Neuro ICU - Do you talk to brain-dead patients?

[quote=elkpark]I have done so when in that situation (which hasn't been all that often), just as a gesture of respect to the person (and family, if present), and because I just don't KNOW what may or may not be going on inside the person. The research I have read indicates that hearing is the last sense to "go" when one is dying, and, although I haven't read anything about how that applies in the case of brain death, it seems like a useful thing to keep in mind.

To me, it seems like a question of practicing the principle of nonmaleficence -- if I talk to the person and s/he can't hear me, no harm is done -- but if I go in the room and treat the person like a slab of meat and s/he does still have some primitive, basic level of awareness, then I have done harm ... I try to treat patients with the same care and respect that I would want someone to show me.

It isn't that I don't understand the principle of "clinically dead" -- it's that I do understand that we don't always have all the answers, and don't always know as much as we like to think we do ... [/QUOTE


I like how you stated it, that is my feeling also, you have put it words better than i could have.

I have always spoken to unresponsive patients. It has been a matter of respect, for them, and their family. And I had the experience of having a patient regain consciousness and relating all of the inappropriate conversations that had taken place at her bedside, including some members of the medical staff referring to her as a gork. I made sure she repeated her conversation to the house staff.

Grannynurse

Yes I do. I had a patient with a brain tumor and I would read her cards to her from her Church family and sometimes she would kind of wiggle her body around. I know she could hear me.

I was assessing a patient last week and a family member said nurse she can't hear you. I cheerfully said the hearing is usually the last thing to go.
I received a very funny look, but I kept on talking.

melissa

I would and applaud those who do. I hope if I was ever the pt my nurse would talk to me. I don't care who tells me just how dead my brain would be in that case, even if you put it in bold!

Sarah Scantlin, recently emerged from a 20-year coma, was able to recall events that happened while she was comatose, such as 9/11.

Hey Y'all

New here. Old nurse, though. Lots of NeuroTrauma background.

Think it's sorta surprising that there's so much (17pages!!) of chat regarding coma, vegetative state, etc when the subject was brain-death. (Interesting chat--no offense intended).

A few years ago when I was young and knew alot, the DX "brain death" was (note--medical diagnosis!!!) done like this:

Ice Water Calorimetrics--large syringe of ICED water drawn up by Neurologist/N-surgeon. Forcefully (FORCEFULLY!!!) injected into Pt's ear. Functioning brain-stem will cause the Pt's eyes to jerk toward the side getting the iced h2o bath. No deviation of eyes = no function of brain stem = brain death.

Apnea test--Pt is hyperventilated for 15-30min to blow off CO2. ABGs are drawn. Pt is taken off VENT. Pt is put on Nasal Cannula at high flow. (Everyone understands--these Pts are ALWAYS on vents, yes?) Serial ABGs are drawn (usually an A-Line is put in for this test if not already in). Lack of respirations is shown by progressively increasing pCO2 levels. (The pO2 level stays high because the Oxygen is passively swirling in the airways.) Lack of respirations = lack of brain stem = brain death.

EEGs can confirm the DX but are not necessary in the two states where I practiced in these units (TN & MD).

Transplantation vultures descend AFTER all the above.

Like others, I have had distastful experiences with vultures. (I'm sure there are lots of wonderful transplantation-nurses. No personal attack intended.)

The original question: "Do you talk to your brain dead Pt?"

Answer: Of course!!! I care for a person. I always talk to persons.

Never had a NDE myself but was put to sleep once in a hospital where I worked and the folks all knew me. They assumed I was 'under' and had a few laughs at my expense. Nothing they'd be ashamed of if they'd known I was eavesdropping--but not intended for my ears!

Papaw John

Good point, I guess I was lumping them together.

But I don't recall talking to brain dead patients. It seems odd, I wouldn't talk to a dead body, it seems disrespectful to say "Mr So-So, we are going to turn you now" to a dead body, just a it would be to not say the same thing to a comatose patient. It's an interesting topic of discussion for sure.

I just saw this thread and didn't took the time to read all the post, so I'm sorry if what I say have been said before!

It's just that I'm working in an organ donation team (not the transplant team or the OPO, only the donation one, sounds a bit complicated but it's unique to our center) Anyway... I work very closely with the families of patients who are asked about organ donation, thus brain dead patients.

With time, it became obvious that once it's clear for the family that brain death really means death, they don't really get why nurses still talk to the patient... I think we have to be very cautious about not getting the family confused. We cannot treat brain dead patients as comatosed ones! The best is to see with the family how they feel about you reacting to the patient. Stating that FOR YOU, it's a matter of respect to keep talking to the patient, even if he's dead, would erase a lot of interrogations.

And we should stop talking about "brain death" and start saying "death" instead, just as we do for death by cardiac arrest... but that's another debate!

By the way, I really liked your answer NurseICURN!

Me again, sorry but couldn't pass this one.
Sarah was COMATOSE!!!!! not DEAD!!!

Comatose means you still have some reflexes, some brain activity, something!
When you're dead, your not comatose! You're... DEAD!

Sorry again!