THE SCENARIO Adam, a 50 year old male, was found at the bottom of the stairs laying face down by his wife and daughter . Adam''s wife noticed blood trickling from his nose and called the ambulance .In A/E a CT scan revealed a subarachnoid bleed. The nurse assigned to look after Adam reported a GCS score of 3 therefore Adam was intubated and ventilated with his head elevated to 30 degrees. Cardiovascular and neurological monitoring commenced , together with fluid management and intravenous crystalloids. He was sedated on propofol and morphine to facilitate ventilation and avoid a rise in intracranial prssure . Two hours later Adam''s heart rate dropped to 38 beats per minute and his blood pressure rose to 180/110. his right pupil was enlarged to size 6 and was not reacting to light. His sedation and analgesia were increased and adam''s wife and daughter were informed of his poor codition. unfortunately within a short while adam''s left pupil also became fixed and dilated. A diagnosis of coning and brainstem compromise was made. Brain stem tests were organised and a diagnosis of brain stem death made. The family were approached re organ donation.