Are my pts "brain dead"?

Nurses Relations

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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.

Specializes in Emergency, Telemetry, Transplant.
I don't work in Neuro;I actually work in Private Duty peds.In any event,I had it explained better on that forum,and I guess its because they understand.

They understand what? Or they gave you the answer you wanted to hear?

I'm sure the family in California knows that they (and a select few others, like they lawyer) understand that their child is not braid dead and she will wake up any day. The hospital and the independent physicians just don't know what they are talking about, and their explanations are just wrong.

Specializes in HH, Peds, Rehab, Clinical.

We get that you don't work in neuro, it the fact that you work with children on vents with varying degrees of response and you seem to have no grasp of whether they have brain function or not...

I don't work in Neuro;I actually work in Private Duty peds.In any event,I had it explained better on that forum,and I guess its because they understand.The poster over there said when a child is born with "loss of brain function,its different than if the child was normal became like that through an accident,for example.I think its better known as "Global Developmental Delays" to me and to the other posters in the Private Duty Forum.

Gosh,I grasp it.I said that a few pages ago. I can "see" that they can't respond,move purposely,etc.We often don't get the full "report" in the home charts. Anyways,as I ve said,I've never seen "PVS" in any home care chart,but now I know why.I'm done,close the damn thread now. If nurses act this way online,then I can only imagine working with them

Never said that either.The whole story isn't being told;I understand we only have one side...it never occured to me she might be on BP meds or unable to obtain a temp.None of that was said.

Specializes in Pediatric Pulmonology and Allergy.

When you're working as a nurse in ANY specialty you don't just put in your 8 or 12 hours and leave. Part of being a nurse is putting in constant effort to reflect on your cases, to read, study, ask questions, attend seminars and continuing education, etc. That's why it's surprising when someone claims to be working in a field for 9 years and doesn't seem to have a grasp on the basics. I guess it's better late than never, but I would start with reading some online articles or ordering some books on PVS versus brain death, rather than relying on online forums for information.

http://jama.jamanetwork.com/article.aspx?articleid=183564

http://onlinelibrary.wiley.com/doi/10.1111/dmcn.12031/full

http://cet.sagepub.com/content/7/3/128.short

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093212/

http://www.els.net/WileyCDA/ElsArticle/refId-a0002212.html

https://www2.aap.org/sections/bioethics/PDFs/Curriculum_Session12.pdf

Specializes in HH, Peds, Rehab, Clinical.

SO well put, Jeanette!

Specializes in Complex pedi to LTC/SA & now a manager.
Never said that either.The whole story isn't being told;I understand we only have one side...it never occured to me she might be on BP meds or unable to obtain a temp.None of that was said.

Of course none of that was said, the family is not permitting the hospital to release the details and is only releasing their myopic view of the situation but they did complain that the IV medications and vent settings were being adjusted in relation to monitor data. The family is putting up a front of denial and thus limiting release of the truth.

A brain dead patient being "preserved via artificial means" requires cardiopulmonary support via ventilator, pressor drugs & IV fluids, external temperature control via hypothermia blankets. The brain stem is dead so there is no intrinsic respiratory drive, rhythm, or blood pressure only mechanical ventilation & biochemical support. The hypothalamus no longer functions so there is no temperature regulation. There is no spontaneous movement to reposition so specialized heated air mattresses are required to hold off skin breakdown. Digestion will shut down soon so a PEG & tube feeding is a waste of time. If left long enough there will be multiorgan shut down as the drugs will only work so long to artificially provide metabolic homeostasis, then the kidneys shut down and the liver stops filtering toxins.

You can review your A&P texts and pathophysiology texts if needed for more understanding or search medscape or the nih for multi-organ system failure to see what happens. Or review some organ procurement service sites to see why time is of the essence in organ procurement from a brain dead individual.

Of course none of that was said, the family is not permitting the hospital to release the details and is only releasing their myopic view of the situation but they did complain that the IV medications and vent settings were being adjusted in relation to monitor data. The family is putting up a front of denial and thus limiting release of the truth. A brain dead patient being "preserved via artificial means" requires cardiopulmonary support via ventilator, pressor drugs & IV fluids, external temperature control via hypothermia blankets. The brain stem is dead so there is no intrinsic respiratory drive, rhythm, or blood pressure only mechanical ventilation & biochemical support. The hypothalamus no longer functions so there is no temperature regulation. There is no spontaneous movement to reposition so specialized heated air mattresses are required to hold off skin breakdown. Digestion will shut down soon so a PEG & tube feeding is a waste of time. If left long enough there will be multiorgan shut down as the drugs will only work so long to artificially provide metabolic homeostasis, then the kidneys shut down and the liver stops filtering toxins. You can review your A&P texts and pathophysiology texts if needed for more understanding or search medscape or the nih for multi-organ system failure to see what happens. Or review some organ procurement service sites to see why time is of the essence in organ procurement from a brain dead individual.
I don't think the explanation can get any better than that!
Specializes in Pedi.
I get that......yes,they have provided the info.After that,I didn't say anything.Where did I say I disagree??????Anyway,I am one of those people who don't put trust in every word a Dr says....Basically,that's who is making the decision in the case of the 13 yr old.

Actually, the judge is the one who made the decision in this case after SIX MDs separately assessed her and agreed that she is brain dead. Who do you presume is more qualified to diagnose brain death than a Neurologist?

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I get that......yes,they have provided the info.After that,I didn't say anything.Where did I say I disagree??????Anyway,I am one of those people who don't put trust in every word a Dr says....Basically,that's who is making the decision in the case of the 13 yr old.
here are the court released documents about Jahi....the 13 year old girl that is brain dead. It goes over physical findings for brain death

http://media.nbcbayarea.com/documents/Fisher+-+Redacted+Rpt_1.pdf

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
.I think its better known as "Global Developmental Delays" to me and to the other posters in the Private Duty Forum.

No, "global developmental delays" does not mean loss of brain function. It just means that a child has developmental delays that span most areas (speech, cognitive, fine motor, gross motor, etc). My daughter had global developmental delays as an infant and toddler - she did not suffer a brain injury, nor did she have loss of brain function (she's now a mostly normal 13yo - as "normal" as 13yo girls can be, I guess).

Specializes in Complex pedi to LTC/SA & now a manager.
No "global developmental delays" does not mean loss of brain function. It just means that a child has developmental delays that span most areas (speech, cognitive, fine motor, gross motor, etc). My daughter had global developmental delays as an infant and toddler - she did not suffer a brain injury, nor did she have loss of brain function (she's now a mostly normal 13yo - as "normal" as 13yo girls can be, I guess).[/quote']

This was thoroughly explained in the PDN forum. Many posters explained that global developmental delays refers to delays in several areas motor, fine motor, speech, cognitive etc. and Esme posted a standard definition of global developmental delays.

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