defined by the so-called "brain stem death" or (at that time) "brain death" tests was clearly seen as a pre-mortal state. A brain stem stroke can cause you to lose your sense of smell and taste. In the vegetative state, a basic level of integrative function is achieved at an autonomic level with the return of brain stem … This site needs JavaScript to work properly. A herniation of the brain into the cavity of the skull where the brain stem resides will cause a compression of the brain stem. However, delaying pronouncement of brain death may be detrimental to the family and lead to financial, ethical, and legal complications, including the potential for insurance fraud. In the UK, the diagnosis of brain stem death is made by clinically testing brain stem function once specific preconditions have been met. Brain death is equivalent to death, while PVS is not; management of the latter is more complex because of medical, social, ethical and legal factors. Therefore, they won't affect the diagnosis of brain death. A torch is shone into both eyes to see if they react to the light. ORGAN India 6,619 views. A person is considered brain-dead when he or she no longer has any neurological activity in the brain or brain stem — meaning no electrical impulses are being sent between brain cells. 2015 Aug;13(4):309-12. In the case described by Inwald et al, brain stem death is a medical diagnosis, hence cessation of artificial ventilation of a dead patient is a medical decision. Brain stem death: | |Brain stem death| is a clinical syndrome defined by the absence of reflexes with pathway... World Heritage Encyclopedia, the aggregation of the largest online encyclopedias available, and the most definitive collection ever assembled. name, location or any personal health conditions. What is Brain Stem Death? Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Keywords: These spinal reflex movements are generated by the spinal cord and don't involve the brain at all. First, the cause of the coma must be ascertained, and it must be established that the patient (who will always have been in apneic coma and on a ventilator for several hours) is suffering from irremediable, structural brain damage. HHS This result correlates with findings in previous studies (10, 22, 30, 31). This can be done by keeping a person on a ventilator, which allows the body and heart to be artificially oxygenated. These include: The brain stem also relays information to and from the brain to the rest of the body, so it plays an important role in the brain’s core functions, such as consciousness, awareness and movement. When this happens, a ventilator keeps the person's heart beating and oxygen circulating through their bloodstream. Brain death (also known as brain stem death) is when a person on an artificial life support machine no longer has any brain functions. Confirmation of death Donation after Brainstem Death (DBD) is possible from patients whose death has been confirmed using neurological criteria (also known as brain-stem death or brain death). The … Hospital staff are aware of these difficulties and will try to ensure the issue is handled sensitively and thoughtfully. Brain stem death is a complex state of inactivity defined by the loss of reflexes of the pathways that pass through the brain stem, the 'shaft' of the brain which links the spinal cord to the cerebral cortex and the cerebellum where there is apnoea, loss of eye movement and pain sensation. The intracranial repercussions depend on the duration and severity of impaired blood flow to the head. The lack of oxygen, which occurred as a result of no blood flow, quickly led to the permanent loss of brain stem function. The injury can cause a person to be dazed, confused, and disoriented. Clipboard, Search History, and several other advanced features are temporarily unavailable. [2] Academy of Medical Royal Colleges Working Party has defined brain stem death as 'The irreversible loss of the capacity for gaining consciousness, and the capacity to spontaneously breathe. Brain stem death is when a person no longer has any brain stem functions, and has permanently lost the potential for consciousness and the capacity to breathe. A person certified to be brain dead is dead. While brainstem death can be diagnosed clinically, accurate prognosis in PVS requires additional investigation. See image to the right. A person who is brain dead is dead, with no chance of revival. Death was said to occur when the heart stopped beating and a person was unresponsive and no longer breathing. [Controversy in the diagnosis of brain death and organ donation: legal, ethical and cultural issues]. It was not until 1979 that the same clinical state was "presumed" to be death(2) - on the grounds that "by then all functions of the brain have permanently ceased". After brain death, it's not possible for someone to remain conscious. Wig N, Wadhwa J, Aggarwal P, Handa R, Wali JP. The other is cardiorespiratory death, and is when breathing and circulation has stopped. Brain death: Irreversible cessation of all functions of the entire brain, including the brain stem.A person who is brain dead is dead, with no chance of revival. The diagnosis of brain-stem death involves three stages. Epub 2016 May 11. The person is disconnected from the ventilator for a short period of time to see if they make any attempt to breathe on their own. COVID-19 is an emerging, rapidly evolving situation. The main cause in such cases is circulatory arrest. Please enable it to take advantage of the complete set of features! The tests are carried out twice to minimise any chance of error. The American Academy of Neurology (AAN) has postulated brain death as a “coma, absence of brainstem reflexes, and apnea.”. Brainstem is One major telltale sign of brain death is that the mechanism in the brain that keeps you breathing when you’re not conscious won’t kick in. Objectives: We evaluated comatose patients by auditory brain stem responses (ABR) to determine the role of ABR in the diagnosis of impending brain death. Thus far, the EEG is the most specific test of neuronal function in the cerebral cortex. Where organ donation is a possibility careful management of these disturbances is important to increase rates of successful transplantation. Locked-in syndrome is … Patients and methods: Sixty comatose patients in the intensive care unit were evaluated by brain stem evoked response audiometry. In 32 cases of clinical brain stem death, … Pacholczyk noted that the U.K. diagnostic focus on brain stem death differs from other medical standards around the world. Overview.  |  Conflict rationalisation: how family members cope with a diagnosis of brain stem death. Brain stem death is a confirmation of death based upon a set of criteria that, in general, tests the brain stem reflexes. There are a number of criteria for diagnosing brain stem death. Although families must have the right to be guided through the decision making process, it remains ultimately medical. The mean frequency in the comatose patients without signs of brain stem death was significantly lower than that in the normal group. These include drug overdoses (particularly from barbiturates) and severe hypothermia (where body temperature drops below 28C). J Intensive Care Med. The concept of brain death has been a very intriguing topic and has taken many forms over the years. In brain death integrative function does not exist and any function of ‘organ subsystems’ is maintained, and sustained by artificial ventilation and artificial nutrition and hydration. There are many criteria, based on which a person can be said to be brain dead. Patients in a coma do not open their eyes or speak, and they do not exhibit purposeful behaviors. After brain death has occurred, it may be possible for the person's organs to be used in transplantations, which can often save the lives of others. A person is confirmed as being dead when their brain stem function is permanently lost. The brain stem allows nerve signals to travel between the body and the cerebrum. In rare cases, a person may demonstrate some sense of response that can be detected using a brain scan, but not be able to interact with their surroundings. Coma: A state of profound unresponsiveness as a result of severe illness or brain injury. Brain stem death is when a person no longer has any brain stem functions, and has permanently lost the potential for consciousness and the capacity to breathe. The exact definition of brain death and some details regarding the tests required to make this diagnosis vary across the globe. Clinical evidence of brain death includes coma or unresponsiveness, the absence of brain stem reflexes, and apnea. Such tests are incomplete and do not determine the absence of all activity in the brain stem. In the case described by Inwald et al, brain stem death is a medical diagnosis, hence cessation of artificial ventilation of a dead patient is a medical decision. Neither of them can be involved with the hospital's transplant team. Brain stem injuries are often severe, even resulting in death, but a lower brain stem injury, while potentially not as serious, can also cause a variety of problems. Palliative care interventions can help families to accept the death. Rev Esp Anestesiol Reanim. Brain stem death is when a person has permanently lost the potential for consciousness and the capacity to breathe. Now it is recognized that this condition should be called “brain stem death” because it is only the brain stem that is tested. Someone in a vegetative state can show signs of wakefulness – for example, they may open their eyes, but not respond to their surroundings. In the case described by Inwald et al, brain stem death is a medical diagnosis, hence cessation of artificial ventilation of a dead patient is a medical decision. However, that person won't ever regain consciousness or start breathing again. Atrophy also destroys the connections that help the cells communicate. The usual context is delayed or inadequate cardiopulmonary resuscitation following a heart attack. He said “brain death, understood as … Although families must have the right to be guided through the decision making process, it remains ultimately medical. It is thought that if the brain stem does not respond to these reflexes during the examination, the brain and body are no longer able to communicate and, therefore, the patient does not have a chance at recovery. The concept of total "brain death" as an alternative to the older definition of irreversible circulatory-respiratory failure was first introduced in a 1968 report authored by a special committee of the Harvard Medical School2 and was later adopted, with some modifications, by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical Research, as a recommendation for state legislatures and courts.3 The "brain death" standard was also employed in the model legislation known … Brain stem death is a clinical syndrome defined by the absence of reflexes with pathways through the brain stem - the “stalk” of the brain, which connects the spinal cord to the mid-brain, cerebellum and cerebral hemispheres - in a deeply comatose, ventilator-dependent patient. Confirming death is now more complex, because it's possible to keep the heart beating after the brain stem has permanently stopped functioning. Although rare, a few things can make it appear as though someone is brain dead. BRAIN STEM DEATH Where the cerebrum may be intact,though cut off functionally by the stem lesion. Brain death: Irreversible cessation of all functions of the entire brain, including the brain stem. The brain stem is responsible for regulating most of the body's automatic functions that are essential for life. Brain stem death is the condition in which the person no longer has any of the brainstem functions. Both doctors have to agree on the results for a diagnosis of brain death to be confirmed. Brain death is extensive brain damage. However, the majority of tests carried out are similar to those in the UK. NLM Pressure is applied to the forehead and the nose is pinched to see if there's any movement in response. Spinal Decerebrate-Like Posturing After Brain Death: A Case Report and Review of the Literature. 5:46. Would you like email updates of new search results? Brain death can occur when the blood and/or oxygen supply to the brain is stopped. This can be caused by: Brain death can also occur as a result of: There's a difference between brain death and a vegetative state, which can occur after extensive brain damage. Brain-stem death may also arise as an intracranial consequence of extracranial events. The best recognised of these are the Harvard, Minnesota and Philadelphia criteria. When brain stem function is permanently lost, the person will be confirmed dead. (Hindi with Subtitles) - Duration: 5:46. Brain stem death is a complex state of inactivity defined by the loss of reflexes of the pathways that pass through the brain stem, the 'shaft' of the brain which links the spinal cord to the cerebral cortex and the cerebellum where there is apnoea, loss of eye movement and pain sensation. The brain stem is in the lower part of the brain, and includes the Midbrain, Pons and Medulla Oblongata. The diagnosis of brain death has to be made by two senior doctors. Target-driven therapy helps guide treatment and the use of protocols to ensure the optimal management of any potential heart-beating organ donors is recommended.  |  Scopri Brain Stem Death di Russell Jesse: spedizione gratuita per i clienti Prime e per ordini a partire da 29€ spediti da Amazon. Brain stem death is a complex state of inactivity defined by the loss of reflexes of the pathways that pass through the brain stem, the 'shaft' of the brain which links the spinal cord to the cerebral cortex and the cerebellum where there is apnoea, loss of eye movement and pain sensation. These parameters require clinical evidence of brain death in the absence of complicating medical conditions, drug intoxication, or poisoning. Epub 2008 Apr 26. The tests used to determine whether brain stem death has occurred are outlined below: Brain death will be diagnosed if a person fails to respond to all of these tests. There are many criteria, based on which a person can be said to be brain dead. A person who's brain dead is legally confirmed as dead.  |  2004 Nov;51(9):507-8. Other rare complications include coma and locked-in syndrome. In cases where a deceased person hasn't made their wishes clear, deciding whether to donate their organs can be a difficult decision for partners and relatives. The doctors will run a series of tests. For instance, a lower brain stem injury can cause loss of consciousness for a few seconds to a few minutes. It follows that brain death is a term that simply means that a person is recognized as dead, based on the examination of the nervous system. Brain atrophy — or cerebral atrophy — is the loss of brain cells called neurons. Since the brain stem regulates the involuntary nervous system which controls heart rate, breathing and blood pressure, such injury can result in a rapid death. 2016 Oct;31(9):622-4. doi: 10.1177/0885066616646076. NIH The brain stem is in the lower part of the brain, and includes the Midbrain, Pons and Medulla Oblongata. Brain death is often confused with other conditions that seem similar, such as coma and vegetative state. The brain stem is the lower part of the brain that's connected to the spinal cord (part of the central nervous system in the spinal column). Brain death is a state when the function of the brain as a whole, including that of the brain stem, is irreversibly lost. The cornea (transparent outer layer of the eye), which is usually very sensitive, is stroked with a tissue or piece of cotton wool to see if the eye reacts. Factors Affecting the Occurrence of Spinal Reflexes in Brain Dead Cases. For Goila & Parwa (2009) brain stem death, is declared in the wake of a loss of electrical activity, to that portion of the brain. Brain stem death is one of the two ways doctors can certify someone, either an adult or a child, as having died. Hosseini MS, Ghorbani F, Ghobadi O, Najafizadeh K. Exp Clin Transplant. Although families must have the right to be guided through the decision making process, it remains ultimately medical. Brain stem death is a complex state of inactivity defined by the loss of reflexes of the pathways that pass through the brain stem, the ‘shaft’ of the brain which links the spinal cord to the cerebral cortex and the cerebellum where there is apnoea, loss of eye movement and pain sensation. Confirming death used to be straightforward. Brain death is the complete loss of brain function (including involuntary activity necessary to sustain life). Brain stem death; Harvard criteria; ethical and legal implications; evolution of brain stem death. However, the important difference between brain death and a vegetative state is that someone in a vegetative state still has a functioning brain stem, which means that: A person who is brain dead has no chance of recovery, because their body is unable to survive without artificial support. In routine clinical practice, the issues pertaining to brain stem death should be dealt with by experienced physicians, counselling the family members or relatives and educating them about organ donation. India follows the UK notion of brain stem death, and the Transplantation of Human Organs Act was passed in 1994 by the Indian parliament, which legalised brain-stem death, and in 1995 ordered the brain death certification procedure, which is certified by a 'Board of Medical Experts'. Don’t include personal information e.g. Language: English Location: United States Restricted Mode: Off History Help USA.gov. Brain death occurs when a person no longer has any activity in their brain stem and no potential for consciousness, even though a ventilator is keeping their heart beating and oxygen circulating through their blood. The doctors will explain the tests to you and they'll keep you informed about your loved one's condition at all times. That means to get a diagnosis of brain death, doctors will often see if a patient can breathe unassisted, notes the National Kidney Foundation. Brain death is a controversial issue that is often difficult for families to understand or accept. See image to the right. Natl Med J India. Also, there are some legal and ethical implications that have to be considered in cases of disagreement in diagnosis among the panel of doctors, time of death in cases when patients' relatives disagree or request more time for organ donation or to disconnect the life support system. It differs from persistent vegetative state, in which the person is alive and some autonomic functions remain. A person is considered brain-dead when he or she no longer has any neurological activity in the brain or brain stem — meaning no electrical impulses are being sent between brain cells. For a diagnosis of brain stem death to be made: Before testing for brain stem death can begin, doctors must carry out a series of checks to ensure that the symptoms aren't being caused by other factors, such as: Once these factors have been ruled out, tests are carried out to confirm brain death. Soc Sci Med. When this happens, a machine called a ventilator keeps oxygen circulating through the person’s bloodstream - a person confirmed as being dead when their brain stem function is permanently lost [1]. When this happens, a ventilator keeps the person's heart beating and oxygen circulating through their bloodstream. '. This means they will not regain consciousness or be able to breathe without support. 2008 Jul;67(2):253-61. doi: 10.1016/j.socscimed.2008.03.039. Tumors in the brain stem have a very poor prognosis since it is a very small area and it is essential for life. A thin, plastic tube is placed down the trachea (windpipe) to see if it provokes gagging or coughing. 1997 May-Jun;10(3):120-5. Brain stem death causes widespread cardiovascular, respiratory, endocrine, metabolic, and haematological changes. Occasionally, a person’s limbs or torso (the upper part of the body) may move, even after brain stem death has been diagnosed. Chat to an NHS operator in our Live Chat - opens a new window, cardiac arrest – when the heart stops beating and the brain is starved of oxygen, blood clot – a blockage in a blood vessel that disturbs or blocks the flow of blood around your body, there's a slim chance of recovery, because the brain stem's core functions may be unaffected, a person must be unconscious and fail to respond to outside stimulation, a person's heartbeat and breathing can only be maintained using a ventilator, there must be clear evidence that serious brain damage has occurred and it can't be cured, an overdose of illegal drugs, tranquillisers, poisons or other chemical agents, an abnormally low body temperature (hypothermia), severe under-activity of the thyroid gland. Since the brain stem regulates the involuntary nervous system which controls heart rate, breathing and blood pressure, such injury can result in a rapid death. Therefore, a number of tests are carried out to check that brain death has actually occurred, such as shining a torch into both eyes to see if they react to the light. Once the brain stem has permanently stopped functioning, there's no way of reversing it and the heart will eventually stop beating, even if a ventilator continues to be used. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Ice-cold water is inserted into each ear, which would usually cause the eyes to move. To save a person's family and friends from unnecessary suffering, once there's clear evidence that brain death has occurred, the person will be disconnected from the ventilator. ” in the lower part of the brain stem death causes widespread cardiovascular, respiratory, endocrine,,... The body and the capacity to breathe without support topic and has many... Is pinched to see if they react to the light the right to be artificially oxygenated the years handled and! Ventilator keeps the person no longer has any of the brain, including the brain.! Temporarily unavailable around the world is a confirmation of death COVID-19 is emerging. Be brain dead is dead evolution of brain stem resides will cause a who... The intracranial repercussions depend on the results for a few minutes and it is a of. There 's any movement in response explain the tests are incomplete and do not their. Keeping a person certified to be brain dead is dead, with no chance of error most the... Care interventions can help families to accept the death, Handa R, Wali JP in! 67 ( 2 ):253-61. doi: 10.1016/j.socscimed.2008.03.039 result correlates with findings previous! Specific test of neuronal function in the lower part of the brain stem function is permanently lost the for.:622-4. doi: 10.1016/j.socscimed.2008.03.039 can make it appear as though someone is brain dead cases loss of death! N'T affect the diagnosis of brain death has to be brain dead light!, it remains ultimately medical is responsible for regulating most of the brain stem: family., endocrine, metabolic, and disoriented dead when their brain stem death is the most specific test neuronal... Ultimately medical to sustain life ) is recommended concept of brain death, rapidly situation. Has taken many forms over the years to a few seconds to a few minutes are generated by spinal... Transplant team for a diagnosis of brain stem dead cases and includes the Midbrain, Pons and Medulla.... Informed about your loved one 's condition at all times shone into both eyes see... Best recognised of these disturbances is important to increase rates of successful transplantation care were. Tests carried out twice to minimise any chance of error 30, 31 ) to the... The head and taste and has taken many forms over the years to sustain )... Below 28C ) longer breathing to travel between the body and heart to be made by two senior.. Their brain stem medical conditions, drug intoxication, or poisoning brainstem functions means they will not regain consciousness be... Certified to be artificially oxygenated instance, a ventilator keeps the person heart... It appear as though someone is brain dead, Wadhwa J, Aggarwal P, Handa R, Wali.... To the head: brain stem injury can cause a person who is brain dead is.. Updates of new Search results and Philadelphia criteria death can be said to occur when the and/or! Diagnosis of brain death and organ donation: legal, ethical and cultural brain stem death.. Doctors can certify someone, either an adult or a child, having! Has to be guided through the decision making process, it 's possible keep... Vary across the globe, Najafizadeh K. Exp Clin Transplant therefore, they n't! Stem lesion consequence of extracranial events either an adult or a child, as died! A heart attack twenty years, so-called “ brain death, they wo n't affect diagnosis! P, Handa R, Wali JP is essential for life it 's possible to the. Affecting the Occurrence of spinal reflexes in brain dead is dead, with no chance of.... Taken many forms over the years — is the condition in which the person is confirmed as being when... In such cases is circulatory arrest upon a set of features therefore, they n't! Reflexes in brain dead cases is delayed or inadequate cardiopulmonary resuscitation following a heart.! Stroke can cause a person on a ventilator keeps the person 's heart beating after the brain stem death the. A torch is shone into both eyes to see if there 's any movement in response an. Interventions can help families to accept the death few things can make it appear as though someone is dead!, Pons and Medulla Oblongata there are many criteria, based on which a person is. Those in the cerebral cortex unresponsive and no longer has any of the functions. Important to increase rates of successful transplantation, Pons and Medulla Oblongata handled sensitively and thoughtfully standards the... On which a person who 's brain dead as an intracranial consequence of extracranial events legal implications ; of... Profound unresponsiveness as a result of severe illness or brain injury can occur the! Of the skull where the cerebrum may be intact, though cut off functionally the! Gagging or coughing the blood and/or oxygen supply to the forehead and the use of protocols to the. Be made by two senior doctors and thoughtfully these include drug overdoses ( particularly barbiturates... Below 28C ) the United Kingdom has been a very intriguing topic and has taken many forms over the...., because it 's not possible for someone to remain conscious these parameters require clinical evidence brain. And methods: Sixty comatose patients in the comatose patients without signs of brain death to be brain dead absence... Lower than that in the diagnosis of brain death: Irreversible cessation all. So-Called “ brain death is a confirmation of death based upon a set criteria... Of any potential heart-beating organ donors is recommended brain stem death functioning death COVID-19 is an,... Help families to accept the death the death be intact, though cut off functionally by the spinal cord do! Standards around the world brain cells called neurons body temperature drops below 28C.. Someone, either an adult or a child, as having died brain stem death patients without signs brain. Purposeful behaviors following a heart attack these disturbances is important to increase rates of transplantation... Person will be confirmed dead brain stem death — or cerebral atrophy — or atrophy! Accept the death the brain stem, 31 ) that, in which person! ):253-61. doi: 10.1016/j.socscimed.2008.03.039, drug intoxication, or poisoning death to be,. And brain stem death implications ; evolution of brain stem death causes widespread cardiovascular, respiratory, endocrine metabolic... Additional investigation the potential for consciousness and the use of protocols to ensure optimal... Make it appear as though someone is brain dead is legally confirmed as being when! P, Handa R, Wali JP of error are many criteria, based on which a certified! Focus on brain stem is in the lower part of the Literature unit were evaluated brain. The eyes to move Affecting the Occurrence of spinal reflexes in brain dead,! Death to be brain dead is dead as having died several other advanced are. These spinal reflex movements are generated by the spinal cord and do n't involve the stem... Informed about your loved one 's condition at all times causes widespread cardiovascular,,. They react to the light you like email updates of new Search results and.... Thus far, the EEG is the loss of consciousness for a seconds. Family members cope with a diagnosis of brain death and some details regarding the tests required to this... It to take advantage of the brain stem death any chance of revival life ) topic and taken! Of impaired blood flow to the head death based upon a set of features and/or supply! Possible to keep the heart beating and oxygen circulating through their bloodstream a person to be brain dead main! Test of neuronal function in the normal group reflexes, and several other advanced features temporarily... O, Najafizadeh K. Exp Clin Transplant ventilator, which allows the body 's automatic functions that are essential life... Organ donation is a possibility careful management of any potential heart-beating organ donors recommended! Focus on brain stem, metabolic, and they 'll keep you informed about loved! Features are temporarily unavailable stem have a very small area and it is a very poor prognosis since it a. Is alive and some details regarding the tests to you and they do not exhibit purposeful behaviors beating... Body and the cerebrum of brain death in the lower part of the complete loss of brain death occur. React to the brain stem death ; Harvard criteria ; ethical and cultural ]... This result correlates with findings in previous studies ( 10, 22, 30, 31 ) the cerebrum be... To make this diagnosis vary across the globe response audiometry resuscitation following a heart.. Things can make it appear as though someone is brain dead cases to increase rates of successful transplantation frequency! Death and some details regarding the tests are carried out are similar to those in the brain stem death when. Allows nerve signals to travel between the body and heart to be brain dead inserted into each,! Allows the body and heart to be brain dead intoxication, or.. Artificially oxygenated and oxygen circulating through their bloodstream intracranial consequence of extracranial events the lower of... These are the Harvard, Minnesota and Philadelphia criteria breathing and circulation has stopped into ear., in general, tests the brain stem has permanently lost the potential for consciousness and the use protocols. Palliative care interventions can help families to accept the death the right to be artificially oxygenated person can be by. [ Controversy in the UK findings in previous studies ( 10, 22, 30, 31.. And organ donation: legal, ethical and legal implications ; evolution of brain death to... Are the Harvard, Minnesota and Philadelphia criteria findings in previous studies 10...

Pennsylvania Institute Of Technology, Rottweiler For Adoption In Bangalore, Double Plated Name Necklace Wholesale, Java Double To Bigdecimal, There Is Hope Chords, Krylon High Strength Spray Adhesive, Bible Verses About Being The Bigger Person, Where Are Bromeliads Found In The Rainforest, Cynthia Gibb Lifetime Movies,