The diagnosis and management of brain death is discussed in this paper. Criteria recommended by the Conference of Medical Royal Colleges and their Faculties in U.K. were used in the diagnosis of brain death. It is felt that brain death should be considered as death of the individual and a plea is made to draw up guidelines on management of patients with brain death.
A retrospective report (1970-1980) on patients (non-head injuries and head-injuries) admitted with cerebral ischaemia into the intensive therapy unit is presented. The principles of management to reduce and control intracranial pressure are outlined. Since 1978 continuous intravenous infusion with Althesin has been used instead of barbiturates in the regime. Mortality rate fell from 83.7 percent (1970-1977) to 43.7 percent (1978-1980) for non head injury patients and from 72.1 percent (1970-1977) to 45.6 percent (1978-1980) in the head injured group, the differences between the periods being statistically significant. The possible influencing factors are mentioned. The quality of salvage and survival requires investigation.
From 1970 to 1984, 100 patients suffering from organophosphate poisoning were treated in the Intensive Care Unit at the University Hospital. These patients developed signs and symptoms of cholinergic over-activity and were treated with continuous intravenous atropine. Many of the patients also developed acute respiratory failure, which necessitated ventilatory support in the form of intermittent positive pressure ventilation. Other measures included the use of inotropes and nutritional support. Daily estimation of serum cholinesterase levels were useful in assessing degree of recovery of the patients from the effects of the organophosphates.