Apnea test and norepi - page 2

Hi everyone, I work in a SICU that gets a lot of neuro patients. Yesterday I had a patient with a very bad SAH (I don't really understand what the Fischer and Hunt & Hess scales mean, but she had grades 4 and 5). She had... Read More

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    Hi Hiliary!
    First of all I have to express some concern regarding the institutions placement of a patient with a severe SAH. I think it's quite unfair to expect someone who isn't very familiar with an aneurysm/AVM patient with an grade IV-V SAH to take care of them! It sounds like you did an awesome job and raised some good questions!
    I'm actually surprised that the coiling was done considering the absence of many of her basic reflexes. But, I have to ask this....our coilings are done under a general and I'm assuming that yours are too....was the exam done while the patient was still under the general? I'm guessing it was not, due to the result of the dolls eyes test.
    To answer the coiling question for Papaw John. Endovascualar coiling of cerebral aneurysms is something that has just been undertaken for the treatment of those unclippable cerebral aneurysm. It's an angio into the cerebral vessels where the radiologist/neurosurgeon floats coils (or some other object of choice) into the aneurysm.
    I'm at a loss as to how to answer your question regarding the apnea test being done initially with the patient on 30mcg (?) of Norepi and then bulking at the idea of doing it on 24mcg. Was the initial test ordered by a resident and then the senior resident or attending assessed the patient? The apnea test is done to determine the absence of the respiratory effort and confirm the diagnosis of brain death.
    Each institution is different in their numbers but at our institution if the pco2 rises to above 60 then it points towards a confirmation of brain death.
    Thank you.

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