Friday, May 13, 2022

What Does No Brain Activity Mean

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What Does Brain Death Mean

Is A Brain Dead Person Actually Dead?

Brain death is a legal definition of death. It is the complete stopping of all brain function and cannot be reversed. It means that, because of extreme and serious trauma or injury to the brain, the body’s blood supply to the brain is blocked, and the brain dies. Brain death is death. It is permanent.

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.

Eeg Study Points To Possible Prognostic Tool Early After Acute Brain Injury

About one in six clinically unresponsive ICU patients showed electroencephalography patterns of brain activity when spoken to soon after acute brain injury, a single-center study showed.

In 16 of 104 unresponsive patients, a machine-learning algorithm that analyzed EEG recordings detected brain activation following researchers’ verbal commands a median of 4 days after injury, according to Jan Claassen, MD, of Columbia University in New York City, and colleagues.

Half of these 16 patients improved to the point that they were physically able to follow commands a median of 6 days later, the researchers reported in the New England Journal of Medicine. The injured patients who showed early brain activity were four times more likely to achieve partial independence at 12 months than similar patients with no activity, they added.

If confirmed, these findings “could inform prognostication of acute brain injury and potentially provide a means of communication with patients who seem unresponsive on the basis of a conventional clinical examination,” wrote David Menon, MD, PhD, and Srivas Chennu, PhD, both of the University of Cambridge in England, in an accompanying editorial.

“However, a third possibility exists: there is activation of cerebral neural circuits for perception of commands that is not accompanied by corresponding motor responses,” they wrote.

Disclosures

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Patients Dont Respond To Pain

The normal ways a person may recoil or verbalize pain are absent when they have experienced brain death. However, ScienceDaily posted an interesting article that states a patient may still have spontaneous movements following a brain death diagnosis.

Pain signals normally travel to the brain for a reaction, but these sudden movements in brain dead patients are spinal reflexes that do not involve any brain activity, according to an expert cited by the source. A study in Argentina shows that of 38-clinically brain dead patients, 15-of them had motor movements in the first 24-hours, but none after 72-hours. Electroencephalogram tests confirmed there was no brain activity in the patients that moved, it adds.

Establishing The Absence Of Respiratory Function

This Is Your Brain On Porn  Awareness Act

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:

  • The person on a mechanical ventilator would be connected to a pulse oximeter. This is the device used to measure the saturation of oxygen in the blood.
  • The ventilator would then be disconnected and a tube would be inserted into the person’s trachea to deliver 100 percent oxygen to the lungs. This ensures the person is never oxygen-deprived if he or she does respond.
  • Blood tests would immediately be performed to measure baseline blood gases.
  • The doctor would then wait for eight to 10 minutes to see if there is any response from the patient.
  • After eight to 10 minutes, the blood gases would again be tested.
  • 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.

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    Diagnosing Brain Stem Death

    There are a number of criteria for diagnosing brain stem death.

    For a diagnosis of brain stem death to be made:

    • a person must be unconscious and fail to respond to outside stimulation
    • a person’s heartbeat and breathing can only be maintained using a ventilator
    • there must be clear evidence that serious brain damage has occurred and it can’t be cured

    From The Deepest Coma New Brain Activity Found

    18 September 13

    When a patient’s brain falls completely silent, and electrical recordings devices show a flat line, reflecting a lack of brain activity, doctors consider the patient to have reached the deepest stage of a coma. However, new findings suggest there can be a coma stage even deeper than this flat line and that brain activity can ramp up again from this state.

    In the case of one patient in a drug-induced coma, and in subsequent experiments on cats, the researchers found that after deepening the coma by administering a higher dose of drugs, the silent brain started showing minimum but widespread neural activity across the brain, according to the study published today in the journal PLOS ONE.

    The findings were based on measures of the brain’s electrical activity, detected by electroencephalography , which shows various waveforms. In comatose patients, depending on the stage of their coma, the waveforms are altered. As the coma deepens, the EEG device will eventually show a flat line instead of a wave this stage is considered to be the turning point between a living brain and a deceased brain.

    “Flat line was the deepest known form of coma,” said study researcher Florin Amzica, neurophysiologist at Université de Montréal.

    Using anesthetic drugs, the researchers recreated the patient’s state in cats. When the cats reached the flat-line coma stage, the researchers increased the anesthetic’s dose, and observed brain activity re-emerging in cats.

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    Establishing The Absence Of Brainstem Reflexes

    Brainstem reflexes are automatic responses that are no different to the knee-jerk tests given at the doctor’s office. They are reflexive actions that indicate whether a person’s neurological functions are normal, abnormal, or absent.

    A person is considered brain-dead if he or she fails to respond to all of the following reflex stimuli:

    • Lack of pupillary reflex means that the person’s pupils do not respond in any way when a light is shined on them. If the person were alive, the pupils would get smaller.
    • Lack of corneal reflex means that the person does not blink and have any response when the doctor touches the eye with a cotton swab or a drop of water.
    • Lack of oculocephalic reflex means the person’s eyes will not fixate on the examiner’s face when his or her head is moved from side to side.
    • Lack of the gag reflex means that the person will not gag, cough, or react when the back of the throat is touched with a cotton swab or a suction device.
    • Lack of response to cold caloric testing means that the person will not respond when ice water is squirted into the ear. If the person were alive, the stimuli would cause the person’s eyes to move in the opposite direction as it effectively “tricks” the inner ear into thinking that the person is spinning.

    After Brain Death Is Declared What Happens Next

    Does a Negative MRI Mean There is No Brain Injury?

    A health care professional will talk with you and your family about certain decisions that need to be made at this time. Among those decisions could be removing the ventilator and the possibility of organ and/or tissue donation.

    Remember, the individual is already legally dead and removing the ventilator does not cause death.

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    Learning About Financial Resources

    You may feel overwhelmed as you learn about the financial resources that may or may not be available to your loved one. But with patience, persistence, and help from others, you will figure out which programs apply and find your way through the application processes.

    Some programs that you will want to learn about include:

    • Health care programs such as Medicare and Medicaid.
    • Income replacement or financial assistance programs such as Social Security Disability Insurance or Supplemental Security Income . You may also want to find out if your loved one had disability insurance through work.
    • Services to help with community living such as state and community agencies that assist people in these areas. For instance, some states have Medicaid waiver programs that provide funding for in-home care to allow people to stay at home.

    You may not find someone who knows all there is to know about how to access these services and programs. The key is to ask questions and follow up to make sure that you and your loved one get all the benefits available. Social workers, therapists, case managers, and your local social security office may be helpful. Others who may be able to help include 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 work.

    Features Of The Confusional State

    • Acting lost or confused. This may include not being able to keep track of the correct place and time.
    • Severe problems with attention, memory, and other mental abilities.
    • Changes in level of responsiveness.
    • Restlessness.
    • Feeling very tired and sleeping during the day.
    • Believing things that arent true.
    • Seeing things that arent there.

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    Hospital Responsibilities Regarding Brain Death Determination

    10 N.Y.C.R.R. § 400.16 requires all New York State hospitals to establish and implement written policies for determining brain death, including:

    • The tests and procedures required for determining brain death
    • Notification of the next of kin or other person closest to the patient that brain death determination is in progress and
    • Reasonable accommodation of an individual’s or Surrogate Decision-maker’s religious or moral objection to use of the brain death standard to determine death.

    In addition, hospitals should create written policies for privileging physicians to make brain death determinations in accordance with accepted medical standards.

    Each of these responsibilities is addressed in further detail on the following pages.

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    Comparison Of Coma Vegetative State And Minimally Conscious State

    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.

    What Happens After Coma And The Vs

    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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    New Brain Activity State Exists In ‘flat Line’ Coma Patients Scans Suggest

    When a patient’s brain falls completely silent, and electrical recordings devices show a flat line, reflecting a lack of brain activity, doctors consider the patient to have reached the deepest stage of a coma. However, new findings suggest there can be a coma stage even deeper than this flat line and that brain activity can ramp up again from this state.

    In the case of one patient in a drug-induced coma, and in subsequent experiments on cats, the researchers found that after deepening the coma by administering a higher dose of drugs, the silent brain started showing minimum but widespread neural activity across the brain, according to the study published today in the journal PLOS ONE.

    The findings were based on measures of the brain’s electrical activity, detected by electroencephalography , which shows various waveforms. In comatose patients, depending on the stage of their coma, the waveforms are altered. As the coma deepens, the EEG device will eventually show a flat line instead of a wave this stage is considered to be the turning point between a living brain and a deceased brain.

    “Flat line was the deepest known form of coma,” said study researcher Florin Amzica, neurophysiologist at Université de Montréal.

    Using anesthetic drugs, the researchers recreated the patient’s state in cats. When the cats reached the flat-line coma stage, the researchers increased the anesthetic’s dose, and observed brain activity re-emerging in cats.

    Care During Coma Or Vs

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    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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    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.

    Donation After Brain Death

    Families of a brain dead patient must, by federal regulations, be provided the option of organ donation. If the family declines donation, the mechanical ventilator, medications and fluids are discontinued, after which the heart stops. If the family says yes to donation, the regional organ procurement organization is involved. The donors body is kept functioning by artificial means, such as ventilated support until the recovery of organs and tissue for life-saving transplant.

    If you support donation it is important to document your decision. This removes the burden off of your loved ones to make the decision once you have passed away.

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    Brain Death Is Different From Vegetative State

    The difference between brain death and a vegetative state, which can happen after extensive brain damage, is that it’s possible to recover from a vegetative state, but brain death is permanent.

    Someone in a vegetative state still has a functioning brain stem, which means:

    • some form of consciousness may exist
    • breathing unaided is usually possible
    • there’s a slim chance of recovery because the brain stem’s core functions may be unaffected

    Someone in a vegetative state can show signs of being awake. For example, they may open their eyes but not respond to their surroundings.

    In rare cases, a person in a vegetative state may show some sense of response that can be detected using a brain scan, but not be able to interact with their surroundings.

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