A patient is admitted in ICU with history of severe head injury . You are suspecting brain stem death . How would you confirm? Which is most diagnostic of brain stem death (BSD) 1. Absence of pupillary reaction 2. Absence of eyelid movement after cornea is touched 3.
Absence of gag and cough reflex 4. Absence of spontaneous breathing for five minutes 5. Apnea testing Answer: Apnea testing is the most confirmatory. Other tests mentioned are also equally important. But apnea test involves disconnection of mechanical ventilation from the patient, followed by the insertion of a catheter or cannula into the endotracheal tube, down to the level of the carina, through which oxygen is delivered. Apnea testing procedure has a simple goal- Elevate Paco2 and observe the patient for any spontaneous respiratory effort to reflect brainstem activity.
