Family wants to keep life support for girl brain dead after tonsil surgery #6

[Leilei]

They were taken two weeks apart.

The latter (purple polish) ones are looking quite abnormal to me. It must be noticeable to the mother, and that was 5 days ago. (and no, it isn't nutritional, it's circulatory)

I would imagine that anyone holding her hand would be able to feel the difference. It's a huge change, in my opinion, but I don't have any medical experience to go by like a lot of you do.

 

[Leilei]

I remember a surgeon telling a patient she would not be allowed to wear nail polish in OR, and that even the nail polish was 'clear' the OR team would remove it before surgery began.

The reason given? OR personnel needed to be able to view the nailbeds. For what, IDK.

Seeing Jahi's pix w. diff colors of polish made me wonder about that.

Anyone have an idea about the accuracy of the stmt---
--- back then, many (30?) years ago. True then?
--- but not now?

Thx in adv.

I had my sons by c-section 24 years ago, and was told the same thing. No nail polish at all.

 

[K_Z]

I remember a surgeon telling a patient she would not be allowed to wear nail polish in OR, and that even the nail polish was 'clear' the OR team would remove it before surgery began.

The reason given? OR personnel needed to be able to view the nailbeds. For what, IDK.

Seeing Jahi's pix w. diff colors of polish made me wonder about that.

Anyone have an idea about the accuracy of the stmt---
--- back then, many (30?) years ago. True then?
--- but not now?

Thx in adv.

Modern pulse oximeters can read thru artificial nails, and most colors of polish that don't have glitter flecks. Black, dark purple, etc are tough colors.

http://www.clinicalguard.com/effect...-the-results-measured-pulse-oximeter-a-5.html

You can also put on the "clip" style sideways on a finger, not just over the fingernail. There are many different types of sensors nowadays.

 

[meanmaryjean]

The sticky wrap-around type of pulse oximeter probe is ok with nail polish. And- not to be crude- but it doesn't really matter if it was accurate or not.

 

[KALI]

As long as my dollars are not being spent on a dead person. I'm fine if that is where the family wants to pour their money.
My pocket is off limits. Period.



QUOTE=Linda7NJ;10113190]Or she will simply start the process when her daughters heart stops. IMO she will be content that she did everything she could do and will be at peace with trying.

IMO she will never believe what you or I do. That's okay.[/QUOTE]

 

[Linda7NJ]

Nail beds turn blue if your circulation ( o2 deficient ) isn't up to snuff.

 

[Linda7NJ]

As long as my dollars are not being spent on a dead person. I'm fine if that is where the family wants to pour their money.
My pocket is off limits. Period.



QUOTE=Linda7NJ;10113190]Or she will simply start the process when her daughters heart stops. IMO she will be content that she did everything she could do and will be at peace with trying.

IMO she will never believe what you or I do. That's okay.

[/QUOTE]

IMO money and ethics do not mix.

 

[Yoda]

Question: do you think it was necessary for Dolan and uncle to bash CHO in the media for mom to get to where they are now? Could mom had just fought the court battle without the press and still had the same outcome? I'm not exactly sure how much the media affected the judges' decisions so I am trying to determine if the media was to help mom with giving Jahi more time or if the media was about $$$ and dolan's own agenda. TIA

 

[otto]

I'd like to add just a bit to this, focusing more on the intraoperative/ postoperative situation, because we look at bleeding a lot differently in the OR, and immediate postoperative period, than the rest of the hospital.

We have absolutely no way to know the urgency with which these unit of blood were given. For example, were they running units in on a Level One (or similar brand) rapid infuser? Or were the units called for from blood bank consecutively? At what time, relative to the admission time to PICU were the transfusions given-- minutes, or hours? Was crossmatched blood given, or uncrossmatched (indicating how much time elapsed in the decision making process up on the unit-- was it truly life and death hemorrhage, or over more time?) How fast did the nurses run the units-- over minutes, or an hour each unit (more standard amount of time in non-emergent tranfusions).

At this point, we don't have any way of knowing the timeline of when the transfusions were given, because the bits of information come from second and third hand comments. Omari Sealey was not present-- he was out of the country, and the mom, NW, had a vasovagal reaction (passed out) and was removed from the area for treatment. The grandmother apparently was not present the whole time, either.

Clearly a physician (or more than one) was present and giving orders, or Jahi would not have been receiving blood. In a post op case such as this, it is unlikely that there would have been standing orders for transfusion.

The bigger questions I have, is "which" physicians were aware of the bleeding? Was it only the intensivist/s? Was ENT aware? Was ENT present? What else was being done to control the hemorrhage? Was emergent return to OR considered? If so, why was it abandoned? Etc.

Return to the OR is the "gold standard" for post tonsillectomy hemorrhage. It is probably likely that the tonsillar fossa was the bleed site, not necessarily the UPPP suture lines. And while a bleed from the turbinate procedures could be impressive in the face of a bleeding disorder, the most likely source was the tonsillectomy site. The entire area is fed by 5 branches of the carotid, so bleeding can be brisk and impressive.

A few math calculations:

Blood volume is calculated cc per kg of body weight. Jahi appeared to be quite overweight, but not very tall (wedding picture with others next to her). She also appears to me to not be fully into adolescence (meaning as a child she has slightly higher blood volume per cc body wt).

I would calculate her estimated blood volume at 80cc/ kg. If her body weight was 150- 160 lbs (conservative), then her body weight in kg was about 70. That gives her an estimated total blood volume of about 5.6 liters (5600cc). Four units of packed cells is about 1000cc total volume. You don't replace blood loss cc for cc (meaning you don't give 1cc packed cells for every 1cc lost). Rather, we will look at blood pressure, ongoing hemorrhage, emergency coags and hgb levels, etc. 1000cc is approximately 20% of her total blood volume. We can also assume she lost some in surgery, maybe 500cc or so if the docs were pretty dry surgeons-- we don't know what happened in the OR.

The uncle (who was not there in the ICU, and is giving a layperson's interpretation) states they suctioned 2000cc out of either her airway, or stomach, or both. That may, or may not have all been blood-- we don't know. We don't really know what her actual total blood loss was, but we can make an educated guess based on what info has been given to the public.

Presumably, her fluid hydration status immediately postop, and BP, were OK before the hemorrhage episode, according to reports that she was sitting up, talking, popsicle, etc. So my very rough estimates, from what we can piece together, is that she may have had a 25-30% estimated blood loss in the acute hemorrhage episode, or possibly much more, depending on unknown factors (which are certainly in the medical record).

The other question I have is when did she arrest, relative to the acute hemorrhage, and transfusions. Did it happen so fast they couldn't retrun to the OR? Were there no OR's, or not enough staff available? They are a level one trauma center, so they have a crew and an OR ready all the time-- but was it in use? What time of day was all this going on? Did she have any evidence of bleeding disorder? Etc. So many questions....that I will probably never get an answer to!

Quoting this in case anyone else missed it.

 

[al66pine]

I had my sons by c-section 24 years ago, and was told the same thing. No nail polish at all.

Glad to know it was prob'ly not a delusion on my part.
But still, why no nail polish in OR then, 24 - 30 yrs ago?

And is nail polish acceptable now on OR patients?

Thx in adv for any response. :seeya:

 

[Herat]

I remember a surgeon telling a patient she would not be allowed to wear nail polish in OR, and that even the nail polish was 'clear' the OR team would remove it before surgery began.

The reason given? OR personnel needed to be able to view the nailbeds. For what, IDK.

Seeing Jahi's pix w. diff colors of polish made me wonder about that.

Anyone have an idea about the accuracy of the stmt---
--- back then, many (30?) years ago. True then?
--- but not now?

Thx in adv.

True.

Look at your nailbed. Push down on the tip and release. See how it goes pale and then turns pink when you release? That's just another way of seeing how effectively your heart is perfusing your peripheral vessels. Some of the instruments used to monitor O2, etc are monitoring more central, larger vessel status. The nailbed perfusion can quickly let you know if someone is starting to vasoconstrict or show vasospasm.

Back many posts ago, someone had postulated that nail polish was being added deliberately to cover up her poor perfusion. I dunno.

 

[otto]

Warning: This thumbnail compares the hand on December 20 and January 3. Please correct me if I have the dates wrong.

This is one link:
http://instagram.com/p/ikT4vbo0gq/#

This is the other:
http://www.ktvu.com/photo/news/local/mother-holding-jahi-mcmaths-hand/p4GzZ/

 

[PoirotryInMotion]

Cherese Jackson ‏@I_Mpower 48m

Jahi McMath Transferred Not Healed http://ow.ly/spfol #JahiMcMath #Health #BrainDead


This article pretty much cuts to the chase.

 

[Linda7NJ]

Question: do you think it was necessary for Dolan and uncle to bash CHO in the media for mom to get to where they are now? Could mom had just fought the court battle without the press and still had the same outcome? I'm not exactly sure how much the media effected the judges' decisions so I am trying to determine if the media was to help mom with giving Jahi more time or if the media was about $$$ and dolan's own agenda. TIA

Excellent question, one we can never know the answer to.

IMO I think the media & Dolan played a pivotal role in where this has gone.

 

[otto]

True.

Look at your nailbed. Push down on the tip and release. See how it goes pale and then turns pink when you release? That's just another way of seeing how effectively your heart is perfusing your peripheral vessels. Some of the instruments used to monitor O2, etc are monitoring more central, larger vessel status. The nailbed perfusion can quickly let you know if someone is starting to vasoconstrict or show vasospasm.

Back many posts ago, someone had postulated that nail polish was being added deliberately to cover up her poor perfusion. I dunno.

I was wondering about that too, somewhat surprised that nail polish was allowed during surgery, or whether was that applied afterward, after the surgery?

 

[jjenny]

I can't help but think about how the mother will feel once she finally realizes what's going on, and after she witnesses the body of her child wither away; once she realizes That her child truly has been dead for over a month. I would be severely traumatized and in shock. They'd have to lock me away.

Mother seems to be in deep denial. I frankly don't think she will ever realize the child has been dead since December 12.
New facility put a feeding and breathing tube into the body.
So this will probably go on for while.

 

[popsicle]

Question: do you think it was necessary for Dolan and uncle to bash CHO in the media for mom to get to where they are now? Could mom had just fought the court battle without the press and still had the same outcome? I'm not exactly sure how much the media effected the judges' decisions so I am trying to determine if the media was to help mom with giving Jahi more time or if the media was about $$$ and dolan's own agenda. TIA

I wholly believe the media was a ploy to get attention for money, get their cause out to the people so they will donate. jmo

It is pretty common to have a TRO in these type case granted per Thaddeus Pope, Law professor and Bio ethicist. They didn't need all the media for that. jmo

 

[BeginnersLuck]

Warning: This thumbnail compares the hand on December 20 and January 3. Please correct me if I have the dates wrong.

This is one link:
http://instagram.com/p/ikT4vbo0gq/#

This is the other:
http://www.ktvu.com/photo/news/local/mother-holding-jahi-mcmaths-hand/p4GzZ/

I'd be willing to bet, the mom sees this change in her hands and anywhere else on her body and contributes it to loosing weight from not "being fed".

After listening to Dr. Byrne he would also most likely say that's the cause.

Her hand looks much older.

Could it be due to ATN?

 

[Zuri]

Thank you everyone for posting the links and the info. This is disturbing on so many levels and effects my sleep. It is an unsettled sleep and I can only imagine how NW is sleeping. I really hope this is over soon, for their sake and Jahi. IMO

 

[Soulmagent]

Has anyone posted this?

http://www.tc.umn.edu/~parkx032/CY-LCADA.html