Brain Death Anatomy and Physiology. Joel S. Cohen, M.D. Associate Professor of Clinical Neurology Albert Einstein College of Medicine. Historical Perspective. Prior to the advent of mechanical respiration, death was defined as the cessation of circulation and breathing .
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Joel S. Cohen, M.D.
Associate Professor of Clinical Neurology
Albert Einstein College of Medicine
Prior to the advent of mechanical respiration, death was defined as the cessation of circulation and breathing
Reticular Activating System
Cranial Nerve III
Cranial Nerves IX, X
ICP>MAP is incompatible with life
Ventral Pontine Infarct
No Response to Noxious Stimuli
Pupils dilated with no constriction to bright light
“Doll’s Eyes Maneuver”
“Cold Caloric Testing”
2. Monitor PCO2 and PO2 with pulse oximetry
3. Disconnect Ventilator
4. Observe for Respiratory Movement until PCO2 = 60 mm Hg
5. Discontinue Testing if BP < 90, PO2 saturation decreases, or cardiac dysrhythmia observed
Recommended when the proximate cause of coma is not known or when confounding clinical conditions limit the clinical examination
No Intracranial Flow
Technetium-99 Isotope Brain Scan
Somatosensory Evoked Potentials