RT Book, Section
A1 Goldenberg, Fernando D.
A1 Ammar, Faten El
A1 Dervishi, Ina
A1 Kramer, Christopher L.
A2 Schmidt, Gregory A.
A2 Kress, John P.
A2 Douglas, Ivor S.
SR Print(0)
ID 1201807721
T1 Coma, Disorders of Consciousness, and Brain Death
T2 Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
YR 2023
FD 2023
PB McGraw Hill
PP New York, NY
SN 9781264264353
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1201807721
RD 2024/10/15
AB KEY  POINTSThe  anatomical  structures  involved  in  the  mechanisms  of  consciousness  are  the  brainstem  (pons  and  midbrain),  bilateral  thalamus,  hypothalamus,  and  bilateral  cerebral  cortical  structures.The  initial  emergent  evaluation  and  management  of  a  comatose  patient  include  the  ABC,  general  physical  examination,  and  neurologic  examination.The  initial  neurologic  examination  should  include  determination  of  the  level  of  consciousness,  pupillary  size  and  function,  eye  movements,  motor  responses  (spontaneous  and  to  a  painful  stimulation),  and  respiratory  patterns.Computed  tomography  (CT)  scanning  of  the  brain  is  the  most  valuable  acute  imaging  test  to  rule  out  a  structural  cause  of  the  coma.The  Uniform  Determination  of  Death  Act  (UDDA)  states  that  “An  individual  who  has  sustained  either  (1)  irreversible  cessation  of  circulatory  and  respiratory  functions,  or  (2)  irreversible  cessation  of  all  functions  of  the  entire  brain,  including  the  brainstem,  is  dead.”  It  also  defines  that  “A  determination  of  death  must  be  made  in  accordance  with  accepted  medical  standards.”While  the  determination  of  Brain  Death  or  Death  by  Neurologic  Criteria  is  a  clinical  determination,  there  are  certain  circumstances  that  require  an  ancillary  test  to  be  performed  in  addition  to  the  clinical  examination  and  apnea  testing.