A patient in the intensive care unit is being evaluated for brain death. Which finding is an indication of brain death?
1. Absence of all motor responses to noxious stimuli
2. No respiratory effort when the patient is off the ventilator for 4 minutes with a pCO2 of 49
3. Absence of a cough reflex with nasotracheal stimulation
4. Pupils that are 3 mm and respond to light
3
Rationale 1: This assesses the presence and degree of a coma.
Rationale 2: Eight minutes and a pCO2 of 60 are required to determine apnea.
Rationale 3: The absence of reflexes demonstrates that higher brain functions have ceased.
Rationale 4: This is a part of the coma level assessment and alone will not validate the degree of brain function that is present or absent.
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