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January 1983

Clinical Problems in the Use of Brain-Death Standards

Author Affiliations

From the Neurosurgical Service, Massachusetts General Hospital and the Harvard Medical School, Boston.

Arch Intern Med. 1983;143(1):121-123. doi:10.1001/archinte.1983.00350010127021

A 20-year-old woman is brought to the emergency room, after being found on the side of the road. She has fixed 8-mm pupils, no extraocular movements, no corneal response, no gag or cough reflex; she makes no response to any stimulus and is not breathing spontaneously. Her BP is palpable at 60 mm Hg, with a pulse rate of 40 beats per minute. In the emergency room, she is resuscitated with intubation, central venous line placement, and administration of volume and pressor agents. An emergency computed tomography (CT) scan shows early cerebral edema but no cerebral hematoma. Twenty-four and 48 hours later, there is no change in her neurologic findings. Her physician requests a neurologic consultation. The consultant establishes the absence of any brain-stem reflexes and asks for an EEG. This shows no activity; her barbiturate level is zero. The neurologic consultant wishes to declare the patient brain dead and

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