05-23-2007, 08:23 PM
The longtime primary care physician of an 85 year-old woman is asked to help mediate care between the family and the hospital's medical service. The patient sustained an anoxic brain injury during an in-hospital cardiac arrest one week ago in which the patient had a pulseless period for at least 5 minutes. On physical examination, her vital signs are normal and stable with the assistance of continuous mechanical ventilation. Pupillary and corneal reflexes are present bilaterally. There is episodic decorticate rigidity, but no purposeful movement present. An electroencephalogram (EEG) suggests severe, diffuse cortical damage. The patient's husband asks the physician if she is brain dead. Which of the following is the most appropriate response?
A. It is too early to predict brain death by the legal definition
B. The diagnosis of brain death can only legally be made by a neurologist
C. The decision on brain death must await the completion of a magnetic resonance image (MRI)
D. The presence of brain stem function and posturing rules out brain death, but the examination findings and supportive data suggest extensive brain damage
E. The suggestion of severe cortical damage by the EEG implies brain death
A. It is too early to predict brain death by the legal definition
B. The diagnosis of brain death can only legally be made by a neurologist
C. The decision on brain death must await the completion of a magnetic resonance image (MRI)
D. The presence of brain stem function and posturing rules out brain death, but the examination findings and supportive data suggest extensive brain damage
E. The suggestion of severe cortical damage by the EEG implies brain death