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Girl Brain Dead after Tonsillectomy

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EaglesWings21 is a ASN, RN and specializes in Medical Surgical.

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NotReady4PrimeTime has 25 years experience as a RN and specializes in NICU, PICU, PCVICU and peds oncology.

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I'd like to comment re: ixchel's question about what causes the damage ultimately. While it's true that delayed response to cardiac arrest (such as in an unwitnessed collapse) contributes greatly to a poor neurological outcome, it's just as closely related to the quality and frequency of compressions. If you're not compressing hard enough to crack ribs, you're not compressing effectively. And if you're not compressing at a rate of 100+ per minute, you're not compressing effectively. (Next time you see someone doing CPR on TV, look at their technique. THAT is poor CPR!) Even in a witnessed arrest with immediate CPR, if the compressions aren't effective the neurological outcomes are generally poor. It always makes me feel the greatest relief when a kid we've been coding for however long begins moving shortly after ROSC because that shows us we did good CPR. My most recent experience with this, I saw the arrest coming and marshalled the troops while there was still a pulse. The patient ended up with nearly an hour of CPR, alternating between ROSC and arrest while we cannulated for ECMO. We had no arterial line to assess effectiveness of compressions, but we knew they were good when the surgeon said, "We need either some more sedation or some roc... this kid is moving under the drapes."

One other comment I'd like to make is about defibrillation. In children without a cardiac history, v-fib is a very rare rhythm. The most common shockable rhythms seen in children are v-tach and SVT. We put them on the defibrillator monitor so we have the capability of shocking or transcutaneous pacing if needed, and to have a record of cardiac events. I only bring this up because Jahi was a pediatric patient so PALS would have been initiated (rather than ACLS) and cardiac arrest in children is usually for different reasons than in adults.

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bakerbakerRN has 22 years experience and specializes in OR.

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I posted the article on the young Pakistani exchange student because I see parallels to some of the comments we have read on this thread. I think the cost of such care has to be considered. Both the cost of what we would consider futile care in Jahi's case and the cost of any catastrophic illness on the system. We have to face the fact that health care is NOT limitless. I saw something similar with the family member of a co-worker. He was a legal immingrant, woefully unde-rinsured,working in local agriculture in my area. He was employed by a business that typically employs legal and illegal immigrants, under or un- insures them, pays them a pittance, provides lodging that I would consider inadequate for a pet. He suffered massive stroke and was in PVS, trached but breathing without support, tube fed. No rehab would accept him, no family stepped forward to take him home (there were some in the area) He died before the hospital could ship him south of the border which was exactly what they told the local family they were going to do.No one claimed his body and the last I heard they were fighting over the $500.00 his co-workers collected to bury him.

I agree!

I can't even begin to list all the issues that arise from advancing medical technology, allowing more and more people to continue to "live" past an event that 20 years ago they would have died and been buried from. I think that's why this Jahi case is so interesting and infuriating. Eventually, limits are going to have to be set and laws are going to have to be put in place to prevent hospitals and LTC facilities from filling up with the bodies of humans that shouldn't be there in the first place. I will be very angry if I don't have any closure with this thing. I hope to God this same thing doesn't have to happen over and over again before anything is done about it.

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Eventually, limits are going to have to be set and laws are going to have to be put in place to prevent hospitals and LTC facilities from filling up with the bodies of humans that shouldn't be there in the first place.
Agreed, but the big question: who gets to choose those limits and write those laws? :confused:

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I am not a nurse but I am very interested in the medical aspect of Jahi's case. I joined this forum specifically to say how helpful it is. It answers so very many questions I had. And thank you, you wonderful nurses, for all that you do!

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klone has 14 years experience as a MSN, RN and specializes in Women's Health/OB Leadership.

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Very good point. I certainly understand the euthanasia/assisted suicide folks more now. However that hasn't changed my mind about legalizing it.

I'm a hospice nurse and we are able to help people die without pain and in a peaceful manner.

And my husband, who has been a hospice nurse his entire career, is firmly in favor of it. He thinks, and I wholeheartedly agree, that Oregon has the right idea.

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ktwlpn is a LPN, RN and specializes in Med Surg, Homecare, Hospice.

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A family member of mine who had estranged himself from the family for years due to substance abuse and psych problems was found dead in his mobile home one summer. Forensics established he had died sitting on his sofa in the spring before he turned on the air conditioning.He was found surrounded (literally) by empty liquour bottles . A family member found him in August . His brother, an EMT ,went into the home. He has seen some horrible things but this was the worst and not just because it was his brother. He told me a little about the fluids, smell and appearance of the body(more then I wanted to hear) Very few objects could be salvaged ,everything from one to the other of the home had that smell. The place had to be burned down.

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And my husband, who has been a hospice nurse his entire career, is firmly in favor of it. He thinks, and I wholeheartedly agree, that Oregon has the right idea.

Yep - in our hospice team (there are 7 of us) . . . .we have disagreement over this as well. Never meant to imply that a hospice nurse would only be against assisted suicide.

:)

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OC_An Khe has 40 years experience and specializes in Critical Care,Recovery, ED.

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Agreed, but the big question: who gets to choose those limits and write those laws? :confused:

"We the people" but only if we engage and are active in the political process. We get the government, laws, and the enforcement of those laws we vote for.

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224 Posts; 6,541 Profile Views

"We the people" but only if we engage and are active in the political process. We get the government, laws, and the enforcement of those laws we vote for.
Absolutely true, but what happens when we the people cannot come to a consensus? 51% may be a majority but not represent a consensus. It's very difficult. :banghead:

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OC_An Khe has 40 years experience and specializes in Critical Care,Recovery, ED.

1,018 Posts; 10,964 Profile Views

Absolutely true, but what happens when we the people cannot come to a consensus? 51% may be a majority but not represent a consensus. It's very difficult. :banghead:

Democracy is. NOT easy. Sometimes it moves very slowly and requires years of effort to build a consensus. We just have to keep working at it. It is one of the genius aspects of our founders

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