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Question No. 2
Q: How is the first cranial nerve reflex test performed and what would the response be in brainstem death testing? (2 marks)
Answer No. 2
Test
Procedure
Confirmatory Response in Brainstem Death
Pupillary Reflex
A bright light is shone into each eye in turn 0.5. Direct and consensual reflexes should be sought 0.5
Pupils are fixed and do not respond or constrict to light 1
2
Question No. 3
Q: How is the second cranial nerve reflex test performed and what would the response be in brainstem death testing? (2 marks)
Answer No. 3
Test
Procedure
Confirmatory Response in Brainstem Death
Corneal Reflex
Cornea is brushed lightly with a swab with care taken to avoid damage to the cornea 1
No blinking elicited by stimulation 1
2
Question No. 4
Q: How is the third cranial nerve reflex test performed and what would the response be in brainstem death testing? (3 marks)
Answer No. 4
Test
Procedure
Confirmatory Response in Brainstem Death
Caloric (Oculo-vestibular) Reflex
At least 50ml of ice cold water 0.5 is instilled into the external auditory meatus over one minute 0.5. Head should be at 30 degrees to the horizontal plane. Clear access to the tympanic membrane must be confirmed by direct visualisation with and otoscope before testing 1
No eye movement during or following injection 1
3
Question No. 5
Q: How is the fourth cranial nerve reflex test performed and what would the response be in brainstem death testing? (2 marks)
Answer No. 5
Test
Procedure
Confirmatory Response in Brainstem Death
Painful Stimulation
Painful stimulus is applied to the supra-orbital ridge (pons), and also to the limbs and trunk 1
No motor response in cranial nerve distribution 1 elicited by stimulation
2
Question No. 6
Q: How is the fifth cranial nerve reflex test performed and what would the response be in brainstem death testing? (2 marks)
Answer No. 6
Test
Procedure
Confirmatory Response in Brainstem Death
Gag Reflex
Posterior pharynx is stimulated with a spatula 1
No gag elicited by stimulation 1
2
Question No. 7
Q: How is the sixth cranial nerve reflex test performed and what would the response be in brainstem death testing? (2 marks)
Answer No. 7
Test
Procedure
Confirmatory Response in Brainstem Death
Cough Reflex
Bronchial stimulation is performed by passing a suction catheter down the trachea to the carina 1
No cough elicited by stimulation 1
2
Question No. 8
Q: During the apnoea test which parameters should be confirmed via blood gas analysis before the test? (2 marks)
Answer No. 8
- Perform a pre-test arterial blood gas to confirm PaCO2 is at least 6.0 kPa 1 and pH <7.4 1
2
Question No. 9
Q: How long should the patient be disconnected from the ventilator during the apnoea test? (1 marks)
Answer No. 9
- Observe for respiratory activity for 5 minutes 1, confirming the start time
1
Question No. 10
Q: Give two options for maintaining oxygenation during the apnoea test? (2 marks)
Answer No. 10
- Options include:
- Connect the patient to CPAP circuit (e.g. Mapleson C) 1
- Administer oxygen via a catheter in the trachea at a rate of >6L/minute 1
2
Question No. 11
Q: Which parameters should be confirmed via blood gas analysis after the test to ensure it is valid? (1 marks)
Answer No. 11
- Perform a confirmatory blood test to ensure an increase in PaCO2 of more than 0.5 kPa 1
1
Question No. 12
Q: What is the legal time of death following brainstem death testing? (1 marks)
Answer No. 12
- Legal time of death is retrospectively noted as the time that the first set of tests confirms brainstem death 1, though death is not declared until after the 2nd test
1