BRAIN DEATH CRITERIA -important for exam

BRAIN DEATH CRITERIA -important for exam

Know the criteria for brain death in adults especially to know that a patient who is hypothermic or intoxicated cannot be certified dead until these are reversed.

Explanation: This consists of 3 components.

I. Cessation of all function of the entire brain- this critereon is mandatory

II.Irreversibility- this too is mandatory

III.Confirmatory investigations (this may be optional or required, depending on local practice)

I. Cessation of all function of the entire brain -mandatory-consisting of ALL the following because even if one of them is present- patient is not brain dead.

A. Unresponsive coma

B. Absent brainstem reflexes

1. Pupillary light reflex

2. Corneal reflex

3. Cephalic (caloric) reflexes

4. Oropharyngeal (gag) reflex

5. Respiration (apnea testing

II. Irreversibility-mandatory

A. Coma of known cause without potential for reversibility

B. Exclusion of contributory, reversible conditions

1. Drug intoxication

2. Neuromuscular blockade

3. Hypothermia (<32.2 C, 90 F

4. Shock

5. Major metabolic disturbance


C. Persistence for an appropriate period of observation (6-24 hours

depending on the cause of coma and local practice)

III. Confirmatory investigations (may be optional or required, depending on local practice

A. Electrocerebral silence (isoelectric EEG)

B. Absence of circulation to the brain

Recognize the indications of CABG (coronary artery bypass surgery

Explanation:

The population that nearly always benefits from CABG does not include everyone with CAD.

The subgroups that benefit are

3 groups of patients-

1) those with triple vessel disease AND LV dysfunction,

2) those with left main disease ,

3) lastly those with Diabetes mellitus as per the BARI trial.

Anyone not falling into these categories is not a great candidate for surgery

Know the workup of a solitary pulmonary nodule

Explanation:

A solitary pulmonary nodule consists of a solid nodule 1-6 cm in diameter that is surrounded by normal aerated lung tissue.

Once this picture is found, one works it up according to the probability of it being malignant.

Some clinical features and some radiological features are useful pointers.

The best is to compare it with another X-ray of the chest that is more than 2 years old (if available). If no change has occurred, it is most likely benign.

Features that point towards a malignant potential are:

Age > 35 yrs
Smoker
Weight loss
Spiculated edges of lesion
<20 % of lesion calcified
In all the above 5 scenarios, a histologic diagnosis is important. if none of the above exist then one should re X-ray it in 6 months

If the lesion is in the medial 2/3 of the lung fields then a bronchoscopic biopsy is best. If in the peripheral 1/3 then a CT guided biopsy is appropriate.

Once a malignancy is established then one has to work - up a non small cell carcinoma. A small cell Ca is considered non-operable and is treated with chemotherapy.