Life, Death and the Bridges in Between - Part I, With Dr Sam Shemie.
Highlights
- How to Tell if a Person is Dead
Key takeaways:
- A person who has a Glasgow Coma Score of 3 or more fixed dilated pupils, apnea, no brainstem reflexes, and no confounding or reversible condition is dead.
- The body is alive but the brain is not working and will not recover.
- The patient is referred to as "somatic support" after the determination of a brainbased death has occurred.
Transcript:
Speaker 1
So how do you help with that? How do you help people understand that a person who came in with brain injury who now has a Glasgow Comascore of three fixed dilated pupils, has apnea, has no brainstem reflexes, has no confounding or reversible condition, yet is lying in bed with their chest rising and their pulse is palpable is dead. How do you educate your colleagues and in particular the family at the bedside about that? And the way to do that is really to understand the fundamental way in which the body functions. The brain doesn't work. No consciousness. No brainstem reflexes and apnea. But the brain is not going to recover. So as long as you replace it with breathing, the chest rises. As long as you get oxygen into the bloodstream, the heart will beat. There's a pulse. How do you distinguish that? And how do you refer to that patient after the determination of a brain based death has occurred? We don't call that person a patient anymore. We don't call that person anymore. We say there is somatic support or in fact the body is alive, but the brain is no longer working and will not recover. You know, we produced this educational video to it's a 90 second public educational video to really talk about the mechanisms of death starting with brain failure leading to respiratory arrest or respiratory arrest leading to cardiac arrest. (Time 0:13:09)
- The Dangers of Brain Death
Key takeaways:
- Families need to be aware of the high mortality risk when a loved one is diagnosed with brain death.
- Once there is an evolution towards brain death, families have a few choices. One is to educate the family with frequent touch points.
- If there is reluctance or uncertainty by the family, this is something that we do now that we have better understanding of the condition.
Transcript:
Speaker 1
And in our conversations with family, we need to make sure that they know that, but that we are doing everything we can to exhaust any intervention that might help reverse the condition. So in the initial phase, families need to be aware of the high mortality risk. And then once there's an evolution towards brain death, you have a few choices. One is educating families with frequent touch points in terms of talking to them, not using medical jargon. If there is reluctance or uncertainty by the family, this is something that we do now that we I would have never done before because I thought it was harsh. But now it's a little bit different. People need to know and people need to see. Having the family observe the brain death examination is very helpful to clarify things. As long as one, you prepare them for the potential for spinal cord reflexes or spinal cord mediated motor responses and explain the disconnection between the spinal cord and the brain. As long as you prepare them for that, it is very sobering and very stark, but very clear in terms of the absence of consciousness, motor response, brain stem function. (Time 0:15:23)
- The Importance of Brain Death Examinations in Canada
Key takeaways:
- Having family members observe the brain death examination is very helpful in clarifying the absence of consciousness, motor response, and brain stem function.
- It is important to prepare them for the potential for spinal cord reflexes or spinal cord mediated motor responses, and to explain the disconnection between the spinal cord and the brain.
Transcript:
Speaker 1
But now it's a little bit different. People need to know and people need to see. Having the family observe the brain death examination is very helpful to clarify things. As long as one, you prepare them for the potential for spinal cord reflexes or spinal cord mediated motor responses and explain the disconnection between the spinal cord and the brain. As long as you prepare them for that, it is very sobering and very stark, but very clear in terms of the absence of consciousness, motor response, brain stem function. And in particular, the apnea test that demonstrates, oh, it really is the machine that is doing this. My loved ones brain is not working. And if the brain's not working, they can't breathe. And that's very convincing in a stark way. And in a way that I used to think was harsh, but now my experience has been the opposite. It's been very helpful to be open about that as long as you prepare families and stop using the term life support. It's no longer life support. It's organ support or body support. The person has died, but the body parts are still working.
Speaker 2
Thank you very much for that nuance. Sam, just to dig a little deeper into this, this issue has special relevance in Canada, (Time 0:15:59)