How is brain-stem death determined?
STEP 1 The first step is to establish that a competent cause of brain-stem death exists. In other words, just because someone is unconscious, we don’t suspect that they are whole-brain or brain-stem dead. There has to be significant injury (trauma, stroke, swelling, etc.) to the brain that makes one suspect death by neurologic criteria. Sometimes, when the medical history is unclear, imaging studies, such as CT or MRI, are able to supply evidence that a trauma has occurred to the brain. In addition, reversible causes of deep coma, such as hypothermia (low body temperature), hypotension (low blood pressure), overdose of certain drugs (such as barbiturates, paralytics, etc.), and a small group of neurological conditions, must be ruled out. STEP 2 Next is the physical examination of the patient. First and foremost, the patient must be unconscious in a very deep coma state, unresponsive to any stimulation, and not breathing on his or her own. In other words, there can be no response of any
