In the profession of any health worker in more than a touch ocacion face death and do not resuscitate order.
What to do with the death of a patient? How to know if work has ceased neurological?
Death may hide many times and others a condition we can make a serious mistake to confuse death.
Under Italian law n. 578, 29/12/1993 and DM n.582, 22/8/1994 this can be checked according to these scientific criteria, so as not to fall into an ethical vacuum.
The death is identified with the “irreversible cessation of all brain functions,” Thought to be verified when, in the absence of concomitant factors (CNS depressant drugs, hypothermia, endocrine-metabolic disorders, previous systemic hypotension) in a degree of power to interfere on the clinical picture as a whole, it is found the simultaneous presence of following conditions:
unconsciousness;
absence of corneal reflex, pupillary, eye, head and oculovestibular, reaction to pain stimuli in the territory of innervation of the trigeminal reflex and spontaneous respiration sternal after withdrawal of artificial ventilation to reach the 60 mmHg hypercapnia tested with pH 7.40 lower blood
cerebral electrical silence (flat EEG) evaluated at a definite period
absence of cerebral blood flow (where provided)
Spinal reflexes, spontaneous or induced, have no relevance for the purpose of verification of death, they being compatible with the condition of irreversible cessation of all brain functions.

In the neonate, verification of death (brain) may be conducted only if the birth has occurred after 38 weeks of gestation and in any case, after a week of extrauterine life.

Observation Period
Continued presence of the above conditions, for a period not less than:
6 hours – for adults
12 hours – for children 1 to 5 years
24 hours – for children up to 1 year

Authorized medical equipment
1 neurofisiopatologo
1 anesthetist / rescuer
1 physician examiner

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