-
Brain stem signs
pupils dilated + unreactive
3
-
No corneal reflex
V + VII
-
No caloric response
VIII, III, VI
-
-
-
No breathing with high CO2
X
-
The duty of care
- the good of your pt is your primary conern- substantial benefit, an outcome which now or in the future the pt would regard as worthwhile
- The pt has a life plan to be respected
- the Dr has techniques falling within the bounds of reasonable medical practice
-
Partnership
means that pts and drs must change sharing responsibilities as well as info and decision making,2 to tange, both have responsibilities to help solve the problem.
-
Ethical + legal duties
- not wholly separable
- law- interpretation
- frameswork of interpretation is ethical
- a reasonable position for a reasonable nz provider to take
-
Death?
- brain death?- GCS + brain stem
- CVS death- the pittsburgh paradox
-
PVS
- Unconscious
- severe diffuse neocortical damage-cardiac arrest or brain injury
- diurnal EEG cycle
- neuroimaging profile consistent w PVS
- no responsiveness to events around
- complete nursing care
- artificial nutritin and hydration
- no prospect of recovery
- how does treatment benefit the pt?
-
How do you know?
tennis and spatial navigation imagery, less lit up
-
RUB
- risk of unacceptable badness
- unacceptable
- Cant be reconnected with the world
-
Locked in syndrome
- results from a lesion in the midbrain or Guillain Barre syndrome
- Pt conscious but cant indicate it by any voluntary responses or other bodily actions
- Can reconnect with the world
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