Brain death - Revision history

Elcatracho: /* Organ Donation */

2021-02-05T19:57:38Z

Organ Donation

← Older revision		Revision as of 19:57, 5 February 2021
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	**Any kind of cancer (EXCEPT skin cancers other than melanoma, certain primary brain tumors). Essentially this means only cancers with very low risk of metastasis are acceptable		**Any kind of cancer (EXCEPT skin cancers other than melanoma, certain primary brain tumors). Essentially this means only cancers with very low risk of metastasis are acceptable
	**Any kind of systemic infection or communicable incurable disease		**Any kind of systemic infection or communicable incurable disease
	**Active Fungal disease (Cryptoccous, Aspergillus, Histoplasma, Coccidioides, Candidemia, invasive yeast		**Active Fungal disease (Cryptoccous, Aspergillus, Histoplasma, Coccidioides, Candidemia, invasive yeast)
	**Active Bacterial infection (Tb, sepsis)		**Active Bacterial infection (Tb, sepsis)
	**Viral infections (HIV, HTLV, rabies, reactive HbsAg, West nile, SARS, enterovirus, HSV, VZV, EBC etc)		**Viral infections (HIV, HTLV, rabies, reactive HbsAg, West nile, SARS, enterovirus, HSV, VZV, EBC etc)

Elcatracho: /* Organ Donation */

2021-02-05T19:57:05Z

Organ Donation

← Older revision		Revision as of 19:57, 5 February 2021
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	**Active Fungal disease (Cryptoccous, Aspergillus, Histoplasma, Coccidioides, Candidemia, invasive yeast		**Active Fungal disease (Cryptoccous, Aspergillus, Histoplasma, Coccidioides, Candidemia, invasive yeast
	**Active Bacterial infection (Tb, sepsis)		**Active Bacterial infection (Tb, sepsis)
	**Viral infections HIV, HTLV, rabies, reactive HbsAg, West nile, SARS, enterovirus, HSV, VZV, EBC etc)		**Viral infections (HIV, HTLV, rabies, reactive HbsAg, West nile, SARS, enterovirus, HSV, VZV, EBC etc)

	*The general goals with organ donation are organ preservation by maintaining: 1) Physiologic levels of neuro mediated hormones, 2) Blood pressure, 3) Obtaining Screening labs		*The general goals with organ donation are organ preservation by maintaining: 1) Physiologic levels of neuro mediated hormones, 2) Blood pressure, 3) Obtaining Screening labs

Ostermayer: /* Organ Donation */

2020-01-11T20:40:44Z

Organ Donation

← Older revision		Revision as of 20:40, 11 January 2020
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	***Consider starting inotropes, to include [[dobutamine]] or [[milrinone]]		***Consider starting inotropes, to include [[dobutamine]] or [[milrinone]]
	***If MAP < 60 despite adequate CI, start peripheral pressor ([[phenylephrine]] or [[norepinepherine]])		***If MAP < 60 despite adequate CI, start peripheral pressor ([[phenylephrine]] or [[norepinepherine]])
	**Place central line with [[CVP]] goals > 5 mmHg		**Place central line with CVP goals > 5 mmHg
	**Maintain fluids at 1.5-2 ml/kg/hr. Choice of fluids include NS for Na < 155, 1/2-NS for Na 156-165, D5W if Na > 165		**Maintain fluids at 1.5-2 ml/kg/hr. Choice of fluids include NS for Na < 155, 1/2-NS for Na 156-165, D5W if Na > 165
	*Screening labs		*Screening labs

Ostermayer: /* Organ Donation */

2020-01-11T20:39:20Z

Organ Donation

← Older revision		Revision as of 20:39, 11 January 2020
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	***Consider starting inotropes, to include [[dobutamine]] or [[milrinone]]		***Consider starting inotropes, to include [[dobutamine]] or [[milrinone]]
	***If MAP < 60 despite adequate CI, start peripheral pressor ([[phenylephrine]] or [[norepinepherine]])		***If MAP < 60 despite adequate CI, start peripheral pressor ([[phenylephrine]] or [[norepinepherine]])
	**Place central line with CVP goals > 5 ~~mmhg~~		**Place central line with [[CVP]] goals > 5 mmHg
	**Maintain fluids at 1.5-2 ml/kg/hr. Choice of fluids include NS for Na < 155, 1/2-NS for Na 156-165, D5W if Na > 165		**Maintain fluids at 1.5-2 ml/kg/hr. Choice of fluids include NS for Na < 155, 1/2-NS for Na 156-165, D5W if Na > 165
	*Screening labs		*Screening labs

DrKarb: /* Brain Stem Reflexes */

2018-02-21T15:26:46Z

Brain Stem Reflexes

← Older revision		Revision as of 15:26, 21 February 2018
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	**Oculovestibular reflex (aka "Cold Calorics")		**Oculovestibular reflex (aka "Cold Calorics")
	***(Irrigation with 60cc cold water to ears on intact tympanic membrane and observe for deviation of eyes/fast beat nystagmus. Allow 5 minutes between either side.		***(Irrigation with 60cc cold water to ears on intact tympanic membrane and observe for deviation of eyes/fast beat nystagmus. Allow 5 minutes between either side.
			****if brainstem reflex is intact, fast beating nystagmus to the opposite side
			****if brainstem reflex is not intact, eye deviation towards the side of irrigation
	***Clotted blood or cerumen in auditory canal may influence response to cold calorics		***Clotted blood or cerumen in auditory canal may influence response to cold calorics
	***Cortex injured but brainstem intact = eyes deviate toward cold ear		***Cortex injured but brainstem intact = eyes deviate toward cold ear

Rossdonaldson1: /* See Also */

2017-10-31T12:57:27Z

Mholtz: Text replacement - "qd" to "QD"

2017-07-07T09:55:25Z

Text replacement - "qd" to "QD"

← Older revision		Revision as of 09:55, 7 July 2017
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	**[[Hypothyroidism]] - 20 mcg T4 IV bolus, then T4 at 10 mcg/hr, which may cause hyperkalemia so administer 10 U regular insulin with 1 amp 50% dextrose before IV bolus		**[[Hypothyroidism]] - 20 mcg T4 IV bolus, then T4 at 10 mcg/hr, which may cause hyperkalemia so administer 10 U regular insulin with 1 amp 50% dextrose before IV bolus
	**Hypoinsulinemia - Insulin drip, titrate to maintain glucose 80-110 with q1 hr checks		**Hypoinsulinemia - Insulin drip, titrate to maintain glucose 80-110 with q1 hr checks
	**Hypocortisol, [[adrenal insufficiency]] - treatment - 15 mg/kg IV bolus qd empirically		**Hypocortisol, [[adrenal insufficiency]] - treatment - 15 mg/kg IV bolus QD empirically
	*[[Hypotension]]		*[[Hypotension]]
	**Place arterial line with goal SBP > 90, MAP > 60		**Place arterial line with goal SBP > 90, MAP > 60

Mholtz at 05:10, 31 May 2017

2017-05-31T05:10:25Z

← Older revision		Revision as of 05:10, 31 May 2017
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	**Abort the test (reconnect ventilator) if SBP <90 or significant SpO2 desat (can draw [[ABG]] at that time, with same criteria as above)		**Abort the test (reconnect ventilator) if SBP <90 or significant SpO2 desat (can draw [[ABG]] at that time, with same criteria as above)
	**Must perform 2 exams 6 hours apart in addition to apnea test		**Must perform 2 exams 6 hours apart in addition to apnea test
	~~'''One-Legacy 800-338-6112'''~~
	==Confirmatory Studies<ref>J Brady Scott, Michael A Gentile, Stacey N Bennett, MaryAnn Couture and Neil R MacIntyre. Respiratory Care March 2013, 58 (3) 532-538.</ref>==		==Confirmatory Studies<ref>J Brady Scott, Michael A Gentile, Stacey N Bennett, MaryAnn Couture and Neil R MacIntyre. Respiratory Care March 2013, 58 (3) 532-538.</ref>==
	*When apnea testing or CN testing difficult		*When apnea testing or CN testing difficult
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	==See Also==		==See Also==
	*[[ACLS (Main)]]
	*[[Post Cardiac Arrest]]		*[[Post Cardiac Arrest]]
	*[[Altered Mental Status]]
	*[[Delivering bad news]]		*[[Delivering bad news]]
	*[https://www.health.ny.gov/professionals/hospital_administrator/letters/2011/brain_death_guidelines.htm Checklists for brain death determination from New York state health department] in Appendix 3

	==References==		==References==
	<references/>		<references/>
	~~Adapted from One-Legacy~~

	[[Category:Neurology]]		[[Category:Neurology]]
	[[Category:Palliative Medicine]]		[[Category:Palliative Medicine]]

Ostermayer: Text replacement - "Hypotension " to "Hypotension"

2017-03-10T12:55:35Z

Text replacement - "Hypotension " to "Hypotension"

← Older revision		Revision as of 12:55, 10 March 2017
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	**Hypoinsulinemia - Insulin drip, titrate to maintain glucose 80-110 with q1 hr checks		**Hypoinsulinemia - Insulin drip, titrate to maintain glucose 80-110 with q1 hr checks
	**Hypocortisol, [[adrenal insufficiency]] - treatment - 15 mg/kg IV bolus qd empirically		**Hypocortisol, [[adrenal insufficiency]] - treatment - 15 mg/kg IV bolus qd empirically
	*Hypotension		*[[Hypotension]]
	**Place arterial line with goal SBP > 90, MAP > 60		**Place arterial line with goal SBP > 90, MAP > 60
	***If goals are not met. a continuous cardiac index monitor (Vigileo or PICCO) may be indicated. Goals are CI > 2.5 and UOP > 1 ml/kg/hr		***If goals are not met. a continuous cardiac index monitor (Vigileo or PICCO) may be indicated. Goals are CI > 2.5 and UOP > 1 ml/kg/hr

Kxl328 at 09:38, 4 March 2017

2017-03-04T09:38:56Z

← Older revision		Revision as of 09:38, 4 March 2017
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	*[[Altered Mental Status]]		*[[Altered Mental Status]]
	*[[Delivering bad news]]		*[[Delivering bad news]]
			*[https://www.health.ny.gov/professionals/hospital_administrator/letters/2011/brain_death_guidelines.htm Checklists for brain death determination from New York state health department] in Appendix 3

	==References==		==References==

← Older revision		Revision as of 12:57, 31 October 2017
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	*[[Post Cardiac Arrest]]		*[[Post Cardiac Arrest]]
	*[[Delivering bad news]]		*[[Delivering bad news]]
			*[[Diagnosis of death]]

	==References==		==References==