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Flashcards in Death Deck (56)
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1

Give five scenarios where prolonged resuscitation is very worthwhile?

1. Electrocution
2. Drowning
3. Overdose
4. Hypothermia
5. Children

2

Commonest example of somatic/clinical death?

Atherosclerotic coronary artery disease

3

After primary cardiac arrest and during cerebral hypoxia, how long does it take to deprive the cortex and then brainstem?

Cortex 2-3 minutes
Brainstem >4 minutes

4

Can brain be destroyed by hypoglycaemia?

Yes

5

What three systems does brainstem control?

Consciousness (RAS)-reticular activating system
Respiratory centre
Vasomotor centre (BP)

6

What is necessary component for whole brain death?

Brainstem death:
innervation
spontaneous respiration
heartbeat

7

Cortical damage but brainstem is intact-spontaneous breathing and heartbeat?

Persistent Vegetative State

8

How long must PVS be going on for before diagnosis?

Greater than 6 months or 12 months

9

What does assessment of PVS include:

No spontaneous meaningful motor response inc voice
No language comprehension or expression
No sustained, reproducible, purposeful or voluntary behavioural response to normal or noxious visual, auditory or tactile stimulus

10

Is there moral dilema for BS death?

No - stop ventilating the corpse

11

When is someone legally dead?

When brainstem is destroyed

12

All sensory input from whole body travels through brainstem except what?

Smell and vision

13

What three CNs cannot be tested at bedside?

1, 11 and 12

14

Give three signs of brainstem activity?

Epileptic fit- cortical activity, motor nerves
Decorticate rigidity
Positive Doll's eye reflex- eyes remain fixed on moving head

15

What are the 3 pre conditions for diagnosing BS death?

1. Deeply comatose, requiring artifical ventilation
2. Cause of coma unknown
3. Reversible causes excluded: hypoxia, hypotension, SOL

16

Name some reversible causes that must be excluded for diagnosing brainstem death?

1. Drugs
2. Alcohol
3. Hypothermia
4. Diabetes/hypothyroidism

17

What cranial nerve tests must be done for diagnosing BS death?

1. Pupils do not react to light (2,3)
2. No corneal reflex (3,5,7)
3. No nystagmus upon ear irrigation (3, 4, 6, 8)
4. No grimace to pain (5, 7)
5. No gag reflex (9, 10)

18

Explain the apnoea test.

100% oxygen for 10 minutes
5% CO2 for 5 minutes
Disconnect from ventilator for 10 minutes
Rising CO2 fails to stimulate spontaneous breath

19

Once circulation stops, how long does it take for cellular death in the CNS?

4 minutes

20

Once circulation stops, how long does it take for cellular death in the peripheral NS?

5 minutes

21

Once circulation stops, how long does it take for cellular death in muscle?

3 hours

22

Once circulation stops, how long does it take for cellular death in blood cells?

6 hours

23

Once circulation stops, how long does it take for cellular death in the skin?

24 hours

24

Once circulation stops, how long does it take for cellular death in bone/cornea?

48 hours

25

What causes cells to die and degenerate?

Autolysis- intracellular enzymes

26

What year was most recent human tissue act installed?

2004

27

Where does human tissue act 2004 apply to?

England and Wales- provisions relating to retention of material for DNA testing apply also to Scotland

28

“material that has come from a human body and consists of, or includes, human cells”

Human Tissue

29

Who is the only person who can retain tissue?

Coroner to establish cause of death

30

What does the HTA 2004 authorise museums to do?

Move human remains