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Practice Current: When do you order ancillary tests to determine brain death?

While recognizing each case is different, please choose the answer that best reflects your common practice and limit free text to strategies that are not included.

Estimated Time: 2 Minutes

CASE 1
A 58-year-old man was admitted with coma and apnea (cessation of respiration) from a traumatic brain injury. Examination 2 days after admission disclosed no evidence of cerebral hemispheric or brain stem function. An apnea test could not be performed because of hypoxemia from neurogenic pulmonary edema.
1. Would you order ancillary test(s) to confirm the patient is brain dead? *This question is required.
Which test(s) would you order? (Please select only one response if you think only one test is needed. Please select more than one response if you would order more than one test.) *This question is required.
CASE 2
A 10-year-old girl became comatose and apneic (cessation of respiration) after the delayed treatment of bacterial meningitis. Two days later she was diagnosed as brain dead after a clinical exam including a proper apnea test.
2. Would you order ancillary test(s) to confirm the patient is brain dead? *This question is required.
Which test(s) would you order? (Please select only one response if you think only one test is needed. Please select more than one response if you would order more than one test.) *This question is required.
Her parents are skeptical of the finality of the diagnosis. Would you now order ancillary test(s)? *This question is required.
Which test(s) would you order? (Please select only one response if you think only one test is needed. Please select more than one response if you would order more than one test.) *This question is required.
Despite the test(s) you ordered, her parents are still skeptical of the finality of the diagnosis. Would you order more ancillary test(s)? *This question is required.
Which test(s) would you order? (Please select only one response if you think only one test is needed. Please select more than one response if you would order more than one test.) *This question is required.
3. How often have family requests influenced your decision to order ancillary test(s)? *This question is required.
CASE 3
A 62-year-old woman suffered a large hypertensive hemorrhage of the pons and medulla extending into the midbrain. On day 2, she had apnea (cessation of respiration), coma, and complete cessation of all brain stem function. 
4. Would you order ancillary test(s) to confirm the patient is brain dead? *This question is required.
Which test(s) would you order? (Please select only one response if you think only one test is needed. Please select more than one response if you would order more than one test.) *This question is required.
The ICU staff thought they saw a limb movement, so an EEG was ordered and showed low-amplitude irregular delta activity and her TCD ultrasound found pulsations of intracranial arteries. In your opinion, is she still brain dead? *This question is required.
5. While United States law equates brain death with cessation of all brain function, United Kingdom law equates brain death with the inability of the brain to control unconscious functions. In your opinion is “brain stem death,” as accepted in the UK, sufficient to declare death, or must all cerebral hemispheric function also be absent? *This question is required.
6. Which test(s) are available to you in your practice? (Mark all that are available.) *This question is required.