Are my pts "brain dead"?

Published

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.

Specializes in HH, Peds, Rehab, Clinical.

Noone expects you to know everything, but considering this is your "specialty", I think this is where some of us are doing the one-eyed squint while wrinkling our nose and tipping our head as we read some of your questions pertaining to how this process works...

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

Up Vote Up Vote ×
Specializes in Advanced Practice, surgery.

These are useful articles around PVS and MCS

http://www.thehastingscenter.org/Publications/BriefingBook/Detail.aspx?id=2166

http://www.rcplondon.ac.uk/sites/default/files/documents/vegetative-state.pdf

Up Vote Up Vote ×

Well,considering my supervisors couldn't answer the question either......Anyway,I guess my pts are in a persistant vegeative state,even though its a grey area.I can't stand this site....most have given good answers,but there persists a few on here that get snarky every chance they get. Geez.First,there was NO need to.Second,European countries and the Usa have different definitions of brain death. There is no one size fits all.Third,I don't know of all the facts in the Cali case,so I'm only going by what I've read.

Up Vote Up Vote ×

Yes,medically speaking,they sound similiar.The one case I am referring to of mine,she is on simv mode,and she has no spontaneous respirations,according the the respiratory therapist.Her breath rate is 16,and she doesn't breath beyond that

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Well,considering my supervisors couldn't answer the question either......Anyway,I guess my pts are in a persistant vegeative state,even though its a grey area.I can't stand this site....most have given good answers,but there persists a few on here that get snarky every chance they get. Geez.First,there was NO need to.Second,European countries and the Usa have different definitions of brain death. There is no one size fits all.Third,I don't know of all the facts in the Cali case,so I'm only going by what I've read.
Actually in Europe they actually have a "less" stringent definition of brain death and don't require ALL brain activity to have ceased before declaring brain death
This forms the standard for the determination of death by neurological criteria in the USA and most European countries and is based, in theory at least, on confirmation of the loss of all brain function including, but not limited to, the brainstem. Unlike whole-brain death, the diagnosis of brainstem death, such as that used in the UK, does not require confirmation that all brain functions have ceased, rather that none of those functions that might persist should indicate any form of consciousness.6 The determination of brainstem death requires confirmation of the ‘irreversible loss of the capacity for consciousness combined with the irreversible loss of the capacity to breathe’ and relies on the fact that key components of consciousness and respiratory control, the reticular activating system and nuclei for cardiorespiratory regulation, reside in the brainstem.3 Despite the apparent differences, the clinical determination of whole-brain and brainstem death is identical, although the role of confirmatory investigations is different. Patients with preserved cortical electrical activity or intracranial blood flow can be considered to be dead in countries that utilize a brainstem approach but not in those where a whole-brain concept is applied. http://bja.oxfordjournals.org/content/108/suppl_1/i6.full
I don't think people are being "snarky" when they are just trying to educate you about something that you admit you know little about.

Where brain death is concerned...there is no grey. You are either brain dead or you are not. The grey comes in when there are apparent similarities like a lack of respiratory effort and non responsiveness that mimic "brain death" when in fact they are NOT brain dead.

Just because a patient shows no respiratory effort doesn't mean they are brain dead and have no brain function

no spontaneous respiration's,according the the respiratory therapist.Her breath rate is 16,and she doesn't breath beyond that
You say according to the respiratory threapist...I would hope you are able to assess this yourself and not go on someone else's word.

We have pointed this out several times I am not sure what you are unclear about. Brain death is a process that involves specific criteria to determine that brain function has ceased. While your patients on home vents may appear to have no self respiration and response means they have suffered irreversible brain injury but that is NOT criteria for brain death...they are not similar at all.

Up Vote Up Vote ×

Going by the definitions posted above,that means Terri Schiavo was alive??????

Up Vote Up Vote ×

Terri Schiavo didn't have a vent nor a trach.She only had a feeding tube.

She actually had spontaneous respirations.

She had brain stem function.

Up Vote Up Vote ×
Specializes in Complex pedi to LTC/SA & now a manager.
Going by the definitions posted abovethat means Terri Schiavo was alive??????[/quote']

Initially Terry Schiavo was in a persistent vegetative state. I don't recall the specifics but she may have been a terminal wean off the vent.

Up Vote Up Vote ×
Specializes in Pedi.
Going by the definitions posted above,that means Terri Schiavo was alive??????

Terri Schiavo WAS alive. She was in a persistent vegetative state with no hope of recovery/improvement. She had been living in a nursing home dependent on a feeding tube for 15 years. Her husband's argument was that he was confident she would not want to continue to live like that. I would hope my family would do the same for me.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Going by the definitions posted above,that means Terri Schiavo was alive??????

Of course she was....she breathed on her own that is what made it controversial to stop feeding her....Terry Shiavo and her Mom.

terri_schiavo_and_mom.jpg

http://en.wikipedia.org/wiki/Terri_Schiavo_case

Up Vote Up Vote ×
Specializes in Pedi.
Yes,medically speaking,they sound similiar.The one case I am referring to of mine,she is on simv mode,and she has no spontaneous respirations,according the the respiratory therapist.Her breath rate is 16,and she doesn't breath beyond that

Again, there are a number of possible etiologies for that. Brain injuries are only one reason why a person might need a chronic vent. People with C1-C3 spinal cord injuries will not breathe on their own at all. They are vented forever from the time of injury as the phrenic nerve (which controls the diaphragm) is no longer stimulated with injuries at this level. They are very much alive. Look at Christopher Reeve (yes, I realize he's dead now but he lived for 9 years as a cognitively intact person on a chronic vent who lacked the ability to breathe on his own).

Up Vote Up Vote ×
Specializes in Nurse Leader specializing in Labor & Delivery.

Terry Schiavo was alive. She was dependent upon feeding tubes with little/no hope for recovery. According to her husband, she did not want to live like that. I wouldn't either.

That's why it's SO important for everyone to have a living will, ON PAPER.

Up Vote Up Vote ×
+ Join the Discussion