A patient is considered terminal after being involved in a motor vehicle accident in which they received massive trauma to the head

Question

As the patient's ICP increases and condition worsens, the family asks you what indications of approaching death will there be. What would be your best response?
A) "There is a change in the pattern of their respirations."
B) "Projectile vomiting and hemiplegia usually occur just before death."
C) "Posturing may develop as pressure on the brainstem increases."
D) "Loss of brainstem reflexes is a sign of approaching death."

Answer 1

Ans: D

Feedback: As ICP increases, the patient's condition worsens, as manifested by the following signs and symptoms: the LOC continues to deteriorate until the patient is comatose. The pulse rate and respiratory rate decrease or become erratic, and the blood pressure and temperature increase. The pulse pressure (the difference between the systolic and the diastolic pressures) widens. The pulse fluctuates rapidly, varying from bradycardia to tachycardia. Altered respiratory patterns develop, including Cheyne-Stokes breathing (rhythmic waxing and waning of rate and depth of respirations alternating with brief periods of apnea) and ataxic breathing (irregular breathing with a random sequence of deep and shallow breaths). Projectile vomiting may occur with increased pressure on the reflex center in the medulla. Hemiplegia or decorticate or decerebrate posturing may develop as pressure on the brainstem increases. Bilateral flaccidity occurs before death. Loss of brainstem reflexes, including pupillary, corneal, gag, and swallowing reflexes, is an ominous sign of approaching death.