@article{Muhammad Osama,Waqar Anwar,Muhammad Tauseef Dildar,Abrar Akbar,Arfat Khalid, Arslan Shehzad, Muhammad Umar, Muhammad Khurram_2018, title={Tension Pneumothorax During Apnea Testing for the Determination of Brain Death}, volume={22}, url={http://journalrmc.com/index.php/JRMC/article/view/856}, abstractNote={<p>The apnea test (AT) is considered as the ‘condition sine<br>qua non’ by most of the intesivists for determining<br>brain death (BD) as it provides an important<br>information for a definitive loss of brainstem function.<br>It is the most difficult clinical test in BD protocols and<br>is also potentially harmful and lengthy. The possible<br>complications of this test include severe decrease in<br>blood pressure, pneumothorax, excessive CO2 retention,<br>hypoxia, acidosis, and cardiac arrhythmia or asystole.<br>It is important to abort the test in the setting of any of<br>the above mentioned complication, which will<br>compromise BD diagnosis. It is important to ensure<br>that certain prerequisites are satisfied before the AT is<br>carried out. These include body temperature 32°C or<br>more, normal PO2 or preoxygenation to obtain an<br>arterial PO2 ≥ 200 mmHg, arterial PCO2 or<br>PaCO2 normal or above 40 mmH, blood pH normal or<br>in the low basic range, pretest systolic blood pressure<br>of at least 90 mmHg, Euvolemia or a positive fluid<br>balance during the previous 6 hours, no drug that can<br>paralyze the respiratory muscles. If continuous or<br>intermittent oxygen supply is preceded by decreasing<br>nitrogen levels of blood gases, high PaO2 levels can be<br>maintained for very long periods of time.<br>Preoxygenation removes alveolar nitrogen stores and<br>helps oxygen transport. There are several techniques<br>for ascertaining that there is sufficient oxygenation<br>during AT .1-5</p>}, number={1}, journal={Journal of Rawalpindi Medical College}, author={Muhammad Osama,Waqar Anwar,Muhammad Tauseef Dildar,Abrar Akbar,Arfat Khalid, Arslan Shehzad, Muhammad Umar, Muhammad Khurram}, year={2018}, month={Mar.} }