used to “shock” a heart may get it functioning again within the first several minutes after it stops. But there is no such method to jump-start or revive a brain that has been deprived of blood and whose cells have died.
How does brain death occur?
When the brain is injured, it responds in much the same way as an injury like a twisted ankle – it swells. Unlike the muscles and tissue of the ankle, however, the brain is in a confined space the skull and has no room to swell.
A head trauma, bleeding in the brain from a stroke or aneurysm, or prolonged cardiac arrest that deprives the brain of oxygen will cause the brain tissue to swell. The action of the brain swelling inside a closed space and the build-up of pressure is what can ultimately lead to brain death. As the brain swells inside the skull, it pushes downward toward the brain stem blocking all upward flow of blood. Depending on the type of injury, this may happen within minutes or over a period of days. Even while the heart is still beating and supplying blood to the rest of the body, blood that carries oxygen cannot reach the brain or the brain stem, which controls heart rate and breathing. The result is that the brain and the person dies.
Documenting Brain Death
Would You Consider A Person Who Is Medically Brain Dead To Be Alive
No. Brain death is death. A patient who is in a coma or persistent vegetative state typically has some brain stem function and possibly other brain function. When a person is brain dead, no part of the brain is functioning any longer.
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Is Recovery From Brain Death Possible
Jahi McMath suffered catastrophic complications from throat surgery in December of 2013 ;three and a half years ago.
She was soon declared to be brain dead, and Oakland Childrens Hospital informed her mother, Nailah;Winkfield,;that life support would be terminated.
Winkfield;sued, but after an independent medical examination, the judge ruled that Jahi was deceased and allowed a death certificate to be issued. He also played Solomon, and worked out a settlement whereby Childrens Hospital transferred Jahi to her relatives while still on life support. She was moved to New Jersey, where she remains today.
At the time, I believed Jahi was dead, and so wrote.
But I also wrote that if she did not deteriorate, as almost all people with properly determined brain death do, my eyebrows would raise. Since then, Jahi has not deteriorated, but apparently, her bodys condition has improved. My eyebrows are above my hairline.
A judge has permitted Winkfield;to demonstrate that the death declaration was erroneous. Important evidence in that process was just filed in the penalty of perjury declaration of an internationally respected neurologist, who states that Jahis condition is no longer consistent with a brain death determination.
First, he notes that one of the bases for declaring Jahi dead was the then-apparent deterioration of her body. From the , starting at page 21 :
And heres something I didnt know:
Attempting To Reverse The Irreversible
The clinical trial will involve a four-step approach. The spinal cords of the brain dead subjects will be injected with stem cells, which are cells that have the ability to differentiate into other cell types, including neurons.
The stem cells minimally manipulated, autologous, adult stem cells derived and expanded from patient fat and/or peripheral blood will serve as some new bricks in the regenerative process, Pastor explained to Medical News Today.
Subjects will also be injected with a peptide called BQ-A derived from ooplasms, the cytoplasm of an egg, or oocyte which Pastor told us will act as the blue print and mortar in the regenerative process.
As well as aiding neuronal growth, Pastor explained that the peptides will help to reprogram and recondition the surrounding tissue at the location where stem cells are injected, and they will also help to target and destroy components of dead tissue.
Once these steps are complete, median nerve stimulation techniques and transcranial laser therapy will be applied to each subject for 15 days, with the aim of spurring connections between the newly formed neurons.
In short, it is our contention that there will be no single magic bullet for success and any traditional single drug approach would be fairly futile. Hence why we are employing this type of combinatorial approach, Pastor told MNT.
Secondarily, he added, we hope the trial will answer certain deeper issues about the human mind.
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