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Thu Dec 21 21:41:02 GMT 2006

Dean,

Yeah, what Ron said. Brain dead is dead. Ded, dead. 

Rob Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Dean Lutrin
Sent: Thursday, December 21, 2006 3:49 PM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Brain dead and bleeding

Ron, agree wholeheartedly. 2 separate scenarios - clinically brain dead, and
severe head injury. I think that we would all agree to operate on severe
head injury, but what is your opinion on clinically brain dead with
(potentially) reversible intra-abdominal bleeding?

Dean

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ronald Gross
Sent: Thursday, December 21, 2006 9:07 PM
To: Critical Care mailing list Trauma &amp
Subject: Re: Brain dead and bleeding

Absolutely correct - read my post again, and while not well stated you
will note that I was referring to the CT that was discussed.  Later on I
referred to a study that proved absence of blood flow, and clearly a 4
vessel angio is the radiologic test that serves to date as the "gold
standard", done if the patient is not stable enough to tolerate an apnea
test..........

>>> Ben Reynolds <aneurysm_42 at yahoo.com> 12/21/2006 1:53 PM >>>
A four vessel angiogram showing a cutoff sign at the
skull base for all four vessels without any
intracranial reconstitution or collateralization of
contrast is the conditio sine qua non radiographic
image of a brain dead individual, assuming a GCS of 3.

You'd be hard pressed to find a clinical exam for
brain death which could refute that.

Ben Reynolds, PA-C
Pittsburgh, PA
--- Ronald Gross <Rgross at harthosp.org> wrote:

> 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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Brain dead and bleeding