Year: 2020
Type: article
Abstract: Two commentaries respond to a case about apnea testing to confirm death by neurologic criteria.To claim one AMA PRA Category 1 Credit TM for the CME activity associated with this article, you must do the following: (1) read this article in its entirety, (2) answer at least 80 percent of the quiz questions correctly, and (3) complete an evaluation.The quiz, evaluation, and form for claiming AMA PRA Category 1 Credit TM are available through the AMA Ed Hub TM .Case BJ is a 10-year-old who was pulled from a pool.He was intubated in the field by emergency medical technicians.Cardiopulmonary resuscitation was performed for 30 minutes before his heart started beating again.Upon arrival in an emergency department, BJ was unresponsive, with sluggishly reactive pupils, but no other brain stem reflexes.After being admitted to the pediatric intensive care unit (PICU), BJ was minimally over-breathing the ventilator.Sedated and cooled to 33 °C for 24 hours, BJ was then gradually rewarmed over the next 24 hours.Three days after rewarming and discontinuation of sedation, BJ did not over-breathe the ventilator and remained comatose with no brain stem reflexes.After another 3 days, BJ's condition did not improve.Eight days after BJ's admission to the PICU, Dr F obtained a cranial computed tomography scan that showed diffuse sulcal and cisternal effacement, loss of gray-white borders, and herniation.Dr F now explains to BJ's parents that BJ is probably "brain dead" and that the next step in BJ's care is to perform a clinical examination to look for evidence of brain activity.Dr F further explains that patients with no signs of brain activity are taken off the ventilator to see whether they breathe spontaneously.Although BJ's parents are upset, they express understanding and agreement with Dr F's assessment plan.Dr F performs the clinical assessment in accordance with the Society of Critical Care Medicine, American Academy of Pediatrics, and Child Neurology Society 2011 standards 1 and concludes that BJ is comatose with no brain stem reflexes.With BJ's parents at the bedside, Dr F performs an apnea test, regarded as a critical part of a
Source: The AMA Journal of Ethic
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W3108824646