Family wants to keep life support for girl brain dead after tonsil surgery #4

[Herat]

(This is a long post, but I feel I've barely touched on the pertinent areas. Airway management and post tonsillectomy hemorrhage is a big topic!)

Excellent post, thank you.

Having to re-operate an actively bleeding fresh T&A, UPPP, and tubinate resection is one of the more difficult scenarios I can think of. For both surgeon and anesthesia.

 

[MsSeal]

If sections of the bowel die how would that affect feeding through a tube. Would the nutrients get through?

Thanks for all the explanations.

 

[Herat]

If a person that is declared dead has been kept breathing on a ventilator for two long, I wonder if, during the 18 minutes it takes for the heart/circulation reflex to stop, there is heaving or whether it's quiet with lower blood pressure.

This situation sure brings up weird questions.

I don't believe there are agonal respirations. That is the medical term for what you are describing.

 

[I Object!]

Spinal fluid is the pressurized cushion that your brain, meninges and spinal cord need to protect them from damage resulting from everyday activities and function.

Blood nose probably refers to the excess blood in the vessels surrounding the nose because it can't get into the brain, much like a lake that forms when a dam is installed in a river. The far side of the damn dries up (brain) and swells into a lake (nose).

What role does cerebral spinal fluid play in terms of ensuring that the brain mechanism functions? What is blood nose in brain dead people?

 

[Herat]

Excellent summary. It is quite unpleasant to say this, but I suspect her brain will be so softened that it will not be able to be sent for sectioning and path. That is the absolute truth of brain death. There is no recovery. None.

Warning: Potentially graphic and disturbing material discussed. Please do not read further if this would disturb you.

At autopsy, whatever is within the skull, including cerebellar fossa, pituitary, vessels, and membranes will be removed and examined fresh, then the specimen will be placed in a fixative solution for probably 2-3 weeks. It will then be examined by the forensic neuropathologist, including microscopic sections. It certainly won't be a convential examination of an intact brain and brainstem. It is important to document to everyone the pathologic findings and the report will be as complete as possible.

 

[K_Z]

Well we could get into all sorts of technicalities about DVM, DDS, Jd, etc.

My comment was only meant to show the similarities in assumptions for lay people in using the terms "nurses" and "doctors".

And it gets even more confusing when you add in that all of the advanced practice nurse programs have a mandate to move to doctoral preparation, as of about 5 years ago. Nurse Anesthetists, Nurse Practitioners, Nurse Midwives, and Clinical Nurse Specialists are all nationally moving to doctoral preparation. "Doctor Nurses".

One of the programs I teach for transitioned to the doctoral degree 3 years ago, the other is still at the Master's level, but will be at the doctoral level in 2 years.

 

[fruity]

Thank you for the posts and links about the medical side of things. I find it really fascinating. That photo of the charred tonsils was a doozy though, lol! I thought I'd seen it all (tonsil wise) when I went on a google image search after a rather disgusting experience with a tonsillolith.

 

[Herat]

If sections of the bowel die how would that affect feeding through a tube. Would the nutrients get through?

Thanks for all the explanations.

There are different levels of damage from infarction or ischemia of the bowel. Nutritional absorption is probably the last thing anyone is concerned about.

Of more significance is the potential for the unsterile contents of the bowel to get into the abdominal cavity because the bowel wall has lost it's structure and integrity through the cellular death. When this happens, areas of the bowel wall have the strength and consistency of wet tissue paper. This can cause peritonitis, sepsis, and vascular collapse.

Our bodies are incredible complex marvels of cellular function, but things happen that upset the delicate balance and cause irretrievable damage. In older days, people just had short hard lives and died at young ages. Now, we can repair some damages, prolong death in others, but we just can't fix everything.

 

[Herat]

Thank you for the posts and links about the medical side of things. I find it really fascinating. That photo of the charred tonsils was a doozy though, lol! I thought I'd seen it all (tonsil wise) when I went on a google image search after a rather disgusting experience with a tonsillolith.

Tonsolliths are just nasty.

 

[otto]

The brain is a highly oxygen-sensitive organ, actually far more so than cardiac or renal tissue. The blood supply to the brain is also more vulnerable than in other organs or extremities. The vessels to the brain constricted and shut off with the major damage and there is no more circulation. The vascular scans in brain dead individuals show the hallmark big nose where blood supply that would have entered the brain through the carotids is shunted to the nose and other facial structures. There is no blood flow into the brain.

Other organs are also damaged due to the hypotensive/anoxic event. She probably has some kidney damage, although she is young enough that it might not affect function that much. The anoxic injury can cause sections of the bowel to die.

There are also other circulatory problems. Our daily muscle movements act as a secondary pump to promote circulation. In a brain dead patient with no volitional muscular activity, the secondary pumping action doesn't exist, and fluid begins to seep into the most peripheral tissues - the skin. The skin and underlying soft tissues become edematous and susceptible to breakdown.

Thank you. So, without breathing, the body is consumed with carbon monoxide?

No blood flow to the brain means the blow flows and then stops circulating in the head, damming up somewhere around the nose? I'm sure I've over-simplified, but wouldn't that mean that the blood pools, or coagulates, on the arms and legs as well? Would that be like lividity in a deceased person?

She was diabetic, so kidney function was a factor to be considered in her death. Her muscles obviously weren't functioning properly, as she had uncontrolled urination.

When my father died, he continued to twitch for three days before he was taken to the cemetery. It was freaky, because even out of the corner of my eye, he was twitching, or moving. I mentioned this to a neurologist friend, who explained that post mortem movement was due to blood cells exploding.

 

[K_Z]

Just to keep the facts straight, do you have a link because the following articles says otherwise?



http://www.cbsnews.com/news/jahi-mcmaths-family-faces-monday-life-support-deadline/



http://www.ibtimes.com/jahi-mcmath-...rl-ventilation-another-week-family-fights-her



http://www.huffingtonpost.com/2013/12/30/jahi-mcmath-removed-from-life-support-monday_n_4518574.html



http://news.nationalpost.com/2013/1...hospital-ordered-to-keep-her-on-life-support/

Very respectfully, in this situation, the primary source verification would be the nursing license board, not the MSM.

Licensing boards for professionals are made easily available to the public for the very purpose of deterring misrepresentation of credentials by anyone, or any entity. For the interests of public safety, if you will. Once anyone has been represented to be a licensed health care professional, it is not inappropriate sleuthing or stalking to consult the publicly accessible nursing board databases to attempt to determine if the individual is a licensed professional. In my opinion, and the opinion of numerous professional societies, as well as the statutes in pretty much every state.

 

[fruity]

Tonsolliths are just nasty.

Yep. I considered having a tonsillectomy just so I never had to deal with one again!

I was writing a description about my experience with coughing up a nasty little piece of evil but it was too gross so I deleted it.

 

[Herat]

Very respectfully, in this situation, the primary source verification would be the nursing license board, not the MSM.

Licensing boards for professionals are made easily available to the public for the very purpose of deterring misrepresentation of credentials by anyone, or any entity. For the interests of public safety, if you will. Once anyone has been represented to be a licensed health care professional, it is not inappropriate sleuthing or stalking to consult the publicly accessible nursing board databases to attempt to determine if the individual is a licensed professional. In my opinion, and the opinion of numerous professional societies, as well as the statutes in pretty much every state.

Thank you for mentioning this.

I'm astonished the MSM is so poor when it comes to documentation. Probably 90% of what I read in MSM about Jahi McMath has substantial errors that could easily have been fact-checked.

 

[otto]

Very respectfully, in this situation, the primary source verification would be the nursing license board, not the MSM.

Licensing boards for professionals are made easily available to the public for the very purpose of deterring misrepresentation of credentials by anyone, or any entity. For the interests of public safety, if you will. Once anyone has been represented to be a licensed health care professional, it is not inappropriate sleuthing or stalking to consult the publicly accessible nursing board databases to attempt to determine if the individual is a licensed professional. In my opinion, and the opinion of numerous professional societies, as well as the statutes in pretty much every state.

The grandmother of the deceased is a vocational nurse certified in IV therapy. It has been reported that this grandmother was handling blood suctioning tubes on a patient in ICU two days (December 11) after a high risk patient had multiple apnea surgeries, resulting in death due to bleeding.

Why doesn't the mother, amicus ad litum, understand that the grandmother, a vocational nurse, may not understand "no apnea" in the independent medical report ... with an understanding that no apnea means no breathing? Why doesn't the patient's mother understand that above ground physical decay of a body is against every religion?

There's a good reason why every culture and religion in the world has buried bodies six feet under. It is to avoid disease. If a facility were established for dead bodies to fester, no reasonable person could be paid enough to be in that environment. It almost seems a bit insane to keep dead people among the living.

 

[Herat]

Yep. I considered having a tonsillectomy just so I never had to deal with one again!

I was writing a description about my experience with coughing up a nasty little piece of evil but it was too gross so I deleted it.

It's just smelly, painful, distressing stuff. It's OK.

 

[Herat]

The grandmother of the deceased is a vocational nurse certified in IV therapy. It has been reported that this grandmother was handling blood suctioning tubes on a patient in ICU two days (December 11) after a high risk patient had multiple apnea surgeries, resulting in death due to bleeding. It is important to understand why the grandmother may not understand "no apnea" in the independent medical report.

What independent medical report?

I'm not following your train of thought, otto.

 

[fruity]

It's just smelly, painful, distressing stuff. It's OK.

In the scheme of things it's pretty minor. But when you're driving and nearly run off the road because of the horror it's scary! The relief was instant though, I'd had a sore throat for weeks.

 

[Herat]

In the scheme of things it's pretty minor. But when you're driving and nearly run off the road because of the horror it's scary! The relief was instant though, I'd had a sore throat for weeks.

Accck. How awful to cough up a tonsillolith while you're driving. I'm glad you regained your composure and are OK.

 

[K_Z]

1. That data is probably from adult measurements. It is probably less in a child.

2. There are unconfirmed comments by the uncle that Jahi had had two prior surgeries. I don't know what those would have been, but it could have altered the local anatomy and bloodflow in that area.

I heard that rumor, also, and I have been contemplating what those procedures might have been. First line surgical therapy for OSA recommends T & A-- and she had this, plus UPPP and turbinate reduction in this combined procedure Dec 9th. IDK what "the other 2" surgical procedures could be.

It occurred to me that maybe the uncle misspoke about what he considers "procedures to treat OSA", and it was assumed he was referring to surgical procedures. If that is possible, he may have meant that she had sleep studies, and other respiratory workups. And/ or that she had a trial of c-pap or bipap as a procedure, following the sleep studies. JMO.

 

[fruity]

A good article. There are plenty of bad ones around, it's refreshing to see facts and truth:

http://m.sfgate.com/health/article/Lack-of-brain-activity-separates-Jahi-McMath-from-5112290.php