Family wants to keep life support for girl brain dead after tonsil surgery #7

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Cubby said:
That is how I read it too. Someone had described how strong the suction devices are and it sounded like something that if used incorrectly could have easily tore open a wound.

Can one of or medical experts give a detailed explanation of how these suction devices work and how similiar or different they are from thse used at a dentists office?

TIA
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The suction device most often used in hospitals is very similar to the one used in dentists. The difference is that dental suction uses a semirigid device attached to suction tubing and this device can be shaped to fit the mouth. Dental suction that I have had seems to be a continuous suction and can cause damage to the cheeks, tongue, lips or any other part of the mouth the tip touches. If the device attaches to tissue suction is maintained and can cause a blister or other damage.

Suction used in hospitals usually consists of a rigid end piece (yankauer) with an opening at the tip and a release valve near the back end of the device. The release valve is covered and uncovered by the thumb to interrupt suction. Tubing connects the rigid device to a canister most often attached to a wall. Suction/vacuum is provided by a device usually built into the wall and has a dial so that amount or strength of suction can be dialed up or down. There is also a lever that allows for intermittent suction (automatic start and stop suction) most often used with a tube that is passed down the nose and into the stomach (high continuous suction is never ok in this situation and if used could actually tear the lining of the stomach).

Yankauer is most often used for oral, nasal or oropharyngeal suction and care needs to be taken not to cause trauma even in a patient who has not had surgery in that area. If the yankauer is put into the mouth and lips close around it suction can suck cheeks together and soft palate and uvula (tissue that hangs at back of mouth) can flutter violently causing snoring sounds. This can cause pain at the back of throat. It is east to see how a clot/s can be easily sucked out and cause severe bleeding. When using a yankhauer suction can be interrupted by tapping finger over the control valve.
 
neesaki said:
Im confused as to where this is coming from that her body will be / is decomposing while she's on the ventilator. Her cells are being oxygenated because she is being given oxygen and her heart is still pumping. Skin break down , muscle break down , yes, but not decomposition. Decomposition is dying tissue, starts when no blood / oxygen supply to the tissues. I am not verified, but a retired RN.
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Thank you for posting that!! I thought I was going :scared:
 
NevadaMom said:
I thought I remember someone saying it's a standard tool to have set up in a PICU room.

My memory is really not anything to go by though. :scared:
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In any intensive care area each bed area should always have suction set up and ready for use so that it only needs to be turned on for use. Maintaining a clear airway is first and most important task in any emergency situation. (ABC's of CPR)
 
Decomposition is dying tissue, starts when no blood / oxygen supply to the tissues. I am not verified, but a retired RN.
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RSBM: Poor little Jahi's brain has not had blood supply since 12/9/13. :(
 
I think Jahi's mother has to come to this conclusion on her own terms- no other person can get her there, IMOO.
 
CHERIE.T said:
:seeya: Karmady. Please know that I didn't mean to insinuate that the mom isn't grief-stricken. I'm certain she is. Thanks for replying.
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Nooo! I didn't think that at all. I have a pretty detached attitude a lot of the time (occupational hazard), so I'M the one who comes off "heartless." I wanted to be clear that I don't for one minute think this mother isn't grieving . . . but...

jmo
 
OK I have to say it, brain death is not the same as actual death. Read here for explaination: Brain death - Wikipedia, the free encyclopedia She is not going to decompose while on the ventilator, nor is her brain actually breaking down.

A brain-dead individual has no clinical evidence of brain function upon physical examination. This includes no response to pain and no cranial nerve reflexes. Reflexes include pupillary response (fixed pupils), oculocephalic reflex, corneal reflex, no response to the caloric reflex test, and no spontaneous respirations.
It is important to distinguish between brain death and states that may mimic brain death (e.g., barbiturate overdose, alcohol intoxication, sedative overdose, hypothermia, hypoglycemia, coma, or chronic vegetative states). Some comatose patients can recover, and some patients with severe irreversible neurological dysfunction will nonetheless retain some lower brain functions such as spontaneous respiration, despite the losses of both cortex and brain stem functionality; such is the case with anencephaly.
Note that brain electrical activity can stop completely, or drop to such a low level as to be undetectable with most equipment. An EEG will therefore be flat, though this is sometimes also observed during deep anesthesia or cardiac arrest. Although in the United States a flat EEG test is not required to certify death, it is considered to have confirmatory value. In the UK it is not considered to be of value.[citation needed]
The diagnosis of brain death needs to be rigorous, in order to be certain that the condition is irreversible. Legal criteria vary, but in general they require neurological examinations by two independent physicians. The exams must show complete and irreversible absence of brain function (brain stem function in UK),[10] and may include two isoelectric (flat-line) EEGs 24 hours apart (less in other countries where it is accepted that if the cause of the dysfunction is a clear physical trauma there is no need to wait that long to establish irreversibility). The widely-adopted[11] Uniform Determination of Death Act in the United States attempts to standardize criteria. The patient should have a normal temperature and be free of drugs that can suppress brain activity if the diagnosis is to be made on EEG criteria.
Also, a radionuclide cerebral blood flow scan that shows complete absence of intracranial blood flow must be considered with other exams - temporary swelling of the brain, particularly within the first 72 hours, can lead to a false positive test on a patient that may recover with more time.[12] Zack Dunlap in 2008 had a false positive of this type, likely due to temporary cerebral edema.
 
nrdsb4 said:
As a former ICU nurse, I have to point out that most nurses have 2 patients. They cannot be in the patient's room at all times. Even if you had a 1:1 ratio, the nurse has to leave the room to get medications, check Dr's orders, look at computer for labs, take or make calls regarding patient care plan, etc. Nurses don't have the luxury of being at the bedside every single moment, even in the ICU.
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So true. Also depending on how long Jahi had been on the ICU ward, she would have just spent about 30 minutes with the nurses an such being settled in, assessed, vital signs recorded, etc. I'll be interested to find out what her assessment was when she got on the ward and then how it declined swiftly after her mother and grandmother got on the scene.

I do thing that it is entirely plausible that they fed her something. Even if it was as seemingly harmless as a sip of coke, it could have burned her throat, set off a coughing spell and dislodged blood clot.

Since Jahi probably hadn't eaten since midnight of the night before, I imagine she was hungry and her mother was anxious to feed her and had promised her whatever she wanted to eat. Since Jahi was just recently out of surgery, she probably was medicated to the point where she was not feeling excessive pain and her family may have took that as a sign that she was ok to eat.

I know my fiance had an outpatient procedure then came home and wanted to cut the grass because he was feeling no pain due to the effects of the meds and enesthesia. So I can see where the "feeling no pain" state can lead a patient to overdo things. Jahi's family said she was talking and laughing so they must have assumed she was fine.

I am truly appalled that this case has gone this far. Her family is so clearly in denial and not thinking clearly. I hope that CHO is able to tell the facts in a court case so that Jahi's family will no longer be able to twist facts and make up stuff to suit their agenda.
 
I don't see the part in the Wikipedia article that substantiates the idea that certain of her systems aren't breaking down. We've had a lot of medical posters on the thread seem pretty certain it is the case.

I did see this in the article though:

The distinctions can be important because, for example, in someone with a dead cerebrum but a living brainstem, the heartbeat and ventilation can continue unaided, whereas, in whole-brain death, only life support equipment would keep those functions going.
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I assume the way people have been talking that she has "whole brain death" but I'd love if someone more qualified would clarify.
 
Isabelle said:
The suction device most often used in hospitals is very similar to the one used in dentists. The difference is that dental suction uses a semirigid device attached to suction tubing and this device can be shaped to fit the mouth. Dental suction that I have had seems to be a continuous suction and can cause damage to the cheeks, tongue, lips or any other part of the mouth the tip touches. If the device attaches to tissue suction is maintained and can cause a blister or other damage.

Suction used in hospitals usually consists of a rigid end piece (yankauer) with an opening at the tip and a release valve near the back end of the device. The release valve is covered and uncovered by the thumb to interrupt suction. Tubing connects the rigid device to a canister most often attached to a wall. Suction/vacuum is provided by a device usually built into the wall and has a dial so that amount or strength of suction can be dialed up or down. There is also a lever that allows for intermittent suction (automatic start and stop suction) most often used with a tube that is passed down the nose and into the stomach (high continuous suction is never ok in this situation and if used could actually tear the lining of the stomach).

Yankauer is most often used for oral, nasal or oropharyngeal suction and care needs to be taken not to cause trauma even in a patient who has not had surgery in that area. If the yankauer is put into the mouth and lips close around it suction can suck cheeks together and soft palate and uvula (tissue that hangs at back of mouth) can flutter violently causing snoring sounds. This can cause pain at the back of throat. It is east to see how a clot/s can be easily sucked out and cause severe bleeding. When using a yankhauer suction can be interrupted by tapping finger over the control valve.
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Thank you, Isabelle. I needed a visual of how that worked.

I can't imagine any hospital employee requesting the family or patient use the suction device themselves. What I envision occuring is NW or MW taking it upon themselves to use the suction device for what was a normal combination of blood and mucous while the nurses were out of the room. There must have been a sudden increase in the blood at which time NW fainted and was taken out of the room.

Then only after NW was taken out of the room was grandma allowed to see Jahi. She came in after the fact, imo. I believe she would have stopped NW and MW from suctioning Jahi had she been in the room when they first started.

I think that's why we are getting the info we are from OS and the family has forbid the hospital from releasing info.


Sad all around.

I think this all occured while only NW and Jahi's step dad, MW, were in the room.




Thank you,
 
ArianeEmory said:
I don't see the part in the Wikipedia article that substantiates the idea that certain of her systems aren't breaking down. We've had a lot of medical posters on the thread seem pretty certain it is the case.

I did see this in the article though:



I assume the way people have been talking that she has "whole brain death" but I'd love if someone more qualified would clarify.
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I'm sure I've seen posters and linked information saying that the US criteria in states like Cali that have adopted the Uniform Determination of Death Act requires whole brain death. Even that Wiki link distinguishes it from the UK standard which, apparently, only requires brain stem death. I think the tests performed by CHO and Dr. Fisher definitely used the whole brain death criteria. But I'm not a medical professional so take it fwiw until one of them chimes in :)
 
Mrs G Norris said:
Life after brain death: http://www.livescience.com/42301-brain-death-body-alive.html
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Thanks. What I'm getting from that article is that it's not something really well understood yet because this scenario typically does not happen. In other words, no one can say with certainty if "decomposing" is the right word. Wikipedia says this:

"Decomposition begins at the moment of death, caused by two factors: autolysis, the breaking down of tissues by the body's own internal chemicals and enzymes, and putrefaction, the breakdown of tissues by bacteria. These processes release gases that are the chief source of the unmistakably putrid odor of decaying animal tissue."

I assume at least some of these processes are happening, since so many other systems are not functioning properly now due to the "whole brain death" she has experienced. Even in a person without brain death, tissue death can occur, e.g. gangrene.
 
Question. If she is recieving antiobiotics can they treat an infection in her condition?

Edited because I didn't mean that she can recover I just mean are they worth it. Can medicine even make a difference?
 
Ok so when these medical experts who have been quoted in various articles claim that Jahi's body is "looking bad" and "will continue to deteriorate over time" what exactly are they referring to?

According to the nurses on this board, Jahi's body will essentially stay intact as long as her cells are receiving O2 and CO2 is being removed from her system. Is it safe to assume Jahi could still be on a ventilator 6 months from now with little physical breakdown because her cells are being mechanically oxygenated?
 
dh109977 said:
Question. If she is recieving antiobiotics can they treat an infection in her condition?

Edited because I didn't mean that she can recover I just mean are they worth it. Can medicine even make a difference?
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Yes they can give her antibiotics.

They basically pump the body with whatever medications they can to "preserve" it and keep the heart and other organs working for as long as possible.

This isn't necessarily typical though in other brain death cases that have received ventilator support.

In a lot of other cases there aren't these extraordinary measures taken and that results in cardiovascular death occurring much quicker.
 
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