• Twitter
  • Facebook
  • Vimeo
  • FCUS Courses
  • Register for FCUS Course
  • Login
Intensive Care Network
  • About Us
    • What is ICN
    • Our Team
  • Events
  • Podcast Series
    • Podcast by Topic
      • Airway Podcasts
      • Cardiac Podcasts
      • Career Podcasts
      • Conference Podcasts
      • Education Podcasts
      • Evidence Podcasts
      • GI/Renal Podcasts
      • Haem Podcasts
      • Metabolic Podcasts
      • Miscellaneous Podcasts
      • Neuro Podcasts
      • Paeds Podcasts
      • Respiratory Podcasts
      • Resuscitation Podcasts
      • Sepsis Podcasts
      • Toxicology Podcasts
      • Trauma Podcasts
      • Ultrasound Podcasts
    • Podcast by Specialty
      • Anaesthetics
      • Emergency
      • ICU
      • Prehospital
    • SMACC
    • ICN
    • Jellybean
    • CICM ASM
  • Blog
  • Resources
    • Clinical Cases
    • Fav Posts/Other Sources
    • Game Changing Evidence
    • Radiology
      • ICU Radiology
    • Simulation Resources
    • Ultrasound
      • Lung Ultrasound
  • EXAMHELP
    • ANAESTHETICS PRIMARY
    • ANZCA FELLOWSHIP
    • CICM Fellowship
    • EMERGENCY PRIMARY
    • ICU Primary Exam
    • PAEDS FELLOWSHIP
  • Contact Us

Radiology Case 18

Home Radiology Case 18
ICU Radiology logo

 

Case 18 from Dimity McCracken

[az_accordion_section] [accordion title=”History” id=”acc-1″]A 27yo man presents to the Emergency Department with an out of hospital cardiac arrest. He regained spontaneous output after a prolonged resuscitative effort. The man had a long history of depression & chronic pain, but no other medical conditions. The cause of the arrest was thought to be an intentional polypharmacy drug overdose (there was a suicide note, multiple empty blister packs, & empty alcohol bottles found by paramedics). The patient had targeted temperature management to 33 degrees (as per the current ARC guidelines).

It is now day 4 post arrest. The patient is intubated in ICU, has GCS 3 despite no sedation for over 72hrs. He is otherwise physiologically normal: no inotropic requirements, good gas exchange, normal renal function etc. You are concerned he may have hypoxic brain injury & decide to get a CT brain. The bedside nurse asked if you are going to test for brain death. What do you say?

[/accordion] [accordion title=”Image” id=”acc-2″]

[/accordion] [accordion title=”Answer” id=”acc-3″]

The CT shows complete loss of grey-white differentiation. There is effacement of the subarachnoid spaces, ventricles & cisterns. This is consistent with severe global hypoxic brain injury.

In answer to the nurse’s question, you could indeed consider brainstem testing if you thought it was appropriate. Look at the resources section for more about this…

[/accordion] [accordion title=”Resources” id=”acc-4″]

*Radiopaedia excellent page on CT findings in hypoxic-ischaemic brain injury

http://radiopaedia.org/articles/hypoxic-ischaemic-brain-injury-1

 

* ICN Podcast: Stuart Lane on prognostication after OOHCA

http://www.intensivecarenetwork.com/index.php/icn-activities/icn-podcasts/684-91-lane-on-prognosticating-post-oohca

 

*LifeInTheFastLane – Prognosis after cardiac arrest (this includes the TTM prognostic guidelines)

http://lifeinthefastlane.com/ccc/prognosis-after-cardiac-arrest/

 

*Oli Flower from ICN on definitions of “brain death” (or rather “neurologically determined death”) & why we need to care about what we call things

https://intensivecarenetwork.com/brain-death-terminology-change/

 

*Oli’s excellent podcast on what is a neurologically determined death & how we do it

https://intensivecarenetwork.com/oli-flower-on-brain-death/

 

*LifeInTheFastLane – how to neurologically determine death (including video of examination)

http://lifeinthefastlane.com/ccc/brain-death-care-organ-donation-patient/

 

*LifeInTheFastLane – how to approach a CICM fellowship exam hot case about neurological determination of death

http://lifeinthefastlane.com/ccc/brain-death-hot-case/

 

*Radiopaedia confirmatory angiography case which shows an absence of cerebral blood flow

http://radiopaedia.org/cases/brain-death

 

[/accordion] [/az_accordion_section]

Share this
Non-invasive cardiac output monitoring: No pain, all gain? By MallematCould it be Poison? By Little
IPSN – Intensivist Parent Support Network WIN – Women in Intensive Care Network ICN UK ICN NZ ICN WA ICN VIC ICN NSW ICN QLD The ICN Story The Team Jellybean Podcasts ICN Blog SMACC Video SMACC Audio Video ECG Simulator by aclsmedicaltraining BASIC SCIENCE CLINIC Simulation Game Changing Evidence ICU Radiology Echo Guide ECHO Cases Clinical Cases EXAMHELP Jellybean Podcasts ICN Blog SMACC Video SMACC Audio Video CICM Fellowship ANZCA FELLOWSHIP PAEDS FELLOWSHIP EMERGENCY PRIMARY ANAESTHETICS PRIMARY End-o-bed-o-gram

  • About
    •  What is ICN
    •  The Team
    •  ICN NSW
    •  ICN QLD
    •  ICN VIC
    •  ICN WA
    •  ICN NZ
    •  ICN UK
  • Resources
    •  Lung US
    •  Exam Help
    •  Clinical Cases
    •  Echo Cases
    •  Echo Guide
    •  ICU Radiology
    •  Game Changing Evidence
    •  ICN Metafeed
    •  Simulation Resouces
  • Media
    •  SMACC Posters
    •  Audio
    •  Video
    •  Pecha Kuchas
  • Upskill
    •  Clinical Cases
    •  Echo Cases
    •  ICU Radiology
  • Exam Help
    •  End-o-Bed-o-Gram
    •  ICU Primary Exam
    •  CICM Fellowship
    •  ANZCA Fellowship
    •  Paeds Fellowship
    •  Emergency Primary
    •  Anaesthetics Primary

® 2021 The Intensive Care Network || All rights reserved || Disclaimer || Site Map || Contact ICN Support

Log in with your credentials

or     Create an account

Lost your password?

Forgot your details?

I remember my details

Create Account