Anoxic brain injury nursing diagnosis

Evidence-Based Review: Nursing Care of Adults with Severe Traumatic Brain Injury. 8735 W. Higgins Road, Suite 300 Chicago, IL 60631-2738 888.557.2266 International phone: 847.375.4733 Fax: 847.375.6430 [email protected] | www.AANN.org. Evidence-Based Review: Nursing Care of Adults with Severe Traumatic Brain Injury.

Anoxic brain injury (ABI) is a common consequence of drowning and can cause severe neurological morbidity in survivors. Assessment of functional status and prognostication in drowning victims can be extremely challenging, both acutely and chronically. Structural neuroimaging modalities (CT and MRI) have been of limited clinical value.This syndrome, called the post cardiac arrest syndrome, comprises anoxic brain injury, post cardiac arrest myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating pathology 3, 4 ( Table 1 ). The contribution of each of these components in an individual patient depends on various factors, including prearrest ...Cortical blindness (CB) is defined as loss of vision without any ophthalmological causes and with normal pupillary light reflexes due to bilateral lesions of the striate cortex in the occipital lobes.[1] Cortical blindness is a part of cerebral blindness, defined as loss of vision secondary to damage to the visual pathways posterior to the …Anoxic-ischemic brain injury occurs when no blood is flowing to the brain. Neurologists commonly encounter this clinical state when evaluating comatose patients who have had a cardiac arrest and prolonged cardiopulmonary resuscitation attempts. Anoxic-ischemic injury may also occur in primary respiratory arrest or severe hypoxemia (eg, asphyxia ...After brain injury, both noxious and non-noxious stimuli then have the ability to drive a positive feedback loop that produces PSH. These stimuli may include common nursing interventions, such as suctioning, turning, repositioning, and bathing, as well as physiologic triggers such as constipation, urinary retention, and pain.Aggression is one of the most common consequences of traumatic brain injury (TBI). Prevalence estimates of post-TBI aggression range from 11% 1 to 34%, 2 likely due to differing samples and definitions. However, the phenomenology of post-TBI aggression is not yet well defined. 3 Aggression may manifest as verbal and/or physical aggression, …May 20, 2009. nursing diagnosis is based upon the abnormal assessment data you have collected about the patient. an anoxic brain injury is a traumatic event that has produced symptoms, none of which you have mentioned. you need to research anoxic brain injuries and make a listing of this patient's symptoms. from those symptoms nursing diagnoses ...Anoxic encephalopathy, a brain injury related to cerebral hypoxia and cerebral anoxia, types of hypoxic-anoxic injuries (HAIs) is a serious, life-threatening injury; it can cause cognitive problems and disabilities. Some HAI injuries are due to a partial lack of oxygen; the term hypoxic means partial lack.

Raj. 28, 1443 AH ... Brain injury from HIE can cause developmental delay, cognitive impairment, cerebral palsy (a disorder that affects the ability to move and ...A hypoxic-anoxic injury, also known as HAI, occurs when that flow is disrupted, essentially starving the brain and preventing it from performing vital biochemical processes. Hypoxic refers to a partial lack of oxygen; anoxic means a total lack. In general, the more complete the deprivation, the more severe the harm to the brain and the greater ... Anoxic encephalopathy, a brain injury related to cerebral hypoxia and cerebral anoxia, types of hypoxic-anoxic injuries (HAIs) is a serious, life-threatening injury; it can cause cognitive problems and disabilities. Some HAI injuries are due to a partial lack of oxygen; the term hypoxic means partial lack. Anoxic brain injury, also known as global hypoxic-ischemic injury, is seen in all age groups (from antenatal to the elderly) as a result of numerous etiologies. The pattern of injury depends on a number of factors including: age of the patient (brain maturity) neonatal hypoxic-ischemic encephalopathy. hypoxic-ischemic injury in older children ...Nov 1, 2021 · Anoxic-ischemic brain injury occurs when no blood is flowing to the brain. Neurologists commonly encounter this clinical state when evaluating comatose patients who have had a cardiac arrest and prolonged cardiopulmonary resuscitation attempts. Anoxic-ischemic injury may also occur in primary respiratory arrest or severe hypoxemia (eg, asphyxia ... A Pennsylvania nurse who prosecutors say administered excessive doses of insulin to nursing home patients, 17 of whom died, pleaded guilty Thursday. ... who had …

1. but still reaches 60% to 70%, and anoxic-ischemic brain injury is the most common cause of death in these patients. 2. , 3. Anoxic-ischemic brain injury is one of the most feared and devastating complications of cardiac arrest. Consciousness is lost within seconds to minutes because of insufficient cerebral blood flow (CBF) in the midst of ... A concussion is a type of traumatic brain injury (TBI). It usually happens when you hit your head or get hit in the head. You may have problems with different brain functions like ...This guideline primarily evaluates the role of hyperosmolar agents (mannitol, HTS), corticosteroids, and selected non-pharmacologic therapies in the acute treatment of cerebral edema; strategies used for refractory cerebral edema or increased ICP (e.g., barbiturates, therapeutic hypothermia) are not highlighted.Decorticate and decerebrate posturing are both considered pathological posturing responses to usually noxious stimuli from an external or internal source. Both involve stereotypical movements of the trunk and extremities and are typically indicative of significant brain or spinal injury.[1] The Nobel Laurette Charles Sherrington first …Diffuse axonal injury (DAI) is a type of traumatic brain injury (TBI) that results from a blunt injury to the brain.[1] In the United States, traumatic brain injury is a leading cause of death and disability among children and young adults. The Center for Disease Control and Prevention (CDC) estimates that there are over 1.5 million reported …

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Introduction. Anoxic encephalopathy, or hypoxic-ischemic brain injury, is a process that begins with the cessation of cerebral blood flow to brain tissue, which most commonly results from poisoning (for example carbon monoxide or drug overdose), vascular injury or insult, or cardiac arrest. Many patients who suffer anoxic brain injury expire ...Anoxic-ischemic brain injury occurs when no blood is flowing to the brain. Neurologists commonly encounter this clinical state when evaluating comatose patients who have had a cardiac arrest and prolonged cardiopulmonary resuscitation attempts. Anoxic-ischemic injury may also occur in primary respiratory arrest or severe hypoxemia (eg, …Abstract. Postanoxic encephalopathy is the key determinant of death or disability after successful cardiopulmonary resuscitation. Animal studies have provided proof-of-principle evidence of efficacy of divergent classes of neuroprotective treatments to promote brain recovery. However, apart from targeted temperature management (TTM ...Abstract. This article reviews clinical and research literature regarding the nursing management of agitation after severe traumatic brain injury. Neuroscience nurses in acute rehabilitation settings use an evidence-based approach to perform multifaceted assessments and implement effective individualized plans of care.Post-cardiac arrest brain injury (PCABI) is caused by initial ischaemia and subsequent reperfusion of the brain following resuscitation. In those who are admitted to intensive care unit after cardiac arrest, PCABI manifests as coma, and is the main cause of mortality and long-term disability. This review describes the mechanisms of PCABI, its ...The serum NSE level also increases in cases of hypoxic brain damage; the serum concentration is proportional to the extent of brain damage . As near-hanging injury causes anoxic brain injury , serum NSE level is expected to predict the neurological outcome of near-hanging patients. However, the prognostic value of NSE in near …

Acquired Brain Injury (ABI) is an umbrella term encapsulating its two main categories: Traumatic Brain Injury (TBI) or Non-Traumatic Brain Injury (Non-TBI) [ 1 ]. TBI is an external traumatic event in which injury to the brain is sustained, while Non-TBI occurs due to an internal disease process that also leads to damaged brain tissue.This chapter provides an overview of traumatic brain injury (TBI), including how it is defined, its mechanisms of injury, and its neuropathology. The chapter also provides a conceptual model on the recovery trajectories after TBI and intrinsic factors related to the variability in its presentation and diagnosis and in recovery from TBI. There is a discussion of the complexity of establishing a ...Anoxic brain injury, also known as global hypoxic-ischemic injury, is seen in all age groups (from antenatal to the elderly) as a result of numerous etiologies. The pattern of injury depends on a number of factors including: age of the patient (brain maturity) neonatal hypoxic-ischemic encephalopathy. hypoxic-ischemic injury in older …Post-cardiac arrest brain injury (PCABI) is caused by initial ischaemia and subsequent reperfusion of the brain following resuscitation. In those who are admitted to intensive care unit after cardiac arrest, PCABI manifests as coma, and is the main cause of mortality and long-term disability. This review describes the mechanisms of PCABI, its ...Diagnosis. Anoxic brain injury, also known as hypoxic encephalopathy, ischemic-hypoxic encephalopathy is a fairly heterogenous entity. It best conceptualized as a spectrum of brain injury ranging from brain death, minimally conscious states, to recovery of consciousness with cognitive impairment and movement disorders to mild transient loss of consciousness with or without transient neurologic ...This guideline primarily evaluates the role of hyperosmolar agents (mannitol, HTS), corticosteroids, and selected non-pharmacologic therapies in the acute treatment of cerebral edema; strategies used for refractory cerebral edema or increased ICP (e.g., barbiturates, therapeutic hypothermia) are not highlighted.Defining Neurologic Outcome. The Glasgow Outcome Scale (GOS) and the Cerebral Performance Category (CPC) are both five-point scales widely used in assessing neurologic outcome. 8 In the GOS, a score of 5 is associated with good cerebral performance with mild or no disability.When you have aches and pains, you might reach for an ice pack or heating pad. But which is better? That depends on the type of injury or health problem you’re dealing with. Whethe...

Nursing Diagnosis. The nursing diagnosis for anoxia brain injury may include: impaired physical mobility, altered nutrition, altered cognitive function, potential infection, impaired communication, impaired bowel and bladder function, altered self-care, impaired memory, risk for injury, and pain associated with the injury. Outcomes.

If you have a bike, you need a helmet, whether you’re 8 years old or 88 years old. Head injuries are common in bike accidents, and they can lead to brain damage and even death. In ...Lesson Objective for Encephalopathy. Gain a comprehensive understanding of encephalopathy, including its etiology, pathophysiology, and the diverse range of symptoms it presents, to facilitate effective nursing care planning. Learn to identify the various underlying causes of encephalopathy, such as infections, metabolic disorders, or toxic ...Brain injury after resuscitation, a common sequela following cardiac arrest, ranges in severity from mild impairment to devastating brain injury and brainstem death. ... Out-of-hospital cardiac arrest: 30-day survival and 1-year risk of anoxic brain damage or nursing home admission according to consciousness status at hospital arrival ...May 31, 2017 · Diagnosis. Anoxic brain injury, also known as hypoxic encephalopathy, ischemic-hypoxic encephalopathy is a fairly heterogenous entity. It best conceptualized as a spectrum of brain injury ranging from brain death, minimally conscious states, to recovery of consciousness with cognitive impairment and movement disorders to mild transient loss of consciousness with or without transient neurologic ... Disorders of consciousness (DoC) are characterized by alterations in arousal and/or awareness, and common causes of DoC include cardiac arrest, traumatic brain injury (TBI), intracerebral ...An interview with Dr Charlie Whiffin, Associate Professor of Nursing Thu 04 Apr 2024 . Headway is delighted to be supporting a team of researchers investigating the support for family members of an individual with traumatic brain injury, led by Dr Charlie Whiffin, Associate Professor of Nursing at the University of Derby.Jan 30, 2022 · Nursing Care Plan for Head Injury 3. Nausea. Nursing Diagnosis: Nausea related to acute concussion secondary to head injury as evidenced by headache and vomiting. Desired Outcome: The patient will report a reduction in the intensity or complete elimination of nausea. Nursing Interventions for Head Injury. Traumatic brain injury symptoms vary depending on whether a TBI is mild or moderate and/or severe. But all TBIs may cause symptoms, including physical issues, trouble thinking or remembering, and social or emotional issues. Children and adults have similar symptoms. TBI symptoms in babies are issues eating or nursing.

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Anoxic/Hypoxic brain injury (ABI/HBI) can be defined as a global disturbance related to brain function with resultant loss (Anoxic) or decrease (Hypoxic) in oxygen supply to the brain. The term anoxia is used to refer to a complete loss of tissue oxygenation. 33. Tissue oxygenation is affected by deliverable blood oxygen content and blood flow.According to one study, an estimated twenty to thirty percent of people hospitalized with a moderate or severe traumatic brain injury are discharged to nursing homes. Within one year, eighty percent of these survivors move to a private home, a community-based residence, an assisted living facility, or a rehabilitation hospital.Diffuse axonal injury (DAI) is a type of traumatic brain injury (TBI) that results from a blunt injury to the brain.[1] In the United States, traumatic brain injury is a leading cause of death and disability among children and young adults. The Center for Disease Control and Prevention (CDC) estimates that there are over 1.5 million reported …Mild traumatic brain injury: a Midwest survey of discharge teaching practices of emergency department nurses. [Research Support, Non-U.S. Gov’t]. Advanced emergency nursing journal, 33 (2), 181–192. doi: 10.1097/TME.0b013e318217c958 [Google Scholar] Bergman K, & Bay E (2010).Evidence-based guidelines (EBGs) are a common tool used in evidence-based medicine by health-care practitioners. Evidence-based medicine is founded on the following two principles (Guyatt et al., 2000; Sackett et al., 1996): (1) there is a hierarchy of strength of evidence behind recommendations, and (2) the clinician uses judgment when weighing …A hypoxic-anoxic injury, also known as HAI, occurs when that flow is disrupted, essentially starving the brain and preventing it from performing vital biochemical processes. Hypoxic refers to a partial lack of oxygen; anoxic means a total lack. In general, the more complete the deprivation, the more severe the harm to the brain and the greater ...Anoxic brain injury is defined by a one-time event that causes harm to the brain. This harm can cause oxygen deprivation to the brain, which leads to brain cell death within minutes. This can lead to complications with a variety of brain functions, including cognitive (mental), physiological (physical) and emotional.Abstract. Effective nursing management strategies for adults with severe traumatic brain injury (STBI) are still a remarkable issue and a difficult task for neurologists, … The effects of hypoxic or anoxic brain injury, where the brain is starved of oxygen, can range from mild, short-term symptoms such as dizziness or concentration problems, through to severe, long-term issues including vision, speech and memory. The body will respond to cerebral anoxia by increasing blood flow to the brain in an attempt to ... An example is seen in prolonged cardiac arrest causing diffuse anoxic brain injury. The basis for prognosis in milder forms is usually the diagnosis and underlying cause (i.e., tumor, stroke, traumatic brain injury, infection, etc.) and early recognition and treatment. ... Nursing care must pay close attention to changes in neurologic status ... ….

This article explores what a registered nurse (RN) does and how you can become one. This article explores how tobecome a nurse Updated May 23, 2023 • 6 min read There's a hard trut...This syndrome, called anoxic-ischemic encephalopathy (AIE, also known as ‘anoxic brain injury,’ or ‘hypoxic-ischemic coma’), can result in outcomes ranging from full recovery to …Strangulation injuries are a heterogeneous set of traumatic pathology that occurs as a result of mechanical force applied externally to the neck and surrounding structures. As a type of asphyxia, these injuries may result in decreased cerebral oxygen delivery either by compression of cervical blood vessels, or tracheal occlusion. Death rapidly ensues without the removal of compressing forces ...The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to impaired verbal communication. 1. Assess for conditions that affect speech.The first stage involves brain cell damage that occurs within the first few minutes due to a lack of blood flow and oxygen. Reperfusion injury would be the second stage. It occurs after the blood and oxygen flow is restored. Reperfusion injuries may last for periods that range between a few days and several weeks.An analysis of 92 closed claims of opioid-induced respiratory depression reported that 22% resulted in anoxic brain injury and 55% in death and that these suits resulted in a median ... 73.4% had it within 2 hours interval of nursing checking, and 62% were noted to have some degree of somnolence before the event; reinforcing the …Cortical blindness (CB) is defined as loss of vision without any ophthalmological causes and with normal pupillary light reflexes due to bilateral lesions of the striate cortex in the occipital lobes.[1] Cortical blindness is a part of cerebral blindness, defined as loss of vision secondary to damage to the visual pathways posterior to the …Strangulation injuries are a heterogeneous set of traumatic pathology that occurs as a result of mechanical force applied externally to the neck and surrounding structures. As a type of asphyxia, these injuries may result in decreased cerebral oxygen delivery either by compression of cervical blood vessels, or tracheal occlusion. Death rapidly ensues without the removal of compressing forces ... Anoxic brain injury nursing diagnosis, One nursing intervention related to hypertension is monitoring and recording the patient’s blood pressure using the correct cuff size and technique, according to Nurseslabs. Nursin..., Anoxic Brain Injury Anoxic brain injury is a component of multiple diagnoses, but it is rarely identified in the list of comorbidities. The diagnoses of cardiac arrest, stroke, anesthesia accident, electrocution, prolonged seizure, asthma exacerbation, at-temptedsuicide,carbonmonoxidepoisoning,neardrown-ing, and massive hemorrhage are quite ... , Volunteering at a nursing home is a great idea for someone who's outgoing. Learn what it's like and how to get started volunteering at a nursing home. Advertisement Honored war vet..., Rehabilitation Nursing, 42(6), 341 346. doi: 10.1002/rnj.289. –. November/December 2017 Volume 42 Number 6. nursing interventions, especially reading, for agitated patients with anoxic brain injury. Case Report. A 48-year-old divorced teacher was admitted to the hos-pital for gynecologic surgery., A hypoxic-anoxic injury, also known as HAI, occurs when that flow is disrupted, essentially starving the brain and preventing it from performing vital biochemical processes. Hypoxic refers to a partial lack of oxygen; anoxic means a total lack. In general, the more complete the deprivation, the more severe the harm to the brain and the greater ... , Roughly 77% of anoxic comas result in death or the permanent vegetative state, while 50% of patients with traumatic brain injury will die or be permanently unconscious. (Patients with anoxic brain injury who received therapeutic hypothermia, or chilled intravenous fluids, after cardiac arrest have a better prognosis than untreated …, This a treat for nursing mothers to help promote healthy lactation. It is pretty simple to make and very delicious to eat. It's time to dust off the food processor and put the best..., This chapter provides an overview of traumatic brain injury (TBI), including how it is defined, its mechanisms of injury, and its neuropathology. The chapter also provides a conceptual model on the recovery trajectories after TBI and intrinsic factors related to the variability in its presentation and diagnosis and in recovery from TBI. There is a discussion of the complexity of establishing a ..., It is possible some diagnoses for anoxic brain injury were not captured, such as milder cases, or some people may have received a delayed diagnosis. As this analysis examined co-diagnoses for anoxic brain injury during the same hospitalization for opioid-related poisoning, the data presented may reflect underreporting. , Neonatal seizures are a commonly encountered neurologic condition in neonates.[1][2][3] They are defined as the occurrence of sudden, paroxysmal, abnormal alteration of electrographic activity at any point from birth to the end of the neonatal period.[3] During this period, the neonatal brain is developmentally immature.[4][5] …, Jul 10, 2021 · Post-cardiac arrest brain injury (PCABI) is caused by initial ischaemia and subsequent reperfusion of the brain following resuscitation. In those who are admitted to intensive care unit after cardiac arrest, PCABI manifests as coma, and is the main cause of mortality and long-term disability. This review describes the mechanisms of PCABI, its ... , Abstract. Background: Anoxic brain injury (ABI) is a syndrome of diverse aetiology, most case series published to date being confined to ABI of a single aetiology or to a limited …, Diagnosis of Traumatic Brain Injury Neurological examination. A quick and complete neurological examination will be done using the Glasgow Coma Scale (GCS), a clinical tool designed to assess the severity of sustained TBI using a scoring system., Nov 5, 2023 · Apneustic breathing is characterized by prolonged, gasping inhalations followed by extremely short and inadequate exhalations. This pattern results from upper pons injury, often due to stroke or trauma, signifying severe brain injury and a poor prognosis. Temporary induction can occur by the administration of ketamine. , Aggression is one of the most common consequences of traumatic brain injury (TBI). Prevalence estimates of post-TBI aggression range from 11% 1 to 34%, 2 likely due to differing samples and definitions. However, the phenomenology of post-TBI aggression is not yet well defined. 3 Aggression may manifest as verbal and/or physical aggression, but ..., A neurological exam is a series of tests that check for disorders of the brain and spinal cord. These disorders cause serious health problems. The exam can help lead to diagnosis a..., Contents: Head Injury Overview. Nursing Diagnosis. Care Plans. Pathophysiology. Head injury involves trauma to the skull leading to temporary or permanent brain damage. There are several different types of traumatic brain injuries (TBIs): Reference: Saunders comprehensive review for the NCLEX-RN examination. Causes., Jan 28, 2023 · Anoxic encephalopathy, or hypoxic-ischemic brain injury, is a process that begins with the cessation of cerebral blood flow to brain tissue, which most commonly results from poisoning (for example, carbon monoxide or drug overdose), vascular injury or insult, or cardiac arrest. Many patients who suffer anoxic brain injury expire without ... , Although the outbreaks of PSH were traditionally described in severe acquired brain injury (ABI) patients [e.g., traumatic brain injury (TBI), anoxic brain injury, stroke, tumors, infections, or unspecified causes], the prevalence of PSH of 33% after TBI compared with 6% after other causes suggests that the dominant underlying cause in PSH is TBI ., While sudden loss of perfusion is responsible for ischemia, failure to supply the required amount of oxygen to the tissues is defined as hypoxia. Among several pathological conditions that can impair brain perfusion and oxygenation, cardiocirculatory arrest is characterized by a complete loss of perfusion to the brain, determining a whole brain …, A diffuse axonal injury, commonly known as sheer injury, is a type of brain injury that does not result in hemorrhage but damages cells in the brain. Since the brain …, Although the outbreaks of PSH were traditionally described in severe acquired brain injury (ABI) patients [e.g., traumatic brain injury (TBI), anoxic brain injury, stroke, tumors, infections, or unspecified causes], the prevalence of PSH of 33% after TBI compared with 6% after other causes suggests that the dominant underlying cause in …, Paroxysmal sympathetic hyperactivity (PSH) is a pattern of recurrent bursts of dysregulated sympathetic activity, resulting from severe brain injury. These episodes of sympathetic activation are short, dramatic, and often triggered by stimulation. PSH can be a challenging diagnosis, which may easily be confused with seizure, respiratory failure ..., A diffuse axonal injury, commonly known as sheer injury, is a type of brain injury that does not result in hemorrhage but damages cells in the brain. Since the brain cells are severely damaged, they cannot function effectively., Disclosures: Fabienne Saint-Preux, MD: Nothing to disclose Case Description: 32-year-old male with history of unintentional heroin overdose complicated by cardiac arrest and anoxic brain injury presenting with functional decline, mutism, catalepsy, rigidity and negativism consistent with catatonia. Marked improvement with …, In contrast to most acute brain pathologies, anoxia induces a global brain injury. The extent of neuronal and glial damage is largely related to the duration of interrupted CBF. …, Nursing Interventions and Actions. Therapeutic interventions and nursing actions for clients with impaired skin integrity include: 1. Skin and Wound Assessment. Based on observed signs, symptoms, and/or results of diagnostic tests, a medical diagnosis can be made, which guides the treatment strategy., Anoxic-ischemic brain injury is the most common proximate cause of death in nonsurvivors (Table 7.1 ). Fortunately, for those discharged with a favorable neurological outcome, long-term survival is excellent. Table 7.1. C7.T1 Patient Outcomes After Cardiac Arrest. Patient Outcome. , The effects of hypoxic or anoxic brain injury, where the brain is starved of oxygen, can range from mild, short-term symptoms such as dizziness or concentration problems, through to severe, long-term issues including vision, speech and memory. The body will respond to cerebral anoxia by increasing blood flow to the brain in an attempt to ... , TBI/ABI/Stroke Support Group Cary, NC. 1st Monday of each month, 6:30 – 8 pm WakeMed Cary Hospital Conference Center Board Room 1900 Kildaire Farm Road Contacts: Norman Case: (919) 244–6221 [email protected] and Brooke Hinnant: [email protected]. , Elevate the head of the bed to promote venous drainage and reduce ICP. Administer prescribed medications, such as osmotic diuretics or anticonvulsants, to manage ICP and prevent seizures. Collaborate with the healthcare team to ensure prompt diagnostic imaging, such as a CT scan, to assess for brain injury and guide treatment., A nursing diagnosis is a professional judgment rendered by a nurse in order to determine nursing interventions to achieve outcomes, NANDA International explains. A nursing diagnosi..., Some families reported professional uncertainty or disagreement between professionals about the patient’s diagnosis – in all cases relating to the PVS/MCS boundary (Families 6-9). (Note that the patient in Family 5 has an anoxic injury, hence the early diagnosis of permanent VS.)