Month: June 2012

Determining Brain Death: 2/3

/ Jordyn Redwood / Leave a comment

I’m continuing with a series on how brain death is determined. All hospitals likely have a policy in place with strict guidelines on how brain death is determined. Check last post for the beginning stages.

Now, we’ll move onto actual testing.

Can the patient breathe on their own? This is a relatively simple test. It’s called apnea testing. The ventilator is turned off and we see what the patient will do. Naturally, when we stop breathing, carbon dioxide will build up in the blood stream. Your body has receptors that monitor the level of CO2 and it will initiate a breath when the levels rise.

Here is the procedure for performing an apnea test.

1. The patient will be on an ECG and pulse ox monitor.

2. Give the patient 100% oxygen for five minutes.

3. After five minutes, disconnect the patient from the vent, but give oxygen via T-piece. The breathing tube will still be in place. At this point, the patient is off the vent and no longer being assisted but will have needed oxygen if they do initiate a breath.

4. Watch the patient for breathing. If any attempt is made to breathe, it is inconsistent with brain death and the test is stopped and the patient is placed back on the ventilator.

5. If the patient has any cardiac arrhythmias, low blood pressure or oxygen level that falls to less than 80% (normal level is 90-100%) then the test is discontinued. These finding will lead more to a conclusion that brain death has occurred.

6. If the carbon dioxide level increases above 60 (normal level is 35-45)—the apnea test is consistent with brain death. The brain is very sensitive to rising levels of carbon dioxide and the absence of a response is consistent with brain death.
Next post, we’ll talk about brain perfusion studies.

Determining Brain Death: 1/3

/ Jordyn Redwood / Leave a comment

Several months ago, I skewered a Hallmark movie for its unrealistic portrayal of discontinuing life support. In light of that, I thought I’d do a special series on determining brain death.


How do medical personnel determine a patient has suffered brain death?

Brain death means that your brain as an organ has died. It is no longer receiving blood flow. Without blood flow, no oxygen is being delivered. Without oxygen, an organ dies. Your brain is your body’s main control. If it has died, you have died.

If you have a character that is brain dead, they should be on life support. Again, if the brain isn’t working, it’s not telling your lungs to inhale. However, we can do this medically with a ventilator. This is why families sometimes have trouble understanding brain death means ultimate death. If we provide oxygen to the lungs, the heart will continue to beat and bodily functions can be maintained for a limited amount of time. A family sees the rise and fall of the patient’s chest and assume the patient is initiating those breaths when in fact it is the machine doing all the work.


There are several ways to determine brain death. Some are not as precise as others. I’ll try to cover least precise to most precise.


Before testing, there is generally an observation period. My hospital uses the following guidelines:


Less than 7 days: Not applicable
Age 7 days-2 months: 2 exams 48 hours apart
Age 2-12 months: 2 exams 24 hours apart
Over 12 months: 2 exams 12 hours apart
Adults (18 years and older): 2 exams 6-12 hours apart.


Also, prior to the exam to determine brain death, the patient must also meet the following criteria:


1. Absence of a reversible condition. The cause of the coma must be documented.


2. Absence of hypothermia. The patient must have normal body temperature.


3. Absence of hypotension. The patient must have normal blood pressure.


4. Absence of drugs or toxins in significant amounts as to interfere with the diagnosis of brain death.


5. Absence of a metabolic cause of the coma.


6. Normal levels of carbon dioxide.


Once these are met, the patient should be observed for the following:


1. No cranial nerve reflexes. Here is an extensive list of what those are: http://www.clinicalexam.com/pda/n_cranial_nerves_exam.htm


2. Flaccid tone in all extremities.


3. No response to deep pain.


Once these are met, the patient proceeds to apnea testing. That’s where we’ll pick up next post.

The Rogue Medical Character

/ Jordyn Redwood / Leave a comment

The dream of getting published has been a long one for me. And today, that day, has arrived! The day I’ve longed wished came true.

To celebrate, anyone who leaves a comment on my blog during this weeks posts will be eligible to win a free copy! I’ll also be drawing from my followers/subscribers lists as well. So, plenty of places for you to win. Drawing cutoff will be Sunday, June 3rd. Winners announced Tuesday, June 5th. To claim, you must e-mail me with your info so definitely check the June 5th post. Must live in the USA.

Then, there’s always where real life and dream life meet in some sort of fantastic collision. What you expected is far from what happens. Both good things and bad things.

Mostly good things.

Running a medical blog for authors is a great source of fun. But even I’m not a medical expert in all areas. My first novel, has an OB physician as a major character. Now, I have never been an OB nurse nor do I have any desire to be. That’s why I had other specialists review my novel to make sure everything was authentic and not just the part that I knew about.

The best medical expert to get to review your work is someone actively working in the area currently. These are the experts I sought out and through that process I learned some important lessons that I’d thought I’d share here.

If your novel has some heavy medical aspects, it is best to have it reviewed by someone who works the area. I recently reviewed a manuscript for someone who was writing about diabetes. The character was newly diagnosed and she had done some research to try and determine what the treatment would be. Let me give some kudos here and say she was close. But close is like not scoring a touchdown when you’re on the one yard line. Wrong route giving insulin. Hanging clipboards at the end of the bed (which is not done anymore people!!) and not providing for rehydration which is the #1 therapy for DKA. It’s the little details that will trip you up.

People don’t want their profession to be disparaged. Now, as a writer, I understand characters needing to do bad things for the sake of the plot. So, how do you handle a medical person gone bad without people practicing in that profession lighting your manuscript on fire?

I recently read a contest entry where the author had two nurses doing very bad things to a patient. Even the “bad” nurses I know would never do the things these nurses were doing– very demeaning things.

Here is how I’ve determined the best way to handle the issue. You must have one character in the profession in the scene who points out the bad behavior and shows how the real medical person is going to act. It’s the seasoned charge nurse that comes into the room and dresses down the two horrible nurses. Now, beauty of this, adds conflict! Particularly if the patient is awake (which in real life should never happen in front of a patient.)

It’s okay to have bad, rogue, medical person as long as another character in the story is pointing it out. Then, the reader will know you know what you’re writing about.

What do you think? How do you handle rogue characters without people in that profession being offended?