Most states have determined that brain death guidelines for infants, children, and adults include one or two of the following conditions: 1. irreversible cessation of breathing and circulation OR 2. irreversible cessation of whole-brain functions (such as cortical or brainstem). The process in confirming brain death may vary from state to state. Presence of doll’s eyes and absence of a nystagmus with cold calorics indicates absence of oculocephalic and oculovestibular reflexes. 

     A normal oculovestibular reflex is seen when cold water is flushed into the ears causing nystagmus. Absence of this reflex is abnormal and may indicate brain death. A normal oculocephalic reflex is present when the head is rapidly turned to one side and the eyes deviate to the opposite side of head movement. Presence of doll’s eyes may be indicative of brain death. The time allowed following disconnection from the ventilator to allow PaCO2 to increase to stimulate a spontaneous breath is 5-10 minutes. 

     Brain death is part of the test plan under neurology. Musculoskeletal/Neurology/Psychology makes up 16% of the exam, which equals 24 questions.