Are my pts "brain dead"?

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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.

Brain death has certain protocol to determine brain activity/circulation. American Academy of Neurology Guidelines for Brain Death Determination | Welcome to Clinical Operations | Life Alliance Organ Recovery Agency at Miller School of Medicine

While many patients may be in a persistent vegetative state....they will show at least some brain activity and have some brain stem function intact. A persistent vegetative state IS NOT brain dead.

There are no wake sleep cycles. There are no purposeful movements. They will not withdrawal to pain. There maybe some spinal reflexes at first but those fade as well.Without the brain there is no life.

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Specializes in Complex pedi to LTC/SA & now a manager.
Yesthey 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. [/quote']

The California teen has NO respiratory effort whatsoever not 2-2.5 hours, not 2 seconds. She only has BP due to drugs.

She is dead. Having spontaneous respiratory effort even for 2 hours is not dead. There are a variety of reasons neurologically impaired/damaged patients require ventilate support including respiratory conditions

So,I think that to be considered brain dead,a person cannot have spontanoeous respirations.

If so,I guess my pts aren't brain dead?

And yes,my pts don't respond to painful stimuli.

I understand clearly that in Nj parents get to decide who pulls the plug,not doctors.

That's the main reason I was confused,among othet things.

I haven't read that she has no spontanoues respirations.

I did read,howvever,that if a person's puplis don't respond to light,that's a signal that separates brain dead from persistant vegeaive state.

None of the 485's I've reas ever stated those things.

Please,be patient with me,as my heart is really heavy for the 13 yo's family.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

What do you mean the parents decide to "pull the plug" in New Jersey....?

Yes,I'm an RN. I've been a nurse for 9 yrs.

As I said,I'm confused. Do you expect me to know everything?

I don't,and that's why I'm asking. I work in home care,and I I understand,its different from the hopsitals

Mom(who is an RN) told me the doctor asked her if she wanted to pull the plug,and mom said the DR gave her an option of putting a trach and gt in place. This happened when the boy couldn't breathe on his own(he was really,really sick)

Specializes in Pedi.
Mom(who is an RN) told me the doctor asked her if she wanted to pull the plug,and mom said the DR gave her an option of putting a trach and gt in place. This happened when the boy couldn't breathe on his own(he was really,really sick)

That's not the same- AT ALL-as the California case. The child in question here isn't dead. It's always the parents' choice whether they want to treat their living child with interventions such as trachs, chronic vents and G-tubes. For a dead child- no hospital or MD is under any obligation- moral, ethical or legal- to continue treatment.

Specializes in Pedi.
So,I think that to be considered brain dead,a person cannot have spontanoeous respirations.

What organ controls spontaneous respirations? If it was dead, how would the person breathe?

If so,I guess my pts aren't brain dead?

No, they are not. Look at what you said they do. They have awake/asleep cycles. They can breathe on their own for short periods of time. Brain dead persons have NO BRAIN ACTIVITY. They are never awake and they do not breathe- at all- once removed from the vent.

And yes,my pts don't respond to painful stimuli.

Well, there are a number of possible etiologies for that, for one. Though what do you mean, they "don't respond"? You said they have awake periods, so they open their eyes at some point. What do they do if you sternal rub them? Some of them may be quadriplegic.

I understand clearly that in Nj parents get to decide who pulls the plug,not doctors.

That's the main reason I was confused,among othet things.

For your patients, who are alive. For brain dead patients, ethically and legally hospitals/doctors do not need consent to withdraw support.

I haven't read that she has no spontanoues respirations.

Who? The child in California? She has been declared brain dead, which means she has failed an apnea test. AL brain dead persons do not have spontaneous respirations.

I did read,howvever,that if a person's puplis don't respond to light,that's a signal that separates brain dead from persistant vegeaive state.

Not necessarily. There are any number of reasons why someone might have non-reactive pupils. I have known many awake, alert and oriented patients over the years with pupils that don't respond to light. Many blind persons' pupils don't. I would bet a good number of your patients are blind.

None of the 485's I've reas ever stated those things.

Stated what things?

Please,be patient with me,as my heart is really heavy for the 13 yo's family.

I don't think there's anyone on here who doesn't feel for the child's family. We can, however, look at the situation objectively and realize that she is dead and no amount of court orders or media articles are going to change that.

Specializes in Critical Care.

Basically brain dead is dead, there is no potential for recovery, truly zero% chance of recovery. A vegetative state has a progressively worsening chance of recovery which may never reach true zero, even though it might be .00001% at some point. Brain death does not require decision makers to decide at what point the chances of meaningful recovery are too low to continue care, that as far as we know may involve at least some form of misery. Other than organ harvest and related procedures, there is no purpose in performing any procedures on a brain dead patient.

Denial is one of the stages of grief, and anything that facilitates that stage is often utilized by loved ones, and few things support that better than the ability to mimic signs of life such as a heartbeat and circulation, even though we're just moving blood through an otherwise lifeless vessel, which is the difference between 'life support' and what is better referred to as 'denial support'.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

You could have been a CNA.

There are cases like the ones you care for that are not so clear cut as brain death. In medicine there is a a lot of grey.

The children you care for have suffered irreversible brain damage that have left them in a comatose/semi-comatose state with no hope of recovery. In these cases the parents are given an option of what is called a terminal wean in which the ventilator support will be removed and the child allowed to die of "natural causes". [h=3]Pediatr Crit Care Med[/h]This is a situation where the parents are giving a choice...to leave their child in this persistent vegetative state (which many parents do) or withdrawal life support and let them go.

This 13 year old girl is nOT one of these cases she has no brain or brain stem function....she is clinically dead and in some sates life support can be withdrawn without "permission"....California is not one of them. However all MD want the family on the same page before removing life support but they are not obligated to do this.

[h=3][/h]

Specializes in HH, Peds, Rehab, Clinical.

Because there is NO brain activity. Why should the hospital have to eat the costs of performing those surgical procedures on a patient who is, for all intents and purposes, dead.

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.

Specializes in HH, Peds, Rehab, Clinical.

Yup, if you take away MY source of ventilation for 5 hours, I'd be dead too. Chance to say anyone of us here would be..

Right, they WILL die after several hours off the vent- they are not already dead. A brain dead person has ZERO brain function, including the brain stem which controls the most primitive functions. They will not take one single breath once support is withdrawn.

The kids you take care of are not in similar situations. They are not dead.

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