Brain Death: What Turns the Exam Into a Diagnosis? A patient is deeply comatose with fixed pupils and absent brainstem reflexes. The examination points toward brain death. But what confirms that clinical picture?🧵

Triple flexion can look purposeful. Hip flexion. Knee flexion. Dorsiflexion. But this movement can persist as a spinal reflex even in patients with no cerebral blood flow.

Explaining brain death to a family is one of the hardest conversations in critical care. A clear definition matters. "Brain death is permanent, and consciousness will not return." Sometimes, fewer words make the message clearer. (New Episode in the comments.👇🏻 )

Brain death is one of the most consequential diagnoses in critical care. What turns a devastating neurological exam into a diagnosis of brain death? Dr. Sean Marinelli walks through the exam, underlying injury, and role of ancillary testing. (New Episode in the comments.👇🏻 )

The same ABG can tell three different stories. You can have the exact same numbers in three very different patients. That’s why the ABG has to be interpreted alongside the clinical picture. The context tells you what the numbers mean.

The lungs and kidneys aren't chasing an A+ in compensation. They aim for a B+. So when an acid-base disorder is appropriately compensated, a normal pH isn't the goal. Appropriate compensation has limits.

Stop Treating The ABG Like a Math Problem A pH of 7.40 can still hide trouble. A CO₂ of 40 can still be abnormal. The same ABG can tell three different stories. Here’s what the numbers reveal when you put them back in context. 🧵