Quotes respectfully snipped for focus.
A flat EEG is not one of the criteria used to determine brain death.
True. To clarify, serial (repeated) EEGs hours apart ARE part of brain death determination, and these are done AFTER any cerebral depressants are withdrawn and allowed to metabolize. However, it is not "required" in brain death determination criteria that each EEG lead be completely flat line. Those who are experts at reading EEGs are skilled at knowing what is "errant" bits of electricity in various leads, versus the type of spikes and waves that would be seen with any living brain function. This is particularly true if a cerebral blood flow study has been done to conclusively demonstrate in an objective way that there is no blood flow in the brain tissue. Lemons and potatoes can be used as batteries to power lights in small science experiments, which demonstrate that they generate electricity, which is why I used that example in a previous post. Electromagnetic energy is emitted by many things in the environment.
http://www.miniscience.com/projects/PotatoElectricity/
http://www.education.com/science-fair/article/lemon-power/
someone talked about the 'hot nose'..........I googled it and that is something I am sure specialists do. But we have no idea what Emory Hospital has done but they are suppose to be the best neuro in the area.
Hot nose sign is an INDIRECT measure of lack of blood flow to the brain tissue seen on a cerebral blood flow study. Blood is shunted to the external jugulars, and shows up as more perfusion in the midface. A DIRECT measure of brain death is the portion of the cerebral blood flow test that conclusively demonstrates whether or not there is ANY blood flow inside the skull to the brain tissue. If there is NO blood flow, brain tissue is dead. 100% accurate. There has never been a single case of confirmed "no flow" where the person has even recovered to a persistent vegetative state. Once the phase of acute swelling "squeezes off" blood flow, the brain will begin to soften and go from a firm gelatinous state to a semi liquid state over days to weeks, which is colloquially called "respirator brain". It is not possible to re-establish blood flow to the brain once it is determined that there is no flow. The capillary and blood vessel system simply doesn't exist any more. There is nothing there to re-establish blood flow "to", if that makes sense. It isn't simply a matter of the swelling "subsiding" to re-establish flow.
If the family wants to keep her on life support, they will probably move her to a nursing facility that will look after her 24/7 or take her home with trained nurses.
We do not know how she is being nourished either. Many questions with no answers.......
Hopefully, K_Z will weigh in. Because of HIPAA, we don't actually know what BK's condition is. "Sources" have said this or said that, but we don't know if they actually have access to her information, and we don't know if they have correctly interpreted any information that they HAVE been given.
Any number of tests could have been done at Emory. The "hot nose" test is not one of the tests which are used to establish a diagnosis of legal death due to brain death. Same with the EEG. It may have been done, probably has been done, but that is not one of the tests which are used to determine brain death because, as stated already by K_Z, presence of electrical activity could be obtained from a potato, which as we all know, does not have a living brain.
In one of the Jahi McMath threads, K_Z posted a link which explains how brain death is determined.
http://www.utmb.edu/policies_and_pr.../IHOP - 09.15.09 - Determination of Death.pdf
Absolutely true. "We" do not know with any certainty what BK's condition is. But anyone with some health care knowledge can read between the lines. It's my opinion based on what I have heard and read that she is brain dead. Others may not agree, and that's ok. Here at WS, we engage in speculation that is not far fetched. And certainly earlier today an awful lot of news agencies were reporting her to be brain dead and family planning to withdraw support on the anniversary of WH's death. So, me speculating that she is brain dead is not that far fetched, IMO!
Having experienced a family member being taken off life support very recently, IMO, the doctors have an idea of how long she will be able to breathe on her own.
This is so incredibly sad.
If she is brain dead, and I believe she is, and has been for days, then unquestionably the doctors know exactly what will happen when they shut off the ventilator. They absolutely know this, because as part of the brain death evaluation, it is required that the patient be disconnected from the vent for up to 10 min at a time, to allow carbon dioxide to rise sharply. Brains control breathing not because of low oxygen, but because of high CO2. The test they do is called the "apnea" test, and it is usually repeated a few times to be sure. They wouldn't do that test if the person was assisting or bucking the vent in any way at all. People who are brain dead don't make any efforts to help or fight the vent-- they are on "demand" settings. Ventilators can be set to "help" someone who initiates a breath by synchronizing the push of air with the pull of inspiration by the patient. Brain dead patients, and patients who are deeply medicated, or paralyzed on meds, or paralyzed from spinal cord damage, do not "help" or buck against the vent breaths. The vent "pumps" air in, and it is expelled by elastic recoil of the chest. (
Greatly simplified, but I hope it gets the message across clearly!)
This link below is fairly technical, but explains the conditions under which apnea test for brain death determination is conducted.
Brain death evaluation is not a "one time" examination. The process requires a least 2 physicians, and most hospitals require one of those to be completely un-involved in any aspect of the patient's care, so they are independent. The evaluation takes place over many hours, and has several components, to ensure that the patient is given EVERY possible opportunity to demonstrate any level of brain function. BK has probably had many, many tests in excess of the basics required, and I'm confident that all of that information has been shared with next of kin.
If she has already been determined to be brain dead, AND the family wants to continue somatic/ organ support for the forseeable future, it's possible that the family will have to go to court to be allowed to remove her from the hospital on the ventilator, just as in Jahi McMath's case. It's highly unlikely that the hospital will keep a brain dead patient on a vent in a private room somewhere else in the facility for an undetermined length of time, and they want the ICU bed back inservice in a reasonable amount of time. Hospitals are not insensitive, particularly in the case of a celebrity, but a situation of confirmed brain death cannot be maintained in an ICU beyond a few days, for a lot of reasons.
The compromise that was reached in the JM case is that the hospital released her body to the ME from the ICU "on paper", who initiated a formal death certificate. The ME has wide latitude to generate paperwork to allow family members to perform various personal and religious rituals on the dead, as well as authorize family to transport the body. Family arranged an ambulance to "somewhere", and they removed her with her oral endotracheal tube in place, and a portable transport vent.
As far as a feeding tube, I'm pretty sure BK doesn't have one of those at this time. "Nourishment" comes from IV fluids. Nourishment in the early days of an injury is not a huge priority, as the gut often shuts down, making enteral feeds not a good plan, and high sugar solutions in an IV will actually make brain swelling worse.
Hope some of this helps with people's questions!
The caveat here in the BK case is that now a criminal investigation is in progress. So, the family may run into legal roadblocks there if they want to take her somewhere, and she is declared dead. Prolonged somatic support "could" destroy physical evidence that is needed for prosecution (as in that child abuse baby case where the parent abusers fought against taking the baby off the vent, to obscure evidence of abuse). There was no allegation of criminal misconduct in the Jahi case, so the judge was more amenable to letting the family take the body. The judge declined to force the hospital to place a tracheostomy or feeding tube as requested by the family, given the patient was dead.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824942/
