Jay Smith is a 31 year old male who sustained severe head trauma following a motorcycle vs. automobile collision. He came to the hospital by paramedic rescue and had a GCS-1/1/2 for a total of 4. On admission to the emergency department, the patient was decerebrate to noxious stimuli, and his pupils were unequal and sluggish. The patient had been intubated in the field; he was given ventilatory assistance, and hyperventilation was initiated to reduce intracerebral swelling. Dopamine was started at 5 mcg/kg/min for a low blood pressure and tachycardia on admission. A computed tomography (CT) scan of the head revealed a subdural hematoma with right-to-left shift and effacement of the right ventricle.
Three days later the patient deteriorated and a CT was repeated. The neurosurgeon evaluated the patient and the CT results and determined that there was no benefit to surgery and that the injury was not survivable. The physician broached the subject of organ donation with the family and the local transplant services support team was notified of the patient’s grave condition.
What are the confirmatory diagnostic tests to determine brain death and what findings indicate brain death?
What are the confirmatory tests done at the bedside to establish brain death? What are the findings of these tests that indicate brain death?