Bobbi Kristina Brown found unresponsive in bathtub. #3

[jggordo]

People Magazine Article...

"But a medical expert tells PEOPLE that the latest developments are not necessarily all bad news – although they indicate that Brown is facing an uphill battle. "Seizures indicate that the patient is not brain dead," says Neurologist Eli Zimmerman of Massachusetts General Hospital. "There has to be some brain activity."
"Dr. Zimmerman, who does not treat Brown, says that 28 days is "a long time" for Brown to be unconscious, but that there's a medical reason to keep her in a medically-induced coma. "Patients are sedated – put into a medically-induced coma – because doctors want the brain to have to do as little as possible," he says. "This way, the brain can heal."


http://www.people.com/article/bobbi...2Fheadlines+%28PEOPLE.com%3A+Top+Headlines%29

 

[passionflower]

People Magazine Article...

"But a medical expert tells PEOPLE that the latest developments are not necessarily all bad news – although they indicate that Brown is facing an uphill battle. "Seizures indicate that the patient is not brain dead," says Neurologist Eli Zimmerman of Massachusetts General Hospital. "There has to be some brain activity."
"Dr. Zimmerman, who does not treat Brown, says that 28 days is "a long time" for Brown to be unconscious, but that there's a medical reason to keep her in a medically-induced coma. "Patients are sedated – put into a medically-induced coma – because doctors want the brain to have to do as little as possible," he says. "This way, the brain can heal."


http://www.people.com/article/bobbi...2Fheadlines+%28PEOPLE.com%3A+Top+Headlines%29

sounds like sugar coating double talk.............JMOO

 

[katydid23]

sounds like sugar coating double talk.............JMOO

I agree. They make it sound like she is resting her brain while it heals itself. If she was a 2 yr old, it might be true. But her situation is not like that, imo.

 

[BetteDavisEyes]

I agree. They make it sound like she is resting her brain while it heals itself. If she was a 2 yr old, it might be true. But her situation is not like that, imo.

The family of Jahi McMath is convinced that their loved one is "resting" so her body can heal. The teen was declared brain dead in December, 2014 but has been on "life support" (respirator, feeding tube) for 14 months. :rose:

 

[Luvrosco]

The family of Jahi McMath is convinced that their loved one is "resting" so her body can heal. The teen was declared brain dead in December, 2014 but has been on "life support" (respirator, feeding tube) for 14 months. :rose:

This is so sad. The family will not believe that she is brain dead, I guess.

 

[joypath]

People Magazine Article...

"But a medical expert tells PEOPLE that the latest developments are not necessarily all bad news – although they indicate that Brown is facing an uphill battle. "Seizures indicate that the patient is not brain dead," says Neurologist Eli Zimmerman of Massachusetts General Hospital. "There has to be some brain activity."
"Dr. Zimmerman, who does not treat Brown, says that 28 days is "a long time" for Brown to be unconscious, but that there's a medical reason to keep her in a medically-induced coma. "Patients are sedated – put into a medically-induced coma – because doctors want the brain to have to do as little as possible," he says. "This way, the brain can heal."


http://www.people.com/article/bobbi...2Fheadlines+%28PEOPLE.com%3A+Top+Headlines%29

BBM:
This is SO "out of context"....IMHO, it is a journalistic "adaptation" of the TWO thoughts: 1. there WAS a reason to put BKB into a medical coma as a standard of care practice and then 2. HIS legitimate, generalized, informative EXPLANATION of the activity/treatment, "medically-induced coma". Furthermore, I BELIEVE that he was attempting to explain/clarify that those who are declared brain dead DO NOT have brain activity.

INVHO, some movement regarding the housing of BKB should be occurring soon if it has not already; ICU beds, no matter WHERE are at a premium as are the skill sets of the HCPs providing that specialized care!

 

[K_Z]

BBM:
This is SO "out of context"....IMHO, it is a journalistic "adaptation" of the TWO thoughts: 1. there WAS a reason to put BKB into a medical coma as a standard of care practice and then 2. HIS legitimate, generalized, informative EXPLANATION of the activity/treatment, "medically-induced coma". Furthermore, I BELIEVE that he was attempting to explain/clarify that those who are declared brain dead DO NOT have brain activity.

INVHO, some movement regarding the housing of BKB should be occurring soon if it has not already; ICU beds, no matter WHERE are at a premium as are the skill sets of the HCPs providing that specialized care!

Totally agree. That quote is out of context, and is a glossy, overly simplistic explanation.

As to moving BK, if she is indeed still receiving care techniques that are "more aggressive", then some of those have to be modified and/ or withdrawn in order for her to be cared for in less skilled settings. Such as, removing intracranial pressure monitoring, invasive lines such as arterial lines, and making decisions about what kind of meds to keep her on. As well as thoroughly exploring "what" will be done as to DNR orders, and criteria for transfer BACK to an ICU setting. Otherwise, she will just bounce back in the first 24 hours out, due to management issues. (IMO.)

At the moment, if news reports are true, she is on one or more heavy doses of medications to completely suppress seizure activity and brain function. Those are usually run on IV drips, and require close monitoring, and lots of sophisticated pieces of ICU level machinery. Many long term care, or skilled nursing facilities, are unable to provide that kind of care, or maintain patients on those sorts of therapies, for a number of reasons. (And can't provide 1:1 care 24/7, usually, either.)

It's one thing to keep a patient in PVS on a ventilator and feeding tube; it's another thing entirely if the patient needs vasoactive drips to maintain cardiovascular function, and essentially a never-ending general anesthetic that has to be maintained by skilled nursing and medical staff.

 

[passionflower]

http://www.gratefulness.org/candles/candles.cfm?l=eng&gi=WS
I started to light a candle for BK but did not know how to bring it over without email,
my prayer was that she goes to heaven peacefully

 

[tlcya]

Thank you passionflower. Candle lit.

 

[K_Z]

A few articles that may interest some: (More can be found if you search under things like "family conflict and withdrawal of life support", etc)

Prolonging the Withdrawal of Life Support in the ICU Affects Family Satisfaction with Care

Of particular interest was the finding that the families of patients who had experienced a longer ICU stay tended to prefer the more extended, sequential withdrawal process. "This finding is in the opposite direction of our original hypothesis," stated Dr. Curtis. "We believed that extending the withdrawal process would lower the satisfaction with care among all families. A longer duration of withdrawal of life support seems unlikely to benefit the patient, because it prolongs non-beneficial and sometimes painful therapies."

"After making the decision to withdraw life support measures from a dying patient in the ICU, some physicians may slow down the withdrawal process to give the family more time to cope," noted Dr. Grady. "The outcome of this study indicates that nurses and physicians need to continue to work with the family throughout the patient’s ICU stay to provide them with accurate information on which to base decisions, and prepare them emotionally for the possible loss of their loved one."

http://www.nih.gov/news/health/oct2008/ninr-15.htm

Withdrawing life support and resolution of conflict with families

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124803/

http://www.med.illinois.edu/FacultyDev/ClinicalEnviron/CulturalCompetence/WithrawingLifeSupport.pdf

 

[K_Z]

I'm going to also offer these 2 studies on end of life decision making. (There are many more scholarly studies to support the same findings, which are in the category of providing "culturally competent care.") There are significantly different race and cultural preferences as different groups of people face end of life decisions. Health professionals must understand that there are differences in how people face these decisions, so that preferences can be respected and accommodated, whenever possible.

http://ajcc.aacnjournals.org/content/19/4/335.full

http://www.medscape.com/viewarticle/747769

 

[Z&BsMommy]

Candle lit..

#ComeHomeChristina

 

[gitana1]

sounds like sugar coating double talk.............JMOO

Why? If she's in a coma, that means she has brain function, right? It's not brain death?

Totally agree. That quote is out of context, and is a glossy, overly simplistic explanation.

As to moving BK, if she is indeed still receiving care techniques that are "more aggressive", then some of those have to be modified and/ or withdrawn in order for her to be cared for in less skilled settings. Such as, removing intracranial pressure monitoring, invasive lines such as arterial lines, and making decisions about what kind of meds to keep her on. As well as thoroughly exploring "what" will be done as to DNR orders, and criteria for transfer BACK to an ICU setting. Otherwise, she will just bounce back in the first 24 hours out, due to management issues. (IMO.)

At the moment, if news reports are true, she is on one or more heavy doses of medications to completely suppress seizure activity and brain function. Those are usually run on IV drips, and require close monitoring, and lots of sophisticated pieces of ICU level machinery. Many long term care, or skilled nursing facilities, are unable to provide that kind of care, or maintain patients on those sorts of therapies, for a number of reasons. (And can't provide 1:1 care 24/7, usually, either.)

It's one thing to keep a patient in PVS on a ventilator and feeding tube; it's another thing entirely if the patient needs vasoactive drips to maintain cardiovascular function, and essentially a never-ending general anesthetic that has to be maintained by skilled nursing and medical staff.

You're the expert. Can you explain in simple language what you believe this gal's status to be based on reports of her being in a medically induced coma, or having seizures, etc.?

I mean, I see a lot of talk about "end of life" stuff but if she still has brain activity and they are trying to reduce swelling, isn't that premature?

 

[BetteDavisEyes]

Passionflower,
Thank you for the group candle. We are united in thought and prayers for Bobbi Kristina and her family. I hope and pray that G-d gives the family the courage and strength to know when it is best to let this young woman go. :rose:

 

[gitana1]

Passionflower,
Thank you for the group candle. We are united in thought and prayers for Bobbi Kristina and her family. I hope and pray that G-d gives the family the courage and strength to know when it is best to let this young woman go. :rose:

I knew a girl who was in a terrible car accident. She was in a coma for months. She was not given a good prognosis. I met her in law school. AFTER the accident. It took her over a year of re-learning everything and she continued to have residual issues. She needed extra time for tests and things like that. But she was in law school.

I'm going to hope for recovery, not pulling the plug.

 

[jillycat]

Have not posted in this thread 'til now, but have been following this case. It's seemed, to me, grim from the beginning.

Anyway, I know this may have been discussed and we have experts here, but the info below was helpful to me in understanding the specific differences in states of consciousness/brain deficits, and some of the sequence in care, as well as patient progression into other states. For example, I didn't know that coma had multiple possible outcomes. We (laypersons) tend to hear of it as 'coming out of', or not.

FWIW and apologies if it's repetitive:

http://columbianeuroicu.org/patient-information.html
http://www.usatoday.com/story/news/nation/2014/01/09/brain-death-states-of-consciousness/4397515/

 

[nrdsb4]

I knew a girl who was in a terrible car accident. She was in a coma for months. She was not given a good prognosis. I met her in law school. AFTER the accident. It took her over a year of re-learning everything and she continued to have residual issues. She needed extra time for tests and things like that. But she was in law school.

I'm going to hope for recovery, not pulling the plug.

I don't know if you saw K_Z's post about prognosis after drowning, but the statistics were incredibly dismal. Hypoxia/anoxia with resulting cardiac arrest is a different animal than traumatic brain injury.

 

[Hiandmighty]

I knew a girl who was in a terrible car accident. She was in a coma for months. She was not given a good prognosis. I met her in law school. AFTER the accident. It took her over a year of re-learning everything and she continued to have residual issues. She needed extra time for tests and things like that. But she was in law school.

I'm going to hope for recovery, not pulling the plug.

Drowning is a different matter, plus there are levels of coma.

I hope BK's family chooses to withdraw life support soon.

 

[gitana1]

I don't know if you saw K_Z's post about prognosis after drowning, but the statistics were incredibly dismal. Hypoxia/anoxia with resulting cardiac arrest is a different animal than traumatic brain injury.

No. I didn't see that. So what is the prognosis? Is it like a persistent vegetative state?

Thank you for that info. So it's not about swelling necessarily?

 

[La Louve]

Hi Gitana,

That's correct. It appears that the multiple times (2? 3?) her doctors have tried to wean BKB off of the medically-inducing coma drugs, she has horrible seizures.

ETA see K_Z's helpful posts #392 and #393