Very welcome to the Internet Book of Critical Care Podcast.

I'm here with Adam Thomas and we're going to talk about brain death.

This is Trey-Trey-Importante.

And we have the proviso that I'm sure there's listeners from many different countries and there might be many different legal definitions of death and brain

death. But we're going to come up with a general approach to the clinical definition of brain

death, which I think is universal, isn't it, Josh? Yeah. So today we'll cover the diagnosis and

specifically evaluation for co-founders, your brain death exam, and then the apnea test, and then some

discussions around confirmatory ancillary testing. So straight into it, let's talk about

brain death basics. Josh, give me a definition and physiology here. So the general definition

is irreversible cessation of all cerebral and brainstem functioning. So the entire brain is down.

This is illegally recognized as being equivalent to death, at least in the United States.

Every country is probably going to be a little bit different.

And once this is met, you know, one strict criteria that we're going to discuss or met, there's

basically a zero likelihood of meaningful neurologic recovery.

So where's this physiology come from?

How does this become the common

final pathway for many different causes of this? So the way this works is essentially a compartment

syndrome within the brain. So some sort of horrific brain injury occurs. Intracranial pressure

increases to a critical level. Profusion drops off. And then you get into the cycle of just

hypoperfusion, more edema, more swelling,

more eczemia and eventually the pressure inside the cranium goes so high that none of the tissues

being profused at all in the entire brain infarcks. Hand at hand with this is the clinical findings

...