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.
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.
If you are referring to Jahi McMath, no, they are not confusing PVS with brain death. The child has been assessed more than once and has met all the criteria for brain death. She has been declared brain dead and therefore legally dead by the court as well, which would not be the case if the patient is simply PVS. The hospital would not be able to insist on disconnecting life support if this was PVS rather than official brain death. That would clearly be a decision for the parents and this would never have made national news.
As to Karen Quinlan, her EEG showed abnormal slow wave activity, indicative of PVS. Her parents were the ones who wanted her off the vent. The hospital fought them, but when they finally won, they did keep her on feeding tubes. She lived on in her PVS for 10 years. This case was very important as it gives loved ones the right to terminate measures they believe their loved ones don't want as either explicitly stated in legal directives or simply verbally to family. The two situations are very very different.
My heart aches as I consider the psychology of the denial of the girl's family.
I start to get a little testy when reading statements from the family's attorney such as "the hospital has refused to order a physician to perform the procedures (trach/PEG) ..." ... dude - a surgeon cannot be "ordered" to perform a procedure - and you might want to know that before making public/court statements that make you look like an uninformed jackass.
But when I read twisted illogic from a nurse whose stated specialty is caring for children who require mechanical ventilation due to considerable brain disability ... I am truly disturbed.
Specializes in Oncology; medical specialty website.
My heart aches as I consider the psychology of the denial of the girl's family.
I start to get a little testy when reading statements from the family's attorney such as "the hospital has refused to order a physician to perform the procedures (trach/PEG) ..." ... dude - a surgeon cannot be "ordered" to perform a procedure - and you might want to know that before making public/court statements that make you look like an uninformed jackass.
But when I read twisted illogic from a nurse whose stated specialty is caring for children who require mechanical ventilation due to considerable brain disability ... I am truly disturbed.
I seriously question her credentials, although yesterday I read a post on another site from an RN who was equally clueless regarding A&P, all the while claiming to have extensive experience in taking care of patients like Jahi. She also said that several of her "brain dead" patients woke up and recovered.
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.
Yes,someone on the previous page was from the UK,and in her articles it indicates EEG isn't needed in Europe.The concept isn't applied consistently throughtout the world. I just read on another site Nj recently(3 months ago) ammended its brain death definiton.
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.
This is the post I'm referring to.It seems what she is saying is that the 13 yr old has lived to long to be considered "brain dead".It seems she is saying that if Jahi was "dead",she would have died long time ago.Am I misinterpreting what you are saying?
Well,what do you know.I made a post back in 2008 asking were my pts in a vegetative state.Guess what the answers were?Most said "no".One poster did say they are,but its insensitive to refer to them as such.Therefore,my pts are brain dead,nor are they in a Pvs state either. They fall within the gray area.
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
I read the old posts of Allnurses,and they were saying an EEG with no waves was the surest way to know that a pt was brain dead.Remember,I did say a few pages back Mom said my pt had no EEG waves when he was tested in the hospital.THAT IS WHERE CONFUSION came in for me.
Going by the definitions posted above,that means Terri Schiavo was alive??????
She was in a persistent vegetative state, not brain dead. However, that doesn't mean that she wanted to be like that, and that was what the legal struggle was all about. Completely different issue than the one at hand.
Aparently,two pts....Zack Dunlap and Stephen Thorpe,were declared"brain dead" yet woke up.Google them. No,they were in a vegetative state nor coma,and on was on the table to have his organs harvested.It isn't as simple as brain dead is dead.The Terri Schiavo Foundation is assisting the family with finding other arrangements.Why can't they send her home on hospice at least?(Of course,with tubes and vents)What really got me annoyed is that Mom is reporting that some hospital staff,including nurses,are referring to her child as "that body" and "deceased".I really hope that isn't true.
Horseshoe, BSN, RN
5,879 Posts
If you are referring to Jahi McMath, no, they are not confusing PVS with brain death. The child has been assessed more than once and has met all the criteria for brain death. She has been declared brain dead and therefore legally dead by the court as well, which would not be the case if the patient is simply PVS. The hospital would not be able to insist on disconnecting life support if this was PVS rather than official brain death. That would clearly be a decision for the parents and this would never have made national news.
As to Karen Quinlan, her EEG showed abnormal slow wave activity, indicative of PVS. Her parents were the ones who wanted her off the vent. The hospital fought them, but when they finally won, they did keep her on feeding tubes. She lived on in her PVS for 10 years. This case was very important as it gives loved ones the right to terminate measures they believe their loved ones don't want as either explicitly stated in legal directives or simply verbally to family. The two situations are very very different.