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Head Trauma

Last Updated: September 27, 2018

Brain Death Determination

1. Coma

  • Noxious stimuli without motor response (except spinal reflexes)

2. Absent Brainstem Reflexes

  • Absent pupillary response to light bilaterally
  • Absent oculocephalic reflex (doll’s eyes)
  • Absent oculovestibular reflex (caloric reflex test bilaterally)
  • Absent corneal reflex
  • Absent facial muscle contraction to noxious stimulus
  • Absent gag and cough reflex

3. Apnea Test

  • Absent respiratory drive despite CO2 challenge (pCO2>60mmHg)

4. Vital signs

  • Core body temperature 36-37oC (normothermia)
  • SBP ≥ 90mmHg
  • PO2 >200mmHg and PaCO2 ~40mmHg à before discontinue ventilator use
  • Verified absence of pharmacologic agent simulating brain death
Changes in Signal Characteristics for Blood on MRI over Time
Time T1 Weighted Image T2 Weighted Image
Acute Gray Black
Subacute White White
Chronic Black Black
Children’s Coma Scale
Consciousness level assessment in children <4 years old
Eye Opening Motor Verbal Score
- Obeys - 6
- Localizes pain Smiles, oriented to sound, follows objects, interacts 5
Crying Interacting
Spontaneous Withdraws to pain Consolable Inappropriate 4
To speech Flexor (decorticate) Inconsistently consolable Moaning 3
To pain Extensor (decereb...
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