[Verse 1] Sedated patient, morning rounds begin, Pupils fixed or sluggish, signals from within, Interrupt the propofol, let the cortex wake, Structured neuro assessment — every point a stake, GCS components, focal drift, and tone, The brain behind the silence isn't truly gone, Tiered ICP framework — start with the floor, Head of bed at thirty, CSF to drain some more [Chorus] CPP is MAP minus ICP, Keep it sixty-seventy, let the pressure breathe, Mannitol draws water, hypertonic holds the seam, Osmolar gap tells you what the kidneys mean, CO₂ at thirty-five, not twenty-two, Prophylactic hyperventilation — nothing good comes through, Check the sodium, check the gap, check the renal trend, Tier one before tier two before you reach the end [Verse 2] TBI wants normovolemia, SAH needs more, ICH bleeds its own pathology, swelling at the core, PEEP can choke the venous return and spike the cranial dome, Lung-protective volumes keep the alveoli home, Nonconvulsive seizures wear no outward sign, Run continuous EEG when the picture won't align, Status epilepticus — levetiracetam first in line, Lorazepam for the acute phase, then escalate the spine [Chorus] CPP is MAP minus ICP, Keep it sixty-seventy, let the pressure breathe, Mannitol draws water, hypertonic holds the seam, Osmolar gap tells you what the kidneys mean, CO₂ at thirty-five, not twenty-two, Prophylactic hyperventilation — nothing good comes through, Check the sodium, check the gap, check the renal trend, Tier one before tier two before you reach the end [Verse 3] Pituitary's fractured — now the sodium swings, DI pours dilute urine, hypothalamus strings, SIADH holds the water, CSW wastes the salt, Three different answers, never treat by default, Paroxysmal sympathetic storms — tachycardia, sweat, and heat, Autonomic dysregulation surging from the defeat, Normothermia targeted, glucose kept in range, VTE timing after bleed — threading the exchange [Bridge] Here is where the rarest word earns its keep — *Obtundation*: that dulled, blunted state of sleep, Not coma, not alert — the liminal between, The most misread station on the neuro scene, And when the cortex quiets past the point of return, Brain death has prerequisites before the tests adjourn — Temperature, pressure, toxicology, metabolic cause, Apnea trial last, after every clinical pause [Verse 4] No motor response, no corneal, no cough, Dolls' eyes absent, caloric testing's off, Apnea test: disconnect and watch the CO₂ ascend, Twenty above baseline — no breath effort, that's the end, Ancillary tests when confounders cloud the view, Nuclear perfusion, EEG flat, angiography too, Document each step, each timestamp, every name — Determination and donation are never the same frame
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