A 47-year-old overweight male with a history of atherosclerosis, diabetes mellit

Question

A 47-year-old overweight male with a history of atherosclerosis, diabetes mellitus type 2, and coronary artery disease (CAD) is found by a neighbor unconscious and not breathing in his front lawn where he appears to have been mowing his lawn. He is rushed to a local emergency room where it is determined that he has suffered a massive inferior myocardial infarction. He is sent to the intensive care unit in critical condition where he is placed on advanced life support equipment, and several days later it is determined that he has minimal brain activity.

After hearing her husband's condition, his tearful wife asks you how it is possible her husband's brain might not function if it was his heart that stopped beating. How would you answer?

As the next of kin, his wife has the right to make husband's medical decisions when he is unable to. Because the length of time that this patient was in cardiac arrest appears to have been substantial, the patient's recovery is highly unlikely. The medical staff gently informs the wife that she has to make a decision regarding his health care: she can withdraw care now or choose to do everything to keep him alive, even though he will most likely die. She asks you what you think she should do. With your knowledge of neurophysiology, how would you answer her?

Explanation / Answer

Since the patient had a history of obesity, atherosclerosis, diabetes mellitus type 2, and coronary artery disease (CAD), the possibility of the minimal brain activity should have been due to blood clot in the brain stem.

When a person is considered brain-dead, then there is no neurological activity in the brain or the brain stem which means no electrical impulses are being sent between the brain cells.
In US and in many other countries, a person is legally dead if he permanently loses all brain activity (brain death). It is also difficult to keep a brain dead person's body temperature normal. The normal blood pressure couldn't be maintained. The essential indigenous hormones cannot be produced when the brain is not active. So, we could suggest the RN procedure for the wife and tell her let him go. We can suggest them the concept of organ donation so that, even if the person is dead, he can at-least be helpful for some person in need.

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