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Thu Dec 21 17:52:18 GMT 2006

Dean,

The determination of brain death CANNOT be made radiologically, and
therefore a CT that shows injuries that are supposedly not compatable
with life does not mean that the patient is brain dead.  Brain death is
a clinical determination that depends on the absence of any and all
brain stem function and apnea in the presence of profound hypercarbia
and high PO2, or proof that there is no blood flow to the brain. 

In my opinion, there is no question in my mind that the patient you
referenced should have been operated on.  The physician that was
"roundly criticized" got off easy, as I see it.

Ron

>>> "Dean Lutrin" <deanlutrin at gmail.com> 12/21/2006 12:11 PM >>>
Dear list

A quick question. What are your feelings on operating on a patient who
comes
into your ER brain dead with intraabdominal bleeding? Do you treat the
abdomen on its own merits assuming that some of the low GCS may be
attributable to hypovolaemia etc...

I am of course assuming that the patient has been intubated without
drugs,
there is no drug history etc etc...

We debated this a bit today where one of the surgeons did not operate
on a
case because the CT brain showed unsurvivable injuries and was roundly
criticised.

Is this a matter of opinion or are there good answers?

Thanks 

Dean Lutrin
JHB, SA

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