Ruptured AVM - page 3

by Mommy_of_3_in_AL..RN 9,934 Views | 24 Comments

I am a student in my last semester of school. I am working on my preceptorship in a local SICU, and had an extremely upsetting case yesterday. A young lady came in a few nights ago after being found unresponsive. She was... Read More


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    I am not religious, and for me it would take an explanation of the science along with a healthy dose of statistics to help me understand. Since they are the kind that religious dogma trumps science it sounds like it would be helpful if you could offer to have them get their preacher in to say a prayer with them and then pull him aside and let him know what is really going on. Maybe he could help them understand. Would doing that violate anything in the ethics code?
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    OK, sorry of this sounds crass, or blunt. In NC we treat brain death the exact same way as you would treat the situation if you were taking care of someone who's heart suffered fatal cardiac arrest. Once they are declared the family is given time for visitation, we often will wait for a relative to come if it's reasonable. We wouldn't wait on someone to get a visa to visit but might wait on a relative flying from California. But, the doctor right's his/her death pronouncement note in the chart and the patient is eventually removed from life support and turned over to the family as appropriate. Brain death sets forth a scenario that offers some additional opportunities, in NC anyone admitted witha Glasgow Coma Score of 5, or if a patient's Glasgow Coma Score drops below 5 must be referred to the state's organ procurement agency. Upon brain death declaration they must be given an opportunity to request organs and tissue for donation. Aside from all this clear concise information and teaching must be given to the family up front. This situation is often easier if the family is actually part of the care team, involved in rounds etc... Keeping the family out of the loop and in the waiting room serves no ones best interests. Family participation in patient rounds, codes, and daily care routines are a must for the patient and the family. Many times when a catastrophic events strike a family member there is a fair amount of secondary trauma to the family, they have to work through the information and be shown that the injury is real and then be educated toward what the medical teams expectations are for recovery. We have the occasional family who swears almighty Jesus, or Jehovah, or Abraham, or Allah will perform a miracle and raise their family member up from the sick good as new. Some times if they refuse to come around we just have to politely explain that they have been declared dead in accordance with the recognized medical standards, and state law, and we are very sorry but we have to turn the machines and the medicines off now.....click. Yeah Chaos and madness usually follows, but then they begin to realize what they refused to after a few minutes, and they leave after a bit and things keep humming along. All be it a very rare occurrence, it has happened to me twice in 12 years in the Neuro ICU. Not a pleasant experience for anyone involved.
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    To SICUTOCRNA

    "i am not sure if you have children--but that gives you a different perspective. sometimes in the morning when i come on to the unit and i see organ donation--i get a pit in my stomach--i think the vultures are circling!! (even though i am an organ donor and think they do wonderful work.) i think what if that was my son or daughter--if they were in an accident and i saw organ donation i would tackle them and tell them to get away from my child--but then again--i would need time "

    Organ donation is another choice in end of life care. Transplant coordinators are not "vultures". They are called in when the person is being evaluated for brain death. Donation often gives the family a sense that their loved ones' death was not in vain. On the flip side, what if it were your son or daughter waiting on the transplant list? Organs aren't pulled off of some shelf. They are generous gifts from brave donor families. Calling them vultures undermines the important work they do for both donor families and transplant recipients. It's disrepectful and rude.
  4. 0
    Quote from sistersledgehammer
    To SICUTOCRNA
    Transplant coordinators are not "vultures". They are called in when the person is being evaluated for brain death. Donation often gives the family a sense that their loved ones' death was not in vain. On the flip side, what if it were your son or daughter waiting on the transplant list? Organs aren't pulled off of some shelf. They are generous gifts from brave donor families. Calling them vultures undermines the important work they do for both donor families and transplant recipients. It's disrepectful and rude.
    Yes, I think the poster realizes this, that the transplant team are not "vultures." She was speaking to the emotional aspect of it--your loved one has just been declared dead and here is a team of people circling in with the intent of carving up the body to portion out the organs to more fortunate recipients. As much as you might realize the benefit of organ transplant in a "saner" moment, most people aren't fully able to feel that way right when dealing with the shock of death, particularly sudden death (as most organ donors tend to be). This is not to diminish the important life-saving work that transplant teams do, but they need to remember to do so with the utmost sensitivity and appreciation to the family of the donor.
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    the utmost sensivity and appreciation to the family of the donor also applies to the transplant coordinator's relationship with the nurses. Calling them vultures is rude. When I'm on a unit and the ICU nurse is screaming why am I taking care of a dead body in front of the patient's room, it's disrespectful. We all need to take a step back as nurses and appreciate that we all have one common goal which is to take care of the patient. This bickering between nurses just holds down out profession.


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