Are my pts "brain dead"?

  1. 0
    I apologize if I am sounding stupid now,but I am just curious. We have all heard about the case in California with the 13 yr old,and how she is brain dead. Of course,she is on a vent,and the family wants her to get a trach and gtube.

    I have several pts that are "unresponsive" meaning they don't talk, blink their eyes, nothing, no purposeful movement, nothing. All but one is on a vent, and all have trach and gt. At least one doesn't even use a gtube. She has been on Tpn for 1.5 years now for all her nutritional needs. One boy is a Dnr order, but with the understanding that we are to rescucitate him using the Ambubag, but if his heart stops, we do nothing. (I haven't seen a Dnr order like that before, and this is the first one I've seen like that)

    It also says "at parents discretion", meaning that they could change their minds and make us do chest compressions. (according to nursing supervisor). This same boy had an EEG,and it shows no activity.

    Anyway,I'm not seeing the big issue with the California case as I have several kids with vents, trach, and gtubes that are well...I'm not saying the words.
    Last edit by Joe V on Jan 1, '14 : Reason: spacing
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  3. 197 Comments so far...

  4. 20
    A "persistent vegetative state" and "brain death" are two different things medically speaking, although I'd argue neither counts as being "alive" in a practical sense.

    "Brain death" involves no reflexes and no spontaneous respirations and has absolutely no chance for recovery of any type. Recovery is possible in a vegetative state, although meaningful recovery becomes less likely over time, after 6 months recovery becomes very rare and will almost always result in significant disability in the event of recovery, after one year in a vegetative state it's referred to as a "permanent vegetative state".
    nursel56, workingharder, aknottedyarn, and 17 others like this.
  5. 11
    We can never venture to guess what it is like for any parent to lose a child. Unless one has been there. And even then, each situation is unique.

    As a parent, it would be so very difficult to make a decision to let one's baby go, even if all of the evidence points to a body with no other evidence of life. However, it is a life, and it is a decision, and as heartbreaking as it may be to the nurses, it is beyond devastating to the parents.

    As nurses, we can only support choices. And the choices are personal and unique. And based on thought processes that are a parent's own.

    We can only keep their babies warm and dry and fed. And as comfortable and peaceful as possible. And God bless each and every one of the nurses that take care of these children. It is devastating, and it takes a special nurse. Thank you each and every one.
  6. 0
    Well,yes,most are vent dependent.

    Some can breathe on their own for 1 to 2 hrs max.
    Others can be off the vent for 5 hrs max,and then breathing becomes haywire.

    So,I guess they are in a vegetative state?
    The only things I see are aw/as cycles in the charts.
    I also see "global developmental delays".

    Most have been on vents longer than 4 yrs.
    All my "kids" are under age 9
  7. 0
    I guess I don't understand why the Doctors in the California case don't place the trach and gtube,and vent, and send the child home with 16 private duty nursing.

    I don't see what's so hard about that. Instead,they want to make the decision for mom,which is wrong.
  8. 11
    Quote from smartnurse1982
    Well,yes,most are vent dependent.

    Some can breathe on their own for 1 to 2 hrs max.
    Others can be off the vent for 5 hrs max,and then breathing becomes haywire.

    So,I guess they are in a vegetative state?
    The only things I see are aw/as cycles in the charts.
    I also see "global developmental delays".

    Most have been on vents longer than 4 yrs.
    All my "kids" are under age 9
    If they breathe they are not brain dean....self resps are an indicator that brain stem function exists.
    SoldierNurse22, psu_213, NRSKarenRN, and 8 others like this.
  9. 21
    Quote from smartnurse1982
    I guess I don't understand why the Doctors in the California case don't place the trach and gtube,and vent, and send the child home with 16 private duty nursing.

    I don't see what's so hard about that. Instead,they want to make the decision for mom,which is wrong.
    We of course don't know the whole story. Chances are this child is on meds to keep her B/P "normal" she is probably on a hyperthermia blanket to maintain normothermia. It has been determined by several medical experts including one from outside the hospital that brain function has ceased. It is cruel and futile to "follow" the parents wishes...there is no life to save. I'd bet a hundred dollars that insurance won't pay for her to go anywhere or have anything done because she is brain dead.

    She is deceased. You cannot live without a brain. Feeding her will NOT help. A trach is unnecessary...she is legally and clinically deceased. The facility is not making a decision for the Mom...this poor child died and modern medicine has kept her body with a beating heart because she is 13 years old. Any and all decisions were made when her brain died. There are no brain transplants. There are no reversal techniques to repair the damage to her brain. She is gone.

    This family is crazy with grief and maybe guilt....for it is reported that the child had a feeling that something would go wrong and I am sure the mother said as mothers do..."Oh honey everything will be just fine" and it wasn't. My heart aches for this family.

    There seems to be no one at "fault"...it is one of the horrible things we see in medicine to remind us we don't hold all the cards nor have all the answers.
  10. 10
    Quote from smartnurse1982
    I guess I don't understand why the Doctors in the California case don't place the trach and gtube,and vent, and send the child home with 16 private duty nursing.

    I don't see what's so hard about that. Instead,they want to make the decision for mom,which is wrong.
    Because the child in California is dead. We don't perform surgery on dead patients unless it is to harvest organs. The actions of the hospital in California are well within established ethical guidelines. Brain death is determinant of death in all 50 states and family consent is not required to withdraw support once brain death has been determined. The hospital is 100% correct when they say that they are not under any obligation to continue to provide medical care to corpse. There's no way this child would qualify for private duty nursing. She is dead, the insurance company is no longer paying for her medical care. They are not going to grant the family the maximum number of PDN hours to provide nursing care for a dead child at home.

    Bioethicist: Girl's tragic case can't change reality of brain death - NBC News.com

    http://www.csmonitor.com/USA/Justice...ilies-disagree

    Your patients are not dead.
    SoldierNurse22, psu_213, Luckyyou, and 7 others like this.
  11. 0
    Yes,they can breathe on their own(some can) but if they were left off the vent and 02 for 2.5 hrs longer,then they would die.

    I'm sorry if I sound like an idiot,but I don't understand,seeing as I take care of kids in similiar situations.

    The boy I described earlier only had an EEG;parents won't consent to other tests.
    His pupils also don't react when light is shown into them.
    Their religion also states that death occurs after the heart stops beating.
  12. 11
    Quote from smartnurse1982
    Yes,they can breathe on their own(some can) but if they were left off the vent and 02 for 2.5 hrs longer,then they would die.

    I'm sorry if I sound like an idiot,but I don't understand,seeing as I take care of kids in similiar situations.

    The boy I described earlier only had an EEG;parents won't consent to other tests.
    His pupils also don't react when light is shown into them.
    Their religion also states that death occurs after the heart stops beating.
    You do not take care of kids in similar situations.....again if they breathe at all once removed from the vent they are NOT brain dead.

    Pupils not responding doesn't conclude brain death it concludes brain damage. Not all comatose patients are brain dead.

    Are you a RN? What is so confusing.


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