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NurseHeart&Soul

NurseHeart&Soul MSN

ED, Critical care, & Education
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NurseHeart&Soul is a MSN and specializes in ED, Critical care, & Education.

NurseHeart&Soul's Latest Activity

  1. NurseHeart&Soul

    CCRN exam and Laura Gasparis lecture

    ANY course put on by Laura Gasparis Vonfrolio is worth the time and financial investment. Laura is one of the nursing greats! You will learn a ton and have a fun time while doing it. I highly recommend her courses. GO FOR IT and good luck on your exam.
  2. NurseHeart&Soul

    Dead or Alive: That is the Question

    Ellie G~. Sounds like you have witnessed some amazing recuperations. Thank you for sharing those stories that are obviously near and dear to your heart. Wonderful that they are both doing so well.
  3. NurseHeart&Soul

    Dead or Alive: That is the Question

    Thank you for your very thoughtful comments that clearly come from some great experience. Much appreciated!
  4. NurseHeart&Soul

    ESI practice thread

    AWESOME idea for a thread!!
  5. NurseHeart&Soul

    ESI practice thread

    Great cases Amy! Keep them coming! I'd make him level 2. Stat CT scan needed for sure. He meets the ESI criteria Decision point B for high risk situation and confusion.
  6. NurseHeart&Soul

    ESI practice thread

    Yes, level 2 and immediate continuous observation put into place.
  7. NurseHeart&Soul

    Dead or Alive: That is the Question

    BSN16, Thank you for adding in the point about the many patients who have a poor prognosis but who may or may never meet brain death criteria. That is wonderful that you are now working with transplant patients. The final piece to this donation series will be a story from a donor mom who knows first hand the value of donation. Thank you for the work that you do!
  8. NurseHeart&Soul

    Dead or Alive: That is the Question

    So glad your nurse friend is alive and well...and working! Awesome! I wonder if there was a confirmatory test done when the statement "no flow to the brain" was made. Sometimes terms are used loosely when in fact there is nothing loose about brain death, no flow to the brain etc... The clinical exam can certainly indicate no flow to the brain but without a confirmatory exam that's not an accurate claim to make. Regardless, sounds like she made an AMAZING recovery which is awesome!
  9. NurseHeart&Soul

    Dead or Alive: That is the Question

    sunny time~ Breakfast? Wow!
  10. NurseHeart&Soul

    Dead or Alive: That is the Question

    Ellie G- I definitely can't imagine being a patient and hearing the discussion about me possibly being an organ donor, and obviously I cannot personally speak to any of the cases mentioned in this article. However, these cases did bring to mind the number of times I interacted with physicians who were not comfortable with pronouncing brain death. A person is never "kind of" brain dead. There are very clear criteria that should be followed and physicians who understand brain death, the criteria, and the confirmatory tests should be the ones determining brain death. I'm not saying miracles never happen... Thanks for your comment.
  11. NurseHeart&Soul

    ESI question

    1) Triage acuity levels are determined by the information obtained and provided not with the help of a subjective opinion like "she is here all the time". That is the type of behavior that will get a patient killed and an ER nurse and facility caught in a legal situation. 2) The initial triage level should NEVER be changed (unless it is by YOU). Your supervisor could make the decision to document why the patient is being downgraded to a level 2 but you are the one with the initial visual of the patient who used your critical thinking skills, experience etc. to come up with the level 1 acuity. Books on triage (see Amazon) further clarify this point. I also agree with many of the other posters on the level 1 decision.
  12. NurseHeart&Soul

    Dead or Alive: That is the Question

    Risk Manager~ Awesome question! In my experience, and in working in the past with coordinators in other regions and states, the practice here tends to vary. The bottom line is when a patient is brain dead technically there is no need for general anesthesia. However, sometimes during the moving process, the donor may become hypertensive, and gas can be administered as a quick and easy way to normalize the blood pressure. Maintaining organ function and stable vital signs throughout the procedure is critical, so in essence anesthesia will often do their job as they know how best in order to maintain needed parameters. Monitoring ventilator settings, O2 sats etc. and adjusting accordingly is still a key role for anesthesia. On a side note, I will say I have seen paralytics given to a brain dead patient in the OR which truly was a comfort measure to the hospital staff not a need for the patient. Thanks for reading and for the great question!
  13. NurseHeart&Soul

    Dead or Alive: That is the Question

    Dead at 0252 hours. I charted, "Pronounced dead by Dr. Smith at 0252 hours. No spontaneous respirations. No visible rise and fall of the chest. Absent breath sounds. No apical heart tones audible via stethoscope. No visible signs of life." During the 45 minutes of cardiopulmonary resuscitation (CPR) on this 55-year-old woman there was no inkling of life. This was enough for the emergency department physician to determine it was time to stop resuscitative efforts. The woman's frail husband sat in a quiet room waiting to hear the status of his wife. I spent the next couple of minutes preparing the room before bringing the husband in. The scattered wrappers from supplies used were picked up off the floor. The intubation tray removed. A fresh gown replaced the blood-stained gown and crisp white sheets were delicately draped over the woman. Only her face and neck were visible along with her left hand that I gently positioned on top of the sheet. Standing at the foot of the bed I gave one last look at the room, and then placed my eyes on the dead woman. Taking that last look to ensure everything appeared presentable to a soon-to-be grieving husband was critical. I was ready to bring the husband to the bedside until I discovered one issue...she was not dead. Or was she? The sheets began rising and falling. I listened for an apical pulse. There was a very regular and rather strong heartbeat. Situations like this make you wonder, how will they know when I'm dead...if I'm really dead? Will someone take my organs for donation if I'm not really dead? This is part 3 of a donation education series that focuses on how brain death and cardiac death is determined. If you haven't read the previous two parts, pause for a moment and read part 1 titled 8 Organ and Tissue Donation Myth Busters and part 2 titled Organ and Tissue Donation: The Facts of Donating Life. Identifying Types of Organ Donors In part 2 we discussed that there are two types of potential organ and tissue donors. These include: Donation after brain death (intubated, on a ventilator, but heart is still beating) Donation after cardiac death (heart has stopped beating) Let's focus first on brain death, because brain death is very confusing to many. The patient will be on a ventilator, the cardiac monitor will often show a beautifully normal heart rhythm, the person looks pink, and appears like they are sleeping. If a person is brain dead by definition they have an irreversible cessation of brain function. They are not sleeping, but rather they are clinically dead. This visual of a loved one can make it difficult for family and friends to process that the person lying on the hospital bed with an often peaceful appearance is actually dead. Determining Brain Death The American Association of Neurology (AAN) uses three cardinal signs to define brain death and this includes: Cessation of brain functioning including the brainstem Coma or unresponsiveness Apnea Understanding the Prerequisites to Brain Death The clinical prerequisites to consider brain death determination include: Clinical condition incompatible with life like trauma, intracranial bleed Neurological imaging that confirms the diagnosis like a CT or MRI Absence of a reversible medical condition like electrolyte or metabolic abnormalities Absence of drug induced coma Normalized core body temperature Evaluating Brain Death via Clinical Testing The clinical assessment to determine brain death requires an absence of all reflexes that includes: Corneal reflex Pupillary light reflex Absent reflexes in the face and maxillary areas Absent cough and gag reflexes Absent occulocephalic reflex known as testing for Doll's eyes Absent occulovestibular reflex (absent nystagmus when cold water is injected into the ear) If there is even a subtle presence of any one of these reflexes then a person is not brain dead. Once all the primitive neurological reflexes are absent, a confirmatory test can be performed to further validate brain death. Confirmatory tests are often what is needed for a family to fully understand that their loved one is brain dead. Performing Confirmatory Testing Two primary tests that are performed to confirm brain death are the following: Testing for the absence of Cerebral Blood Flow with cerebral angiography Performing an apnea test, to confirm the absence of spontaneous respirations Practice Parameter - American Academy of Neurology Determining Brain Death: Who Performs the Declaration of Death Brain death is determined by a medical physician. The requirements for determining brain death vary by state and country. In some areas, one physician can determine brain death and in other areas two physicians are required, often one of those physicians must be a neurologist. A standard practice seen is that these two brain death exams take place six hours apart. Determining Cardiac Death A person can also be declared dead once there is cessation of spontaneous respiratory and cardiac function. This may occur following natural causes, cardiac arrest or, possibly a grim prognosis that leads to the withdraw of life support. Whatever the circumstance, donation of organs or tissues would never occur until after a licensed medical physician declared death. Should you be worried about donating organs prior to death? Absolutely not...unless of course, you willingly consent to be a live donor donating a kidney or liver. Should you be worried donation after cardiac death will occur but you aren not really dead? Maybe you or your loved one are the person who will spontaneously begin to breathe and move the sheets. Don't be worried. Donation after cardiac death does not occur until a person has been declared dead for a minimum of 5 minutes. In the case at the beginning of this article, it turned out the woman was eventually determined brain dead due to anoxia from prolonged down time prior to the onset of CPR. She ultimately became an organ donor. So dead or alive? The answer is clear as long as clinical guidelines are used to determine brain death and an adequate timeframe passes before donation after cardiac death occurs. In part 4 of this series we will learn about donation from the perspective of a donor mother who made the decision to donate her son's organs during the most horrific time in her life. Until next time...Embrace the Journey...wherever your journey may take you!
  14. Myths surrounding organ and tissue donation were discussed in part 1 of this donation education series and were hopefully dispelled. If you missed part 1, you can read it at https://allnurses.com/general-nursing-discussion/8-organ-and-1098026.html. In part 2 of this series, clarification as to what organs and tissues can be donated and when a person may begin to be considered a potential organ donor will be discussed. Identifying Organs and Tissues that can be Donated for Transplantation Heart Lungs (either as a pair or individually) Liver (can be split for two recipients) Kidneys (two) Pancreas Two Cornea Tissues including bone, tendons, ligaments, and cartilage In simple terms, a single organ donor can potentially save the life of eight...yes, eight...individuals. An additional two individuals can benefit from the gift of sight. Tissue donation can potentially benefit hundreds of people when used in orthopedic surgeries such as spine fusions, joint replacements, and hip and knee reconstruction to name just a few. Choosing to be an organ and tissue donor isn't just a small gift but rather a gift that can reach hundreds of people and thousands of miles to recipients in many locations. Recognizing Clinical Conditions that Can Lead to Brain Death Anyone who has sustained a severe neurologic injury can potentially progress toward brain death and make them a potential organ donor. This includes: Severe traumatic brain injury from blunt head injury, gunshot wound etc. Subarachnoid hemorrhage Anoxic brain injury due to prolonged cardiac arrest with a long downtime, drowning, or an intentional or accidental overdose Referring a Potential Donor: The Criteria Criteria for referring a person to the local Organ Procurement Organization (OPO) differs by region and OPO. However, generally speaking, here are some baseline criteria you should know: A possible organ and/or tissue donor is a person who is on a ventilator who has experienced a significant neurological insult with a Glasgow Coma Scale of less than 5. A possible tissue donor is any person who has suffered a cardiac death. Calling the OPO Before Brain Death The patient isn't brain dead. Why would I notify the OPO? What is critical to understand is that notifying the OPO of a potential donor does not mean the person will become a donor or that every possible measure to save the person's life will not be taken. The early call to the OPO allows for an awareness of the patient presence within the critical care area and provides an opportunity to be available in the event the conversation of organ donation arises. Additionally, the hospital is legally required to make the referral call as part of the Centers for Medicare and Medicaid Services participation. The OPO should be notified of the following: All potential donors or deaths If the family begins asking questions about organ donation If a discussion arises regarding withdrawing support Indicating a Desire to Donate: When the Family Brings Up Donation Sometimes as the family is beginning to see the grave prognosis of their loved one, a conversation regarding the possibility of donation may arise. When this occurs, it's recommended the clinical staff do the following: Acknowledge what a wonderful gift the family is considering Let the family know you will contact your local organization who can answer questions about donation Contact the local OPO as soon as possible Individuals specifically trained to discuss organ donation should be the ones to approach the family about the possibility of donation when the right time arises. This is not to say that the critical care nurses and physicians are not key players in the donation process. They most certainly are and no donation would be possible without their knowledge, dedication, and tireless efforts to maintain organ function. Understanding Brain Death Brain death is sometimes used as a loose term in the acute care setting. What is important to note is that brain death is death and is irreversible. Although a person with brain death may appear like they are sleeping, they are not. Brain death is the cessation of all brain activity including brainstem function that inhibits the ability to breathe spontaneously. In part 3 of this series, we will discuss in more detail how brain death is determined prior to an organ donation case proceeding. Failing to Meet Brain Death Criteria: Donation after Cardiac Death Not all patients who meet clinical triggers for a donor referral will become brain dead. Some will improve which of course is always the desired outcome. Others may have a significant neurological injury but do not meet strict brain death criteria. If the prognosis is so grave that the patient will likely die within a short period of time once artificial life support is withdrawn, donation after cardiac death or DCD, may be an option. The recovery of organs takes place only after the patient has been pronounced legally dead. Nationwide approximately 20% of donations now occur following cardiac death. DCD is an added option for families who wish to donate life when brain death criteria have not been met. Thank You To all of you who are registered donors or who have considered the national donor registry, thank you. For those of you interested in investigating further how you can let your wishes surrounding donation known, log onto www.RegisterMe.org Additionally, more information about organ and tissue donation can be found at the United Network for Organ Sharing (UNOS) website located at www.unos.org Until next time...Embrace the Journey...wherever your journey may take you.
  15. Myths surrounding organ and tissue donation were discussed in part 1 of the donation education series and were hopefully dispelled. If you missed part 1, you can read it at https://allnurses.com/general-nursing-discussion/8-organ-and-1098026.html. In part 2 of this series, clarification as to what organs and tissues can be donated and when a person may begin to be considered a potential organ donor will be discussed. Identifying Organs and Tissues that can be Donated for Transplantation The following organs and tissues may be donated: Heart Lungs (either as a pair or individually) Liver (can be split for two recipients) Kidneys (two) Pancreas Cornea (two) Tissues including bone, tendons, ligaments, and cartilage In simple terms, a single organ donor can potentially save the life of eight…yes, eight…individuals. An additional two individuals can benefit from the gift of sight along with potentially hundreds of others through tissue donation. Tissue donation can benefit hundreds of people when used in orthopedic surgeries such as spine fusions, joint replacements, and hip and knee reconstruction to name just a few. Choosing to be an organ and tissue donor isn't just a small gift but rather a gift that can reach hundreds of people and thousands of miles to recipients in many locations. Recognizing Clinical Conditions that Can Lead to Brain Death Anyone who has sustained a severe neurologic injury can potentially progress toward brain death and make them a potential organ donor. This includes: Severe traumatic brain injury from blunt head injury, gunshot wound etc. Subarachnoid hemorrhage Anoxic brain injury due to prolonged cardiac arrest with a long downtime, drowning, or an intentional or accidental overdose Referring a Potential Donor: The Criteria Criteria for referring a person to the local Organ Procurement Organization (OPO) differs by region and OPO. However, generally speaking, here is some baseline criteria you should know: A possible organ and/or tissue donor is a person who is on a ventilator who has experienced a significant neurological insult with a Glasgow Coma Scale of less than 5. A possible tissue donor is any person who has suffered a cardiac death. Calling the OPO Before Brain Death The patient isn't brain dead. Why would I notify the OPO? What is critical to understand is that notifying the OPO of a potential donor does not mean the person will become a donor or that every possible measure to save the person's life will not be taken. The early call to the OPO allows for an awareness of the patient presence within the critical care area and provides an opportunity to be available in the event the conversation of organ donation arises. Additionally, the hospital is legally required to make the referral call as part of the Centers for Medicare and Medicaid Services participation. The OPO should be notified of the following: All potential donors or deaths If the family begins asking questions about organ donation If a discussion arises regarding withdrawing support. Indicating a Desire to Donate: When the Family Brings Up Donation Sometimes as the family is beginning to see the grave prognosis of their loved one, a conversation regarding the possibility of donation may arise. When this occurs, it's recommended the clinical staff do the following: Acknowledge what a wonderful gift the family is considering. Let the family know you will contact your local organization who can answer questions about donation. Contact the local OPO as soon as possible. Individuals specifically trained to discuss organ donation should be the ones to approach the family about the possibility of donation when the right time arises. This is not to say that the critical care nurses and physicians are not key players in the donation process. They most certainly are and no donation would be possible without their knowledge, dedication, and tireless efforts to maintain organ function. Understanding Brain Death Brain death is sometimes used as a loose term in the acute care setting. What is important to note is that brain death is death and is irreversible. Although a person with brain death may appear like they are sleeping, they are not. Brain death is the cessation of all brain activity including brainstem function that inhibits the ability to breathe spontaneously. In part 3 of this series, we will discuss in more detail how brain death is determined prior to an organ donation case proceeding. Failing to Meet Brain Death Criteria: Donation after Cardiac Death Not all patients who meet clinical triggers for a donor referral will become brain dead. Some will improve which of course is always the desired outcome. Others may have a significant neurological injury that does not meet strict brain death criteria yet the patient will likely die within a short period of time once artificial life support is withdrawn and the family wishes to donate the gift of life. In these circumstances, this donation is known as donation after cardiac death or DCD. The recovery of organs takes place only after the patient has been pronounced legally dead. Nationwide approximately 20% of donations now occur following cardiac death. DCD is an added option for families who wish to donate life when brain death criteria have not been met. Thank You To all of you who are registered donors or who have considered the national donor registry, thank you. For those of you interested in investigating further how you can let your wishes surrounding donation known, log onto www.RegisterMe.org Additionally, more information about organ and tissue donation can be found at the United Network for Organ Sharing (UNOS) website located at www.unos.org Until next time...Embrace the Journey…wherever your journey may take you.
  16. Myths surrounding organ and tissue donation were discussed in part 1 of this donation education series and were hopefully dispelled. If you missed part 1, you can read it at https://allnurses.com/general-nursing-discussion/8-organ-and-1098026.html. In part 2 of this series, clarification as to what organs and tissues can be donated and when a person may begin to be considered a potential organ donor will be discussed. Identifying Organs and Tissues that can be Donated for Transplantation The following organs and tissues can be donated: Heart Lungs (either as a pair or individually) Liver (can be split for two recipients) Kidneys (two) Pancreas Two Cornea Tissues including bone, tendons, ligaments, and cartilage In simple terms, a single organ donor can potentially save the life of eight…yes, eight…individuals. An additional two individuals can benefit from the gift of sight. Tissue donation can potentially benefit hundreds of people when used in orthopedic surgeries such as spine fusions, joint replacements, and hip and knee reconstruction to name just a few. Choosing to be an organ and tissue donor isn't just a small gift but rather a gift that can reach hundreds of people and thousands of miles to recipients in many locations. Recognizing Clinical Conditions that Can Lead to Brain Death Anyone who has sustained a severe neurologic injury can potentially progress toward brain death and make them a potential organ donor. This includes: Severe traumatic brain injury from blunt head injury, gunshot wound etc. Subarachnoid hemorrhage Anoxic brain injury due to prolonged cardiac arrest with a long downtime, drowning, or an intentional or accidental overdose Referring a Potential Donor: The Criteria Criteria for referring a person to the local Organ Procurement Organization (OPO) differs by region and OPO. However, generally speaking, here are some baseline criteria you should know: A possible organ and/or tissue donor is a person who is on a ventilator who has experienced a significant neurological insult with a Glasgow Coma Scale of less than 5. A possible tissue donor is any person who has suffered a cardiac death. Calling the OPO Before Brain Death The patient isn't brain dead. Why would I notify the OPO? What is critical to understand is that notifying the OPO of a potential donor does not mean the person will become a donor or that every possible measure to save the person's life will not be taken. The early call to the OPO allows for an awareness of the patient presence within the critical care area and provides an opportunity to be available in the event the conversation of organ donation arises. Additionally, the hospital is legally required to make the referral call as part of the Centers for Medicare and Medicaid Services participation. The OPO should be notified of the following: All potential donors or deaths If the family begins asking questions about organ donation If a discussion arises regarding withdrawing support Indicating a Desire to Donate: When the Family Brings Up Donation Sometimes as the family is beginning to see the grave prognosis of their loved one, a conversation regarding the possibility of donation may arise. When this occurs, it's recommended the clinical staff do the following: Acknowledge what a wonderful gift the family is considering Let the family know you will contact your local organization who can answer questions about donation Contact the local OPO as soon as possible Individuals specifically trained to discuss organ donation should be the ones to approach the family about the possibility of donation when the right time arises. This is not to say that the critical care nurses and physicians are not key players in the donation process. They most certainly are and no donation would be possible without their knowledge, dedication, and tireless efforts to maintain organ function. Understanding Brain Death Brain death is sometimes used as a loose term in the acute care setting. What is important to note is that brain death is death and is irreversible. Although a person with brain death may appear like they are sleeping, they are not. Brain death is the cessation of all brain activity including brainstem function that inhibits the ability to breathe spontaneously. In part 3 of this series, we will discuss in more detail how brain death is determined prior to an organ donation case proceeding. Failing to Meet Brain Death Criteria: Donation after Cardiac Death Not all patients who meet clinical triggers for a donor referral will become brain dead. Some will improve which of course is always the desired outcome. Others may have a significant neurological injury but do not meet strict brain death criteria. If the prognosis is so grave that the patient will likely die within a short period of time once artificial life support is withdrawn, donation after cardiac death or DCD, may be an option. The recovery of organs takes place only after the patient has been pronounced legally dead. Nationwide approximately 20% of donations now occur following cardiac death. DCD is an added option for families who wish to donate life when brain death criteria have not been met. Thank You To all of you who are registered donors or who have considered the national donor registry, thank you. For those of you interested in investigating further how you can let your wishes surrounding donation known, log onto www.RegisterMe.org Additionally, more information about organ and tissue donation can be found at the United Network for Organ Sharing (UNOS) website located at www.unos.org Until next time...Embrace the Journey…wherever your journey may take you.