The Undead Patient: The Complexity of Brain Death Determination in Drug Overdose

In this episode Ryan explores the concept of brain death and the implications of drug overdoses causing false positive diagnosis of brain death. He is joined by an author of the ACMT Position statement on brain death in overdose (Dr. Andrew Stolbach MD) as well as authors of two case reports (neuro critical care physician Dr. Ranier Reyes and emergency physician Dr. Doug Stranges) involving bupropion where patients had absent brain stem reflexes after overdose but made a full neurologic recovery. We delve into the criteria used to determine brain death and the challenges faced by families and healthcare professionals when dealing with this sensitive topic. 00:00-19:00 Introduction to brain death guidelines19:00-28:00 Introduction to limitations in guidelines regarding overdose28:30-38:00 Interview with ACMT Position statement author39:00- End- Interview with Bupropion brain death mimic authors and summaryLinks references in showAmerican Academy of Neurology Bran death guidanceACMT Position statement on brain death in overdoseBrain death mimics with cerebral edemaCase report of “hypoxic patient with diffuses cerebral edema” who recovered in 48 hourCarbamazepine with diffuse cerebral edema who recoveredCases taking >2 months to recover brain stem reflexeshttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)07577-3/fulltexthttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543058/Attempts to withdraw care in as little as 48 hours Dr. Stranges case reportDr. Reyes case reportNarrative review of brain death mimicsIntroductory casesCaroline Burns- Patient who woke up on operating tablePaul Maturo- Patient woke up in a morgueA Morel DilemmaSupport the showReview the show where ever your listeningGet Messages from Toxo (Join the Newsletter!)Join as a supporting memberAd free episodesBonus content and early accessDiscounts and give aways on GOTA PICCEM Mushroom card gameThe GOTTA PICCEM Poisonous Mushroom Game!The Poisonus Fungus Amongus Children's Book!Full book reading (6 minutes!)Tox trinkets (Rep the show at home!)Reach the showEmail: [email protected] Show ResourcesRyan's Medical Games and ResourcesShow Website