This question pertains strictly to near drowning. My son suffered an anoxic brain injury 2 yrs ago from a near drowing and nothing was done to relieve the edema or the increased ICP. No drugs...nothing. They didn't even measure is ICP. Told me there was no use since there was nothing they could do and he would probably die by morning anyway. Some trauma docs have such lovely bedside manner.
This was a level 1 pediatric trauma doc. Think he could have had a little more compassion?? He made the decision on his own that my son wouldn't recieve treatment for his brain injury. I have the doctor's notes. It makes me sick that he was just going to provide supportive measures but no treatment and allow my child to die.
I do know now that there were things they could have done, but at the time I was not a nursing student....just a mom. He only got the code drugs....epi, atropine, lidocaine, bicarb. No diuretics....no Mannitol...nothing. He did get fentanyl and versed though when the decerebrate posturing started.
Another mom of a near drown told me the docs told her that swelling is not the only problem....only if ICP is involved. If increased ICP is involved then there are things they can do like surgery. Since anoxia causes global injury and edema, not localized like a TBI would, how could any surgery or, in this mom's words "techniques" be done that would help?
Is it possible to have cerebral edema without increased ICP? Seems to me the edema from lack of oxygen would cause the increased ICP in a near drowing incident. Or is there something else, other than edema from anoxia, that could cause the increased ICP in near drowning? Sorry to ramble, but her statements just didn't make sense to me. I haven't, and won't question this mom on this, but I'd like to make sense of it. I suppose if there was minimal edema that ICP may not be an issue, but most of these kids suffered massive edema. I hope I'm making sense trying to explain this!
Thanks a lot for any info,
Feb 1, '04
Confusing that they didn't try Decadron or Solu-Medrol to reduce the cerebral edema--I know that now they are falling out of favor, but 2 years ago Decadron, especially, was still very much in use for that purpose. One wonders why they didn't follow the standards in effect at that time.
I don't think a subarachnoid screw would have been that invasive either--it's not like a full-blown craniotomy or a trip to the O.R. was needed for that----easy enough to put in at the ICU bedside with a single burr hole created with a cordless drill by a neurosurgeon--why not monitor ICP utilizing this very simple technique? Could it have hurt? As an O.R. nurse, I have accompanied many a neurosurgeon to the ICU to insert a subarachnoid screw for cerebral edema whatever the underlying cause--
Obviously none of us can be Monday morning quarterbacks here with the limited info available to us--one would have to review the chart in detail to determine what mitigating circumstances there were that influenced the MDs decision.
That said, I think you, as the parent, should have had some say in how aggressive you wanted your son's care to be--even involving the hospiatal administration and ethics committee, if necessary. There was no possible way you could have known about this at the time, though, unless someone advocated for you and suggested it--I was a nurse for a long time before I even knew that a hospital ethics committee existed.
I am so sorry for what you experienced, ohmom2boys, but very glad you have your son and are enjoying every day you have with him.
To passing thru: I thought your response was a bit cold and callous--if you did not mean to come across this way and I misinterpreted you, I apologize--but imagine that this was your child and think how you could have worded your response a bit more empathetically--obviously ohmom2boys is hurting--
Last edit by stevierae on Feb 1, '04