Block 4 - Step 2 Self-Assessment 2022 - AMBOSS

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Top Highlights

• Advanced directives related to life-sustaining measures, such as full code or do-not-resuscitate orders, are only relevant in living patients;

• irrelevant once brain death is diagnosed.

• presence of cardiac activity and spontaneous or reflex motor responses as a result of bioelectrical activity restricted to the spinal cord, peripheral nerves, and muscles

• exclude confounders (e.g., sedative/paralytic use, severe metabolic derangements, hypotension),

• the patient is comatose, does not have brain-mediated motor responses (e.g., decorticate posturing, facial grimacing), has brainstem areflexia, and has a positive apnea test.

• independently verified by another physician.

• Once brain death is confirmed for such a patient, all forms of life support including mechanical ventilation are futile and consent from an SDM is not required to discontinue life support as the patient is legally dead.

• surrogate decision-maker (SDM)

• life support can be continued for a short while so that they can say their goodbyes.

• life support should be discontinued right away.

• Advanced directives related to resuscitation (e.g., full code) are irrelevant once brain death is diagnosed.