Module2MrsDorci

MacMurray Medical Center

Jacksonville, IL

Patient: Say, Doris R. Hosp. #356782 Age/Sex/DOB: 83 yrs. F 06 July 1930

Room: ICU #6

Ordering Provider: Samuel Good, MD

Consultation: Dr. Oscar Sugar (Neurology)

I was asked by Dr. Good to see the patient after she was brought into the ED via paramedics who were performing CPR.

The patient has no clinical evidence of brain function upon physical examination. This includes no response to pain and no cranial nerve reflexes. Reflexes include pupillary response (fixed pupils), oculocephalic reflex, corneal reflex, no response to the caloric reflex test and no spontaneous respirations.

It was important to distinguish between brain death and states that may mimic brain death (e.g., barbiturate overdose, alcohol intoxication, sedative overdose, hypothermia, hypoglycemia, coma or chronic vegetative states). The drug panel was negative to 25 substances including ETOH. Some comatose patients can recover, and some patients with severe irreversible neurological dysfunction will nonetheless retain some lower brain functions such as spontaneous respiration, despite the losses of both cortex and brain stem functionality. This is not the case with this patient. She is unable to maintain respirations independently and remains intubated. Thus, anencephaly, in which there is no higher brain present, is generally not considered brain death, though it is certainly an irreversible condition in which it may be appropriate to withdraw life support.

EEG recordings from 3 days have six sessions, with total durations about 30 min.

The EEG was flat, though this is sometimes also observed during deep anesthesia or cardiac arrest. I consider this confirmatory value in light of the patient’s unresponsiveness.

After examining the patient and evaluating the EEG recordings, the diagnosis of brain death with an irreversible prognosis is most appropriate.

Please let me know if I can be of further assistance to you. I did speak to the daughter, and she is aware of my findings.

Oscar S. Sugar, MD, PhD, FAAN