Confirming Death

Confirmation Of Death

          Criteria for Brain Death/Brainstem death 

• The patient must be comatose state at least six hours.
• No Abnormal Decorticate or decerebrate postures should be present
• Absent Pupillary Light reflex (CN II, III)
• Dilated fixed pupil not responding to light surest sign of brain stem death
• Pupils are usually midsized but may be enlarged but they should not be small
• Absent Corneal Reflex (CN V, VII)
• Absent Vestibulocochlear Reflex (CN III, IV, VI, VIII) (No eye movement in response to caloric irrigation of ears)
• Absent Oculocephalic Reflex
• Absent Doll’s eye reflex
•  Eyes will move with the head
• No occular movements on rapid turning of head.
• Absent Gag Reflex (CN IX, X)
• Absent Tracheal Cough Reflex (CNX)
• Absent Central Motor Response to Pain (CN V, VII) (No response to deep somatic stimulation).
• A positive apnea test(apnea despite induced hypercapnia)

                                          Test To Detect Stoppage Of Respiration/Circulation 

After disconnection of ventilator.

• Complete Cessation of Circulatory Function 

1. Magnus’s test: Fingers fail to show congestion and swelling to a ligature applied at their base.
2. Finger nail test:blanching and filling of blood on applying pressure and release of pressure.
3. Diaphanous test(transilluminationtest):Fallure to show redness in finger web spaces on transillumination from behind.
4. Icard’s Fluorescein test:Failure to produce yellowish green discoloration of skin on injection of fluorescrin dye.
5. Heat test
6. Artery incision test
7. A flat E.C.G. for a continuous period of five minutes

 Entire and permanent cessation of respiratory function 

1. Mirror test:Mirror held in front of nose does not show vapors and blurring
2. Feather test:No movement of feather if held in front of nose.
3. Winslow’s glass water test.

Winslows Test

Snapshot