A patient is admitted to the critical care unit with the diagnosis of massive head trauma caused by an MVA.The patient is unresponsive and on mechanical ventilation.EEG is negative for brain waves.The family has agreed to organ donation.The nurse turns the patient's head quickly from side to side.The eyes do not move.The nurse knows this is the result of a loss in the

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Oculocephalic reflex: Ocular movements are lost with brain death.The oculocephalic reflex,also described as doll's eyes,involves fast turning of the head to both sides.In brain death,this should not generate any eye movements.Oculovestibular reflex: Because the oculovestibular reflex is tested using iced water or normal saline,it is sometimes called cold calorics.The head of the bed is elevated 30 degrees,and approximately 50 mL of ice water or normal saline is injected into the ear; no movement of the eye toward the side of the stimulus should be present.It is recommended that the patient be observed for up to 1 minute after each ear irrigation,and 5 minutes should be allowed before testing the opposite ear.Corneal and jaw reflexes: Facial sensory and motor responses are elicited by testing for corneal and jaw reflexes.Stroking a cotton-tipped swab gently across the cornea tests the corneal reflexes.Pupillary reflexes: Pupillary signs are evaluated by absence of the light reflex,which is consistent with brain death.Most often the pupils are round,oval,or irregularly shaped,although dilated pupils may remain even after brain death has occurred.

A Patient Is Admitted to the Critical Care Unit with the Diagnosis