actually its not BRAIN death at all. Cosmic your definitions are missing one vital word
Death (legal and medical) is defined as "The irriversable cessation of brain STEM activity or funtion". It has NOTHING to do with the ceribral cortex
Its a clinical diognosis (as oposed to one done with the use of teritiary tests like MRI's)
I dont have my clincial prac book to hand so i am going to have to relie on someone elses work rather than my own
The first thing to establish is that there are no organic or pharmalogical causes that could induce the absance of reaction, for instance is the person on anasetics which would depress reflexes or is there an infection which is interfering in nerotransmission, or hypothermia.
once established there are 7 tests to be carried out
the tests for brain stem death are:
- 1 pupillary reaction to light
Pen light is shone into the eyes to check if the pupils contract
- 2 Blink reflex
a piece of cotton wool is scraped across the cornia to check if the pt reacts to an irritation of the eye by blinking
- 3 Facial nerves
painful pressure is aplied to the nerves running through the cheek to see if the pt grimaces
- 4 Turning the head
With the eyes held open the pts head is twisted from side to side to see if the eyes move, i honestly forget the reaction that is surposed to be observed in this but i THINK it is that the pts eyes will follow the roof (ie roll up as the head is tilted down) if the pt is in a coma
- 5 Eye movement from ice water
again with the eyes held open ice water is injected into the ear. In a coma pt this will ilicit a similar eye movement to the one seen above
- 6 Gag reflex
A tube is put down the pts throat to illicit a gag reflex. Though some people can overcome this reflex concious, a coma pt cant and will show signs of coughing or chocking. Oviously a dead person has no reaction
- 7 Spontanious breathing
The pt is well ventalated for a few min to make sure the body is well surplied with oxygen and then disconected. A coma pt will show signs of the body reacting to the build up of CO2 and try to breath on there own. A dead person will show no reaction to the build up of CO2. To make sure the levels are correct blood gasses maybe taken before and during this test to be 100% sure that the body is well oxygenated and that the CO2 is building up
These tests are done on both sides of the body were apropriate to rule out any injury to those paticular nerves and the test is repeated after about 10 min from memory.
You are wrong that the change from clinical death (cardiovascular failure) to brain stem death was because of moden tech. It actually has nothing to do with it. In situations like a heart atack for instance CLINCIAL death is still used to determine death (30 min of unresolved pulseless Ventricular Tachicardia or 5 min of Ventricular Asistolyie). The change was to do with organ transplantation, medical staff needed a way to determine if a pt was dead in order to do a beating heart transplant. The main thing is that if a pt is going to be an organ donor, the heart lung machine is NEVER turned off untill the pts organs have been removed. This gives a better viability to organs like the heart which require constant perfusion