[buffetfan]

Hi! I am second semester nursing student and have been doing my clinicals in MICU. A couple of weeks ago I had a patient who came into the hospital complaining of abdominal pain. It was discovered that he had appendicitis and an appendectomy was performed. He did well after the surgery, but was taken back into surgery to remove a hematoma that had formed. He also did well after the second surgery, but not long after he was returned to a regular room he started having bronchospasms. The code team worked on him for about 45 minutes before they got him stabilized. Cerebral edema and eventual herniation of the brain occurred. Can someone explain to me what might have caused him to go into bronchospasms in the first place? This patient was young and it has bothered me ever since not knowing why. I also wonder if this kind of thing is common?

[Zinobile]

It almost sounds like the patient had an anaphylactic reaction to a medication. It's very hard to tell without seeing the chart, obviously, or having seen the patient, but it's my guess that he either had a drug reaction or if he was receiving a blood transfusion, then a transfusion reaction maybe that led to the bronchospasm. Whatever the cause may have been, it sounds like he was anoxic for awhile, causing cerebral edema which ultimately led to the herniation. I can understand why this would stick with you, especially since it started out as an appendectomy!

[papawjohn]

Hey Buffetfan

Seems to me that you're asking about two issues. First, how did the Pt pass thru the RecoveryRoom and get back to his room and then crash? Zinobile suggests blood reaction (did the Pt have blood started?--pretty good thought if so, altho bronchospasm isn't a common way for that to manifest itself.) Also a new antibiotic coulda been started with an allergic reaction following.

The code team taking 45 min to stabilize a Pt is a baaaad sign for that Pt. Usually a cardiac event is either fixed or not fixed in short order.

Respiratory issues are usually fixed by the placement of the EndoTracheal Tube. But the ETT only allows us to cram air in from the top; the smaller airways in 'spasm' keep oxygen from getting to the alveolus where the Oxygen and CO2 are exchanged. If the Pt's 'bronchospasm' kept him from getting oxygen for more than 5min, the brain suffered the death of large numbers of neurons. Our Central Nervous System is a HUGE consumer of oxygen!!! Didja know that 1/3d of the cardiac output is aimed at our brain?

Like any organ that's damaged, the brain swells up when this happens. If your ankle swells up--no problem. You elevate it, ice it, wrap it and stay off it. If your brain swells up--BIG PROBLEM. No place for the pressure to go, you see? So the swelling causes more brain damage, and the brain damage causes more swelling which causes more damage and on and on.

If this goes far enough the brain actually bulges through the big hole at the back of the head (Foramen Ovale) that the spinal cord connects to the brain through. This is 'herniation'.

Very sad event. I s'pose this was a fairly young person? (Usually you think this when you hear about appendicitis.) Terrible, terrible. You're right to try to think about what happened and why.

Papaw John