Earliest definite sign of death is:
|A||Absent brain stem reflexes|
|B||Stoppage of mucosal ciliary action respiratory passage|
|C||Retinal anterior column breakdown|
|D||None of these|
a. In order to establish brain death,Q the irreversibly comatose pt must be shown to have lost all brain stem reflex responses, including the pupillary, corneal, oculocephalic, oropharyngeal, and respiratory reflexes; and should have been in this condition for at least 6 hours.
b. Spinal reflex movements do not exclude the diagnosis, but ongoing seizure activity or decerebrate or decorticate posturing is not consistent with brain death. Q
c. An isoelectric electroencephalogram, when the recording is made according to the recommendations of the American electroencephalo-graphic society, is especially helpful in the confirming the diagnosis.
d. Alternatively, the demonstration of an absent cerebral circulation by I.V. radioisotope central angiography or by four-vessel contrast cerebral angiography can be confirmatory.