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EEG GUIDELINES*

  1. A minimum of eight scalp electrodes and ear lobe references covering the major brain areas shall be used; ground electrode should not be used in ICU or if electrical monitoring equipment is in-use.

  2. Disk electrodes will be applied; inter-electrode impedances will be kept under 10,000 ohms and over 100 ohms; the inter-electrode distance should be at least 10 cm.

  3. Each electrode will be tested by touching it separately to create an artifact potential on the record.

  4. Sensitivity will be increased from 7.5 μV/mm to 2 μV/mm during most of the recording with inclusion of appropriate calibration.

  5. Filters should provide a wide window i.e., time constant 0.3 sec-land high frequency > 70 Hz.

  6. EEG should be tested for reactivity to loud noise and pitch.

  7. Recording will be done for at least 30 minutes.

  8. A pair of electrodes will be applied on the dorsum of the right hand at a distance of 6-7 cm; electrocardiographic monitor will be applied.

  9. Electromyographic artifacts can be seen sometimes in a patient with electrocerebral silence.  If these obscure the recording, neuromuscular blocking agents like pancuronium or succinylcholine may be used, but during the recording only.

  10. Recording should be made only by a qualified EEG technologist.  A repeat EEG should be obtained if there is doubt about electrocerebral silence
MINISTRY OF HEALTH
NATIONAL KIDNEY FOUNDATION

POTENTIAL CADAVER DONOR MAINTENANCE PROTOCOL
 Date
   &
 Time
 Patient's Name:  Age:  Sex:
 Hospital:  Record No.:
 Check
 

  1. Introduce nasogastric tube and Foley's catheter.  Maintain accurate intake and output.  Establish a CVP line.  Weigh the patient or assess the weight.

  
 

  1. INVESTIGATIONS:

    Once only: Titers for CMV, HSV, EBV, Brucella, Toxoplasma and VDRL.  Screening for HIV, HBsAg, HBsAb, HBeAg, anti-HCV.  Blood group, Rh factor, Creatinine clearance, Cultures of urine, blood and if any, wounds.

    Daily: CBC, LFT, PT, PTT, Blood glucose, Chest X-ray, EKG and Urine analysis.

    4 hourly: Blood urea or BUN, Serum creatinine and electrolytes and if indicated, ABG.

  
 
  1. If the patient is stable with a systolic BP of 100-110 mm Hg, the urine output should be measured hourly and must be replaced by i.v. dextrose 5% OR 0.45% saline adding an extra 30 cc to the measured urine volume (volume by volume replacement).
  
 
  1. If BP is less than 100 mm Hg and CVP is less than 10 cm H2O, give a fluid challenge of 500 cc of normal saline to obtain a systolic BP of 100­110 mm Hg. Repeat as necessary.  Up to 4 liters may be needed in the first hour.
  
 
  1. If systolic BP remains below 100 mm Hg even after fluid replacement, start EITHER dopamine 5 μgm/Kg/min or dobutamine 5 μgm/Kg/min or epinephrine 0.1 - 1 μgm/Kg/min with Pitressin 5 - 10 units i.m. q 6h.  Wean vasopressors as BP stabilises.
  
 
  1. In a patient with stable BP, if urine output remains less than 50 cc/ hour for two consecutive hours and the CVP is found to be above 12 cm H2O, give furosemide 20 - 40 mg i.v. Repeat q 2h, if necessary.
  
 
  1. If heart rate is below 50 /min isoproterenol 0.5 - 5 μgm/min may be given depending on response.  Titrate as needed.
  
 NAME OF THE DOCTOR:

 SIGNATURE:

This protocol should be carried-out by the ICU doctor or treating physician.