Traditional methods of diagnosing DEATH useless - what now?

Question

Oh dear, how can we tell for certain now?

Woody Lander - now a healthy 14 months old - was pronounced dead at Leeds General Infirmary after frantic attempts to save him by medical staff apparently failed. He had stopped breathing following a heart attack. He was handed to his parents so they could say goodbye but when nurses started removing tubes from his body he began "twitching". Staff tried again to resuscitate him, this time successfully starting his heart 30 minutes after he was pronounced dead.http://newsvote.bbc.co.uk/1/hi/magazine/6404593.stm

The case highlights how it is not always as straight forward as it may seem to tell if someone has died. So how do you know if someone is dead?"

Answer 1

Not so uncommon at all. Many people have been considered dead and were not. I have had wxperience with this myself. Sure thought a young lady was dead after an accident so put my attention to another. It turned out the one showing ife died and the young lady lived. Such is the way it goes.

Answer 2

Their muscules relax and their bowel and bladder empty pretty quickly, failing that after a while they break out in maggots.

Answer 3

They should have checked for brain activity. If there is none, they are dead.

Answer 4

I guess if you're unsure, you can wait til rigor sets in.

Answer 5

After several minutes of cardiac arrest, cardiopulmonary resuscitation (CPR) will occasionally restore cardiac activity, but it will not necessarily restore completely USEFUL brain function. Brain metabolism requires a constant high flow of oxygenated blood and nutrients. During cardiac resuscitation, perfusion to the brain decreases sufficiently to promote hypoxia and tissue edema. A number of mechanisms contribute to the deterioration and ultimate failure of reflow. Hyperviscosity resulting from hemoconcentration of plasma proteins and formed elements contribute to initial poor reperfusion at the capillary level. Endothelial cell swelling and edema of the pericapillary astrocytes also greatly inhibit reperfusion by decreasing capillary diameter to less than 5 µm. During reperfusion, abnormally high amounts of superoxide convert almost all available nitric oxide to peroxynitrite, which is regarded as the agent that causes most of the damage to brain capillary endothelial cells. Damage to the endothelium not only increases edema but also causes endothelial protrusions (blebs), which can block capillaries. Calcium-mediated vasospasm is also implicated.

The current medical standard in the US is electrocerebral silence (ECS).

Brain death is the cessation and irreversibility of all brain function, including brain stem.

Nowadays, modern ressucitative devices and technics can maintain the function of the heart, lungs and visceral organs for a period of time(hours or days) after the life-maintaining centers of the brain stem tissue have stopped function, which results in a medical dilema of a dead brain in a otherwise living body. In the other hand, the development of transplant surgery and the need of viable organs have focused ethical and legal attention on the desirability of agreeing on the medical criteria of brain death.

Criteria For Diagnosis of Brain Death
Electrocerebral inactivity (ECI), or electrocerebral silence (ECS), is defined as no cerebral activity over 2 mV using a montage that uses electrode pairs at least 10 cm apart with interelectrode impedances <10,000 ohms and >100 ohms.

According to guidelines of the American Clinical Neurophysiology Society, the following are minimum technical standards for EEG recording in suspected brain death:


A minimum of 8 scalp electrodes

Impedances between 100 and 10,000 ohms

Integrity of entire recording system tested by touching each electrode individually to obtain appropriately located artifact potential

Interelectrode distances of at least 10 cm

Sensitivity of at least 2 mV for 30 minutes of the recording, with appropriate calibrations documented

High-frequency filter (HFF) not set below 30 Hz and low-frequency filter (LFF) not set above 1 Hz

Additional monitoring techniques used as necessary to eliminate or prove waveforms are artifactual

No EEG reactivity to strong and thorough tactile, auditory, or visual stimulation

Recording performed by a qualified technologist working under the direction of a qualified electroencephalographer

If ECI in doubt, EEG repeated after an interval (suggested 6 h)


In 1981, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (USA) developed standards for the determination of brain death which with some modifications are accepted worlwide.

Some steps are imortant to be followed:

Unresponsiveness
The patient is completely unresponsive to external visual, auditory, and tactile stimuli and is incapable of communication in any manner.
Absence of cerebral and brain stem function
Pupillary responses are absent, and eye movements cannot be elicited by the vestibulo-ocular reflex or by irrigating the ears with cold water.
The corneal and gag reflex are absent, and there is no facial or tongue movement.
The limbs are flaccid, and there is no movement, although primitive withdrawal movements in response to local painful stimuli, mediated at a spinal cord level, can occur.
Apnea Test: An apnea test should be performed to ascertain that no respirations occur at a PCO2 level of at least 60 mmHg. The patient oxygenation should be maintained with giving 100% oxygen by a cannula inserted into endotracheal tube as the PCO2 rises. The inability to develop respiration is consistent with medullary failure.
Nature of coma must be know
Known structural disease or irreversible systemic metabolic cause that can explain the clinical picture.
Some causes must be ruled out
Body temperature must be above 32 C to rule out hypothermia
No chance of drug intoxication or neuromuscular blockade
Patient is not in shock
Persistence of brain dysfunction
Six hours with a confirmatory isoelectric EEG or electrocerebral silence, performed according to the technical standards of the American Electroencephalographic Society
Twelve hours without a confirmatory EEG
Twenty-four hours for anoxic brain injury without a confirmatory isoeletric EEG
Confirmatory tests (are not necessary to diagnose brain death)
EEG with no physiologic brain activity
No cerebral circulation present on angiographic examination( is the principal legal sign in many European countries)
Brain stem-evoked responses with absent function in vital brain stem structures

Answer 6

That is seriously bizarre.

Answer 7

evidently god changed his mind.