Physical Examination Free

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
4+ Hyperactive with clonus
3+ Hyperactive
2+ Normal
1+ Hypoactive
0 Absent
Strength Testing Scale
Grade Description
5/5 Normal Strength (movement against gravity with resistance)
4/5 Movement against gravity with slight (4-) / moderate (4) / strong (4+) resistance
3/5 Movement against gravity only
2/5 Movement with gravity eliminated
1/5 Visible/palpable muscle contraction
0/5 No contraction

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