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Can You Recover From Being Brain Dead

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Has Anyone Recovered From Being Brain Dead

Miraculous recovery for 13-year-old declared brain dead

This is a question our experts keep getting from time to time. Now, we have got the complete detailed explanation and answer for everyone, who is interested!

Asked by: Granville O’Keefe

However no one can recover from brain death. If the clinician has any doubt as to whether there can be even minimal recovery, brain death is not declared. A determination of brain death means that the patient has died brain death is irreversible.

How Is It Decided That A Person Is Brain Dead

A doctor performs tests to make a diagnosis of brain death. These tests are based on sound and legally accepted medical guidelines. Tests include a clinical exam that shows a person has no brain reflexes and cannot breathe on their own. In some situations, more tests may be needed. You may ask your doctor to explain or show you how brain death was determined in your loved one.

The person may show spinal cord activity or reflexes, such as twitching or muscle contractions. Spinal reflexes are caused by electrical impulses that remain in the spine. These reflexes can occur even though the brain is dead.

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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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 âshockâ 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 â 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

What Is Brain Death

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Brain Death is when an irreversible and complete loss of brain and brain stem function has taken place. This means that there is absolutely no brain activity and brain activity will not return.

It is considered both a legal and medical definition of death.

At this point, the patient is incapable of surviving without mechanical support.

You can see the difference of a brain with blood flow and brain activity, and one that is without any function.

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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 latterâs 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 physicianâs moral attitude, and consequently, his or her clinical acts must be directed to what is necessary to heal and to help this patient .

The Challenges Of Defining And Diagnosing Brain Death

A new Johns Hopkins support team helps clinicians and families understand a difficult diagnosis.

Karen Nitkin

    A woman lies in a bed at The Johns Hopkins Hospital. Aided by a ventilator, her lungs inflate, deflate, and fill again. Her heart beats and her skin is warm. But her eyes stay closed and she does not react to stimuli such as pain and light.

    Is she alive or dead?

    If youre unsure, or if the question makes you uncomfortable, youre not alone. The hypothetical case described here reflects a real problem: the inherent difficulties of diagnosing and accepting brain death.

    The topic was the focus of a September Ethics for Lunch discussion in the Chevy Chase Bank Auditorium of The Johns Hopkins Hospital, hosted by the Berman Institute of Bioethics.

    The panel was moderated by anesthesiologist and critical care specialist Robert Stevens, who says the line between life and death, once clearly perceptible in the form of a beating heart, is now sometimes harder to see because of advances in lifesaving technologies.

    The modern intensive care unit can keep a person with severe brain injuries alive, he says, but may also mask evidence that the person has died. The shift from a deep coma to brain deathpermanent cessation of all brain functionmay not be immediately obvious to an untrained observer. Yet recognizing this transition from life to death is critical for families, the medical team and potential organ recipients.

    Watch the Ethics for Lunch panel discussion.

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    How Does Brain Death Happen

    It typically occurs after a major injury or illness where the blood supply to the brain is blocked or the brain begins to swell within the skull.

    This can be a traumatic head injury, a stroke, or the heart stopping for a prolonged period. These traumatic events cause the brain to lose oxygen, lose blood, or begin to swell beyond recovery.

    What Happens After Coma And The Vs

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    The first sign of consciousness is usually visual tracking. This occurs when the patients eyes follow people or an object. Other signs include:

    • Following simple instructions such as, Squeeze my hand, or Say your name.
    • Communicating by saying words or indicating yes or no with head nods or gestures.
    • Engaging in automatic behaviors like scratching the skin or crossing/uncrossing the legs.

    People with brain injury will recover consciousness at a slow or fast rate, based on how severe their injury is. For people with very severe injuries, return of consciousness is a slow process. People with less severe injuries may move through the phases listed above quickly. Some of the stages described here may not be recognized or may not occur at all. For people with very severe injuries, recovery may stop at one of these stages.

    Coma rarely lasts more than 4 weeks. Some patients move from coma to the VS. Others may move from coma to partial consciousness. It is rare for a person with severe brain injury to move directly from coma, or the VS, to full consciousness. People who are unconscious for a short time generally have had a less severe brain injury. As a result, they are likely to have a better recovery than people who are unconscious for a long time.

    Another stage of recovery is called the minimally conscious state, or MCS. People in the MCS cant respond or communicate consistently.

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    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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    How Is Brain Death Related To Organ Donation

    In order to be medically able to become an organ donor, an individual must pass away on a ventilator in a hospital. While being brain dead is not the only way this can happen, it is the most frequent condition of those who become organ donors.

    Only after someone has been declared brain dead, legally dead, the hospital will contact the local organ procurement organization to begin the consideration of donation. Not until this point is it looked up to see if someone is registered as a donor and/or the family is approached to be asked if they would like their loved one to be a donor.

    Once a legal record of donor registration is found and/or a family has consent then the organ donation process will begin. If someone is not a registered donor and the family does not consent the person will not become a donor.

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    Is There Treatment For A Vegetative State

    Once doctors have determined that there is no way to reverse the brain trauma, treatment involves caring for the personâs physical needs. People can live in a vegetative state for years if they get appropriate care. This may mean having home health workers help care for them, or they may need to be in a nursing facility.

    People in a vegetative state need assistance with activities such as eating, bathing, and getting in and out of bed. They may need to be put on a feeding tube. Their caregivers will need to pay attention to their skin to avoid pressure sores from being in the same position in a bed or in a wheelchair for too long.

    Respiratory infections and urinary tract infections are significant risks for people in a vegetative state. Blood clots can also be a problem due to their lack of mobility. Caregivers need to be trained to be alert to these possible health issues.

    Can The Brain Heal After Lack Of Oxygen

    How long can a brain dead person survive?

    A full recovery from severe anoxic or hypoxic brain injury is rare, but many patients with mild anoxic or hypoxic brain injuries are capable of making a full or partial recovery. Furthermore, symptoms and effects of the injury are dependent on the area of the brain that was affected by the lack of oxygen.

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    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.

    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.

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    Problems With The Clinical Tests For Brain Death In General

    With the worldwide legal adoption of brain death as death , it appears that the medical community has accepted the clinical test-criteria for brain death as if they were scientific truths, even though they are fraught with known flaws and problems. Only a few of these are mentioned below.

    The first fundamental flaw is the lack of scientific data required for the validation of the clinical tests for the determination of brain death. Medicine is an empirical science every test procedure and medical product must be validated through various phases of rigorous testing before they can be put to use in clinical practice. Yet, the Harvard report cited no medical studies or any patient data that would validate the clinical tests put forth for establishing brain death and equating it with death. The one single prospective study was the 1977 Collaborative Study conducted by the National Institutes of Health evaluating the data collected on 503 brain-dead patients . It then called for a larger clinical trial, which still remains to be carried out. Without a valid scientific foundation, the whole of the clinical test battery is merely opinion-based, that is, reflecting the opinion of the thirteen members of the Harvard Committee and their subsequent followers.

    Comparison Of Coma Vegetative State And Minimally Conscious State

    Brain dead woman can be taken off life support: judge

    Inconsistent

    As with the VS and MCS, how fast people recover and how much they recover from the confusional state may vary. Most people who reach the confusional state make further progress. The severity of their brain injury and related health problems determine the degree of recovery. The less time the person is in the confusional state, the better their recovery will be. Mild problems such as poor sleep or urinary tract infections may lengthen the confusional state, but they may not affect the outcome.

    Once the confusional state ends, people can usually pay attention, keep track of place and time, and hold onto memories of daily experiences again. They will likely still have serious cognitive problems such as impaired attention or memory or slowed thinking. These problems are likely to get better over time. While some people make limited progress, others make a good deal of progress.

    This image shows patterns of recovery that may follow coma. Some people wake up quickly from coma they may briefly stay in the MCS before further recovery. They may also have mild impairments. Others may be in the MCS for a long time after emerging from the VS. They usually have more long-term impairment. Slow recovery may continue for several years, especially for those with traumatic injuries. Sometimes, people stay in the VS or MCS for a long time. In some cases, these conditions may be permanent.

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    Critical Evaluation Of The Clinical Tests For Brain Death

    The clinical test-criteria for the determination of brain-death are well engrained in the brain-death literature since they have not changed much between the 1968 Harvard Report and the 2010 American Academy of Neurology Guidelines for Brain Death Determination . While the number of possible confirmatory tests, which are ancillary and optional, has increased, the core clinical tests performed at the bedside have remained unchanged. They include: coma, with complete unresponsiveness even to the most painful stimuli absence of brain stem reflexes and apnea, that is, absence of a breathing drive as tested with a CO2 challenge. Ancillary tests are of two types, for the purpose of detecting either brain electrical activity or evidence of brain blood flow. The 2010 guidelines specify, however, that in adults, ancillary tests are not needed for the clinical diagnosis of brain death and cannot replace a neurologic examination . Without the use of ancillary tests, the determination of the US-based whole brain death is identical to that of the UK-based brainstem death.

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