Vols. Videos

Physical Examination

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 → before discontinue ventilator use
  • Verified absence of pharmacologic agent simulating brain death
Reflex Testing Scale
Grade Description