JSK - Brain death

Brain Death Determination Note

Patient Information: @NAME@ MRN: @MRN@ Age: @AGE@ DOB: @BDAY@

Etiology of Coma: *** Irreversible Cause: ***

Prerequisite Conditions: Major Electrolyte Abnormality: *** Major EndocrineAbnormality: *** Major Acid Base Abnormality: *** Toxins or Drugs: *** Hypothermia (Temp < 36): *** SBP > 100 mm Hg: *** Sedative Medications: *** Other Confounding Variables: ***

NEUROLOGIC EXAMINATION: Intubated and not sedated Commands: does not follow commands No vertical gaze or blinking to command Pupils: *** No gaze deviation or dysconjugate gaze Corneal Reflex: Absent Facial Grimace: Absent VOR: (Cold Calorics) no response of eye movements Gag/Cough: absent

Motor Exam: RUE - No movement to central and peripheral noxious stimulation LUE - No movement to central and peripheral noxious stimulation RLE - No movement to central and peripheral noxious stimulation LLE - No movement to central and peripheral noxious stimulation

Respiratory Drive: NOT overbreathing the ventilator Ventilator: Turned to pressure support without autoflow and elevated flow trigger.No respirations or diaphragmatic movement seen

Apnea Test: ***

@RESUFAST(PHART,PCO2ART,PO2ART,HCO3ART,BEART,O2SATART)@

Confirmatory Test: *** Autopsy: Discussed with next of kin and family but they declined. Medical Examiner: ***

The time of death was recorded and certified at *** on ***/***/***.

@JSKME@