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.
Soomeone has a prior thread on aLLnurses(its closed now) titled "Icu nurses...do you talk to brain dead pts"? Its very interesting,and by reading that,you would be really surprised the number of nurses who don't know the difference(heck,even Doctors)
In the old Allnurses topic I referenced above,Talexandria even wrote that the staff on the Neuro unti even refer to pts as "brain dead" when they weren't.(pg 6).Also,a nurses wrote in that thread she believes brain dead pts can hear.
As I said on the first page,my pt has flat EEG waves. In England,they don't even need to do an EEG to determine brain death.On that thread,most were saying an EEG is a definite determination of brain death,in addtion to other tests.At least 2 nurses said they woke up after being declared brain dead.
From what I've read there are differences state to state although not being from the US I have no idea if this is true, no legally required minimum level of medic and the EEG, doplar, CTA are used as ancillary tests to confirm brain function has ceased.
This is an interesting read discussion the need for international guidance and some major differences between nations
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
In the old Allnurses topic I referenced above,Talexandria even wrote that the staff on the Neuro unti even refer to pts as "brain dead" when they weren't.(pg 6).Also,a nurses wrote in that thread she believes brain dead pts can hear.
That thread is 10 years old and like everything in medicine things change as we grow and learn. While I don't think brain dead patients can hear...I still talk to them. It is the right/respectful thing to do. I talk to patients during post mortem care.
If they are hanging out up in the corner of the room....I don't want them meeting me at the pearly gates telling me I was disrespectful
That thread is 10 years old and like everything in medicine things change as we grow and learn. ***While I don't think brain dead patients can hear...I still talk to them. It is the right/respectful thing to do.***** I talk to patients during post mortem care. If they are hanging out up in the corner of the room....I don't want them meeting me at the pearly gates telling me I was disrespectful
Are you saying its possible the 13 yr old in Cali. Isn't brain dead,because she has lived too long?Are you saying its possible for brain dead pts to have cardiac death even if they are on a vent and pressors?
Are you saying its possible the 13 yr old in Cali. Isn't brain dead,because she has lived too long?Are you saying its possible for brain dead pts to have cardiac death even if they are on a vent and pressors?
Where in the world did you see anyone imply anything like you've inferred above anywhere in this thread? "Isn't brain dead because she has lived too long"? That's a contradiction in terms and pretzel logic that the likes of Auntie Anne would struggle to answer.
As I said on the first page,my pt has flat EEG waves. In England,they don't even need to do an EEG to determine brain death.On that thread,most were saying an EEG is a definite determination of brain death,in addtion to other tests.At least 2 nurses said they woke up after being declared brain dead.
You've mentioned the UK a couple of times. Is that your location? Neither you not your supervisors know the difference between PVS, brain death and other brain injuries? It must be quite an agency.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Are you saying its possible the 13 yr old in Cali. Isn't brain dead,because she has lived too long?Are you saying its possible for brain dead pts to have cardiac death even if they are on a vent and pressors?
NO! That isn't what anyone said at all.
Yes....this child in California WILL DIE regardless of pressors and the vent eventually. Her supported system cannot survive for an extended period of time before they will shut down and die. Because she is 13 this process can take longer but it WILL happen. She will become edematous and weep fluid if she isn't already, her kidneys will fail, she will get an overwhelming infection and the heart will stop.
I just don't have a crystal ball to give you a day date and time but cessation of a heart beat is imminent.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
You've mentioned the UK a couple of times. Is that your location? Neither you not your supervisors know the difference between PVS, brain death and other brain injuries? It must be quite an agency.
New Jersey. They are in New Jersey. I posted an article/source about brain death protocol in one of these threads that included England's protocol which is one of the places, if not the only place, that doesn't' require EEG silence.
I believe the OP is referencing this post, made yesterday:
The brain stem is what determines life or death. It is responsible for those unconscious functions of the body such as breathing . As a former critical care nurse I am concerned that they are saying brain death and it may actually be persist any vegetative. All the years of experience I have with those declared with brain death generally die regardless of the ventilator and/ or pressors. The body will ultimately die on its own. She has been "alive" way too long since it was evaluated.
Funny when the Karen Ann Quinlan case made headlines about 30 yrs ago they said she was brain dead too. She lived another 10 yrs after she was removed from the vent.
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smartnurse1982
1,775 Posts
Soomeone has a prior thread on aLLnurses(its closed now) titled "Icu nurses...do you talk to brain dead pts"? Its very interesting,and by reading that,you would be really surprised the number of nurses who don't know the difference(heck,even Doctors)