Craziest Trauma

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1) Woman vs. bear - Turns out taunting even a relatively non-agressive black bear in front of her cub with partially cooked steaks is a bad idea. Her left arm, leg, and side of her face were shredded beyond recognition.

2) Motorcyclist, not wearing leather, hit and then dragged by a semi-truck for 1/2 mile down the freeway at full speed. Both of her legs were completely degloved; it looked like a musculature/vascular out of an anatomy textbook. I was on a trauma surgery rotation and helped on her *multiple* OR trips for debridment and attempts at skin grafting over the 2 months.

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Funniest mechanism I saw the other week: motorcycle Vs. dog at 60 mph
I think the dog lost.
 
I missed this one by one day, but heard all about it in detail. Guy was at a fetish/SNM club and his fetish was to tie a rope around his scrotum and have someone pull...pull really hard. Guy arrived via EMS in full leather attire i.e. assless chaps...and a friend had has scrotum and testicles on ice in a silver champagne holder. Lots and lots of blood :(
 
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from rotation at the medical examiner's office: 25 year old female tugboat operator finds herself between the tug rope and the edge of boat (a bad, bad place to be). rope goes slack from wake, then snaps back with her holding it. evisceration via perineum, one hand amputated, other hand with multiple finger amputations, severe occipital fracture from her head banging against the side of the boat after she apparently flew through the air from the force. severe rope burns pretty much everywhere.

from work with forensic anthropologist: small plane crash into shack filled with old shopping carts. bolognese sauce comes to mind.
 
1 year old bitten all over by rats.

3 year old dropped from the 14th story of a high rise because he wouldn't steal candy for a 13 year old. Dead on arrival.

18 year old fell into a silo with an auger going. Amputated above the iliac crest. Alive and doing well.

An adult put a nut around the base of his penis. Had to get the fire department to cut the nut off.
 
I could give hundreds. One of the more memorable ones was a new worker removing tractor trailer axles. He had been told of the rule not to go between them, they shift when the axles are removed. So what does he do, he kneels between them. The one shifts, and crushes his head.
He has viable vital signs on scene. His head felt like a crushed boiled egg. I had 2 suction units going, so I could intubate.
It turns out, all the blood and mess in his throat, was because the crushing popped his head like a pimple. (inwards)
 
3 year old dropped from the 14th story of a high rise because he wouldn't steal candy for a 13 year old. Dead on arrival.

.

That one makes my head hurt. It makes one wonder, was the tyke intentionally dropped or was the older kid trying to scare them into complying and just lost their grip on the poor kid.
 
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The thought was that it was intentional. The court system had no idea on how to handle the kid who dropped the 3 year old.
 
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I could give hundreds. One of the more memorable ones was a new worker removing tractor trailer axles. He had been told of the rule not to go between them, they shift when the axles are removed. So what does he do, he kneels between them. The one shifts, and crushes his head.
He has viable vital signs on scene. His head felt like a crushed boiled egg. I had 2 suction units going, so I could intubate.
It turns out, all the blood and mess in his throat, was because the crushing popped his head like a pimple. (inwards)

Just...wow.
 
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C spine, rib & pelvic fractures + subdural s/p falling off a bridge.

He fell off the bridge while hanging over the side in an attempt to take a dump onto moving traffic.
 
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C spine, rib & pelvic fractures + subdural s/p falling off a bridge.

He fell off the bridge while hanging over the side in an attempt to take a dump onto moving traffic.

I... seriously?? :wow:
 
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18-wheeler going down the interstate hits a bird. Bird shatters the windshield, and nails the driver in the face. I think you can use your imagination for the rest of it.
 
18-wheeler going down the interstate hits a bird. Bird shatters the windshield, and nails the driver in the face. I think you can use your imagination for the rest of it.

Now I don't see my ducking every time this happens as unreasonable. (and yes, a bird has hit my car more than once)
 
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Now I don't see my ducking every time this happens as unreasonable. (and yes, a bird has hit my car more than once)

You need to stop commuting in migration patterns :smuggrin:
 
Small caliber pistol to the head. The bullet was just sticking out of the skull and didn't do any real damage.

I have a good friend that is a homicide detective down south and he told me about a guy who was shot in the back of the head, and the bullet went right through to the front, and went through the skull in the front, but didn't break the skin in front, so he looked like a unicorn. However, just like the pictures in "Spitz and Fisher", he was still dead.
 
Two of them come to mind, one that I treated and another that I just happened to be in the ED when the patient arrived...

1. F150 going 40 rear ended a motorcycle at a red light (drunk driver)...motorcycle driver landed about 15 feet from the motorcycle...they had fluids and blood going in on the pressure infuser when I left the ED...he wasn't in too good of shape..

2. Inmate at a state prison was stabbed in the neck during an altercation with a metal shank, sliced his carotid and he was actively squirting blood from the neck on arrival. Vascular team was waiting and they didn't even take him into the trauma bay...the paramedic held his neck and rode the stretcher to the OR
 
C spine, rib & pelvic fractures + subdural s/p falling off a bridge.

He fell off the bridge while hanging over the side in an attempt to take a dump onto moving traffic.

I remember that genius! Wasn't he down there for awhile too?

My favorite storywise (surprisingly not all that interesting to look at) was the 38 week preggo lady who was shot in the belly by her husband while he was cleaning his gun and she was making cookies.

Everyone was fine.

Best part? The flowers in her room the next day. The card: "It's a Boy! Sorry I shot you."
 
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I remember that genius! Wasn't he down there for awhile too?

My favorite storywise (surprisingly not all that interesting to look at) was the 38 week preggo lady who was shot in the belly by her husband while he was cleaning his gun and she was making cookies.

Everyone was fine.

Best part? The flowers in her room the next day. The card: "It's a Boy! Sorry I shot you."

I just don't understand how someone who is competent enough to clean a gun would forget the first step. UNLOAD. I mean you always teat a firearm as if it was loaded. I could see some dumb@ss who knows nothing about a gun not thinking logically. But someone with the forethought to clean a gun should know this....rant off, sorrry
 
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I just don't understand how someone who is competent enough to clean a gun would forget the first step. UNLOAD. I mean you always teat a firearm as if it was loaded. I could see some dumb@ss who knows nothing about a gun not thinking logically. But someone with the forethought to clean a gun should know this....rant off, sorrry

Call me silly, but something makes me suspect that alcohol may have been involved. :p
 
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I just don't understand how someone who is competent enough to clean a gun would forget the first step. UNLOAD. I mean you always teat a firearm as if it was loaded. I could see some dumb@ss who knows nothing about a gun not thinking logically. But someone with the forethought to clean a gun should know this....rant off, sorrry

Somehow, I don't buy the "accident" story.

But then, I read too many detective novels.....
 
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Somehow, I don't buy the "accident" story.

But then, I read too many detective novels.....

It's a Law And Order episode waiting to happen!

*doink doink*
 
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Now I don't see my ducking every time this happens as unreasonable. (and yes, a bird has hit my car more than once)

i love how you place the blame on the bird.
 
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i love how you place the blame on the bird.

Damn right. Birds are dumb enough to fly into windshields. People thus have to attempt to avoid them.

So, stupid birds can create lots of problems for people.
 
Some stories from along the coasts:

Self inflicted gsw to the face using a .270 or .308 (can't remember). Course, pt is sitting on his dock wearing a diving weight belt. Uses his toe on the trigger. I found part of his maxilla in the front yard. The dock was in his back yard. Divers found the rest of him in the estuary.

Scallop fishermen takes his paraplegic wheelchair bound brother out for a day at sea. Scallop dredge (probably weights 1000 lbs) parted from the cable and came down on fisherman's head, removing most of it. Paraplegic brother had to sit there for an hour as the Capt raced for shore.

Boeing 747 exploding at 10,000 feet with 230 people on board. Some were intact, most were not. Longest couple of days of my life.

Have lots more, but those were the worst. Can't wait to work in an ED where I might have some survive!
 
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One day while working on the ambulance, a job went out for a kid (19 or 20 I think) that was riding his croch rocket and went over the hood of a car after running into the front fender of it and was then promptly driven over (and parked on top of) by a big a*s truck; the real axle of the truck caught the kid and twisted him up in it while dragging him for about a hundred feet. Upon arrival of the BLS and ALS bus, the patient was twisted awkwardly under the truck but was conscious and talking despite an above the elbow traumatic amputation of the arm. Police ESU worked with the rescue company to lift the truck off the kid with airbags. As soon as the truck (I think it was a garbage truck so it STUNK) was raised enough to "untwist" the kid and place him onto a backboard, he immediately went unconscious and clenched down. I think he had bilat pelvis Fx and bled out when the "twist" that was stabilizing his pelvis was relieved. With no paralytics available for intubation (since he was clenched down) and surgical trachs not in the ALS standard of care where I live, the patient coded shortly thereafter. After being pronounced in shock trauma, we were all sad to hear that this young man was in the Army and had just returned from a combat deployment in Iraq (this was about the time the war was BAD) and had returned home without a scratch and it was his first time out on the bike since getting back. Certainly made me rethink getting a Harley.
 
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One day while working on the ambulance, a job went out for a kid (19 or 20 I think) that was riding his croch rocket and went over the hood of a car after running into the front fender of it and was then promptly driven over (and parked on top of) by a big a*s truck; the real axle of the truck caught the kid and twisted him up in it while dragging him for about a hundred feet. Upon arrival of the BLS and ALS bus, the patient was twisted awkwardly under the truck but was conscious and talking despite an above the elbow traumatic amputation of the arm. Police ESU worked with the rescue company to lift the truck off the kid with airbags. As soon as the truck (I think it was a garbage truck so it STUNK) was raised enough to "untwist" the kid and place him onto a backboard, he immediately went unconscious and clenched down. I think he had bilat pelvis Fx and bled out when the "twist" that was stabilizing his pelvis was relieved. With no paralytics available for intubation (since he was clenched down) and surgical trachs not in the ALS standard of care where I live, the patient coded shortly thereafter. After being pronounced in shock trauma, we were all sad to hear that this young man was in the Army and had just returned from a combat deployment in Iraq (this was about the time the war was BAD) and had returned home without a scratch and it was his first time out on the bike since getting back. Certainly made me rethink getting a Harley.

Yikes. Scary case, one I would hope to never have to handle myself - so don't take this as a criticism, it's certainly not meant that way. However, it sounds like what might have happened was that when the pressure was relieved all the dead tissue distal to the crush injury released its potassium and caused the guy to code precipitously. It's a phenomena that's been described before.

That's not to say that one has any choice but to lift the effing garbage truck off the patient, but that things aren't likely to go well once you do.
 
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Yikes. Scary case, one I would hope to never have to handle myself - so don't take this as a criticism, it's certainly not meant that way. However, it sounds like what might have happened was that when the pressure was relieved all the dead tissue distal to the crush injury released its potassium and caused the guy to code precipitously. It's a phenomena that's been described before.

That's not to say that one has any choice but to lift the effing garbage truck off the patient, but that things aren't likely to go well once you do.

This whole thing reminded me of this (no, I'm not calling BS on the OP, just saying that's what came to mind). Perhaps the urban legend was based on what you're describing, with the potassium release.
 
This whole thing reminded me of this (no, I'm not calling BS on the OP, just saying that's what came to mind). Perhaps the urban legend was based on what you're describing, with the potassium release.

A buddy of mine is with they NYPD; he said that it happens about once a month where people are caught between a subway car and the platform. I also heard about it happening at the steel plant near where I grew up.

Death results from exsanguination, not hyperkalemia. The crushing injury tamponades the blood loss, which is lost when the pressure is released.
 
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A buddy of mine is with they NYPD; he said that it happens about once a month where people are caught between a subway car and the platform. I also heard about it happening at the steel plant near where I grew up.

I see that Snopes changed its classification from "False" to "Unclassifiable Veracity", so obviously they got some e mails about it! :idea:

ETA: This was done chillingly well in an episode of Homicide: Life On The Streets. Part one is here:


http://www.youtube.com/watch?v=qhplAN8ie2w

You can find the rest on YouTube if you're so inclined.

That episode was the first time I'd ever encountered anything like that. I'm kind of surprised that Saint Elsewhere hadn't done it first!


Death results from exsanguination, not hyperkalemia. The crushing injury tamponades the blood loss, which is lost when the pressure is released.

It sounds like an awful way to go! :eek:
 
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WilcoWorld,
You make a very interesting point. However, since I wasn't in a position to see what kind of position his lower body was in under the truck. Also, those ESU cops and the rescue specialists worked extremely fast and they had him out from under that truck probably within 15 minutes of receiving the call in the dispatch center. In shock trauma, I heard the doc say that he likely bled out on the spot so that's what I was basing my idea on.

You bring up another very interesting trauma job that I was on though which involved a MVA with a dump truck on the interstate, a damn near 5 hour extrication, five distinct EMS agencies, about 8 different fire departments, a USAR team, and a hundred degree heat. Somehow the driver of this triple axle dump truck rolled his rig over onto the beginning of guard rail just right so that the rail started wrapping itself around the cab of the truck as it rolled and thus pushing the dashboard down and trapping the drivers legs under the dash that was continuously being compressed by the guard rail. One BLS unit and one ALS unit was dispatched for the actual MVA. Upon seeing the scope of the job, the state police bird was requested, another BLS agency was requested for firefighter rehab given the temp, two ALS supervisors, and the EMS physician response vehicle was requested along with the doc for on-site medical control. To complicate things, the truck came to a rest on a ledge and was in danger of shifting and falling ~25 feet to a roadway below. Therefore, three large commercial cranes were called in to stabilize the truck. I was on the BLS truck that was supposed to provide firefighter rehab. However, when the members of the volunteer squad that was called for the actual MVA presented in flip flops and tennis skirts to the extrication (gotta love volunteers), our assignments were quickly reversed. After about 4 and a half hours of firefighters from 7 different departments attempting the extrication, (all paid departments with at least two of them being urban departments experiencing 15000-25000 runs a year so they were no amateurs) the UASI USAR (Urban Search and Rescue aka the rescue gurus) team was called in from a large city approximately 15 miles away. Up to that point, the ALS crew had followed standing orders for a multi system trauma, i.e. 2 large bore (14G) IVs, maintenance of the airway, etc. Suprisingly, the patient was in quite a bit of pain considering from his pelvis down was being crushed under the weight of the dashboard, huge diesel engine, and about 25 feet of guardrail but he was talking and affectively communicating with his rescuers. By the time that the UASI (just refers to the grant that funded the USAR teams) team was called, the ALS crew had run out of both fluids and morphine ampules so they were relying on the physician response vehicle's supplies. Through the on-site medical control by the EM doc from the trauma center, I believe the Pt. got well over 100 mg of morphine sulfate intravenously throughout the ordeal. Mind you, this was all being done on an open interstate because the state police were unwilling to completely shut it down since there was already a 12+ mile delay so they decided to open two of the five lanes and place several fire service tarps up between the lane of travel and the incident to prevent rubbernecking (or at least that's what I think). Anyway, the USAR team got there and was able to get the Pt out within 20 minutes and decided it would be a great idea to put him face down on the waiting backboard. After correcting them of their mistake, I took a look at the patient's lower body and was not suprised to see that it was a good 2-3 times the size of what it should be; I was assuming that he would be suffering from compartment syndrome after such a long entrapment. Throughout transport to the bird that had landed at a corporate complex about a mile away, the patient remained conscious and speaking appropriately (even with so much narcotics). I helped to load the patient into the bird and off they flew to a level II trauma center, although a level I center was only an additional 1-2 minute flight time. Several weeks later I got the disposition that the patient had a below the knee amputation of one leg but was able to keep the other leg after several surgeries. I was quite impressed with the medical skill of the trauma service and the surgeons for saving such mangled limbs because I was sure that he would lose them both when I saw them immediately post extrication. At the end of the day, I felt good because I was able to help a guy out but I was friggin exhausted! That hundred degree heat and the black pavement really took a toll on me!
 
This whole thing reminded me of this (no, I'm not calling BS on the OP, just saying that's what came to mind). Perhaps the urban legend was based on what you're describing, with the potassium release.

I had this happen to a MVA patient. 8yo girl pinned by the dash just above her umbilicus, conscious on arrival. Soon as the guys on the crash truck roll the dash she goes out and crumps.

Had a call out on an attempted suicide once. Small caliber pistol to the temple. Bullet wrapped around the skull and out the orbit. Lost his eye. Not all that gruesome but just a bad day for someone already apparently depressed.
 
Had a call out on an attempted suicide once. Small caliber pistol to the temple. Bullet wrapped around the skull and out the orbit. Lost his eye. Not all that gruesome but just a bad day for someone already apparently depressed.

Oh man...I hate the failed suicide attempts. Nothing worse than telling a super depressed person "hey...guess what...you failed again...and btw, you need a liver transplant."
 
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Oh man...I hate the failed suicide attempts. Nothing worse than telling a super depressed person "hey...guess what...you failed again...and btw, you need a liver transplant."


Even worse if they've already HAD a liver transplant.

Liver transplant pt + depression + lithium + ativan + ice cream + blender and downed it all.

At least he gave it a better try than most I see... and the ice cream was a nice touch.

Ok, back to trauma now!
(I so totally don't miss working at a trauma center!!!)
 
I wonder if suicidality is a contraindication to liver or kidney transplant. I do know of a guy that cut off his hand and had it replanted, but he said that he would cut it off again, and, when he did, they left it off.
 
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I wonder if suicidality is a contraindication to liver or kidney transplant. I do know of a guy that cut off his hand and had it replanted, but he said that he would cut it off again, and, when he did, they left it off.

It is. I've actually see a couple of people die after Tylenol overdose because they were ineligible for transplant listing due to untreated depression and active suicidal ideation.
 
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I only work EMS but I've seen my fair share. Some memorable ones in the past few years:

Head Vs. Windshield; decapitation.

Left side of body Vs. Boat propeller; amputated arm, 5 broken ribs, and a collapsed lung.

18 wheeler Vs. 18 wheeler, head on. First time I've seen intestines outside of a cadaver lab.
 
Keep in mind im a 17 year old volunteer :p.

I've seen trauma. It's exciting. I hate some of it due to outcomes and age, I love when we save people.

My most memorable trauma was a self inflicted 60 M GSW to the chest. Responsive and verbal on arrival. Initially the exit wound was middle of the back entrance was supposedly abdomen. Lots of blood. After about 30 minutes patient goes unresponsive, sat drops. Doctor intubates, surgeon paged. Patient then goes asystole, CPR started. Surgeon walks in looks at patient once says stop CPR your doing nothing and asks for a thoracotomy tray. I almost pass out because I was about to see this. He cracked him, tons of blood from chest cavity. Heart massage and warm saline actually heated in the microwave because our fluid warmers were too slow. Got the patient back and ran to the OR I got to stand behind the surgeon holding blood while his hands were in the guys chest. I had to write the code summary thing like recording everything that happens during this one. Was amazing. The guy didn't make it sadly :(.


Saw a 30 M crush injuries. Working on a tower, tower knocked over by crane. Him and his cooworker were strapped to it. coworker wrapped in electrical wires and called in the field. Patient we got had amputated limbs he coded a few times until we could get him flown out to a level 1. This was porbably my first real trauma. More details just didn't want to add them.

Teenage F, GSW head 12 gaudge. Definitely an eye opener.

My last one that was impressive was a mvc. Multiple patients. The one that was critical had a tree branch in his eye. Coded.

Every day in the real world as I call it is different. I've seen a lot except for burns.
 
Ive seen a bunch of crazy ones so far, but the most disturbing was a 50 y/o m who laid his motorcycle down and slid into the guard rail with his wife. The motorcycle was ok c/ only minor damage. His wife was decapitated and declared at the scene so I never saw her. The man in question was partially decapitated. Meaning that the top of his head, everything above (and including) his eyes was cut clean off. Brain matter all exposed of course. He was still breathing on his own and had a strong pulse. He was kept alive in the ICU for over 24 hours, so that he could become an organ donor. Donated heart, lungs, liver, and kidneys. I got to assist on the procurement which was cool. It was just gruesome taking care of someone in that condition for over a day.

I realise this post is a few years old, but purely for the sake of curiosity (I do volunteer work with a group that raises awareness of Organ Donation, so this is of some interest to me) would it theoretically be possible to keep someone 'alive' for the purposes of organ procurement, if that person had been completely decapitated? Considering after brain death there essentially isn't a brain (not a functioning one anyway), is having an attached head actually necessary to keep the basic functions of respiration and heartbeat going, at least temporarily?
 
I realise this post is a few years old, but purely for the sake of curiosity (I do volunteer work with a group that raises awareness of Organ Donation, so this is of some interest to me) would it theoretically be possible to keep someone 'alive' for the purposes of organ procurement, if that person had been completely decapitated? Considering after brain death there essentially isn't a brain (not a functioning one anyway), is having an attached head actually necessary to keep the basic functions of respiration and heartbeat going, at least temporarily?

You ask quite an interesting question. First, though, you can't be completely decapitated and still have vital signs, although virtually all of the head can be removed but leaving the medulla, which would control (mostly) the autonomic functions. That would be like a little stump on top of the neck, but the rest of the gourd being gone.

The ethical question then arises. It is acknowledged that it is the brain, and not the heart, that makes us people. Moreover, losing the cerebrum is incompatible with life. When someone is declared "brain dead", that is when the head is intact, and the person appears a whole person (even though not responsive). Very frequently, once the determination of brain death is made, the life support systems (like the ventilator) will be disconnected, allowing the body to die. Keeping those people on the ventilator to buy time until the organs can be harvested is a well-known and accepted situation.

So, what becomes of such a body? It still has vital signs, but most certainly has ceased being a person (still human, yes, but not a person). Therefore, where does it stand? If it is not a person, are you actually "keeping it alive"? What is it, exactly, that you are keeping alive? I have training and some small specialization in ethics, so I know what I would do. The next of kin would be contacted. Even if the body has been dismembered, the memory of the person is maintained, and the question of donation can be much more easily addressed, as, in this case, there is absolutely no possibility in any regard, even accounting for the supernatural and unknown, of a "miraculous" recovery, or any other, more tangible, recovery. Immutable and unavoidable. The question of removing life support will occur soon, irrespective of harvesting organs and tissues. If there is no next of kin, the hospital can obtain an ethics consult (and I believe would come to the same conclusions as I have). There would still be brain death testing, which would, prima facie, be concluded as brain death being present (due to the absence of all the structures which would be tested - ipso facto, those are dead). Then, evaluation of suitability for organ donation would occur. The balance of the dignity of the patient, likelihood of recovery, and prognosis would be balanced against premortem wishes and the greater good of organs for transplantation. My interpretation is that the equation tips strongly towards the greater good, and away from the dignity and prognosis. However, if the patient or next of kin made or makes known a specific desire for organs to not be used, and/or to "do everything", that would lead directly to "pulling the plug", as everything had been done. The head is gone, and that person is gone save for memories.
 
Thank you for your answer, Apollyon. Whilst I don't feel qualified to comment on it in any detail, we do get a number of people contacting our group to ask questions related to the procedure for the procurement of organs when a loved one dies. They generally want to know things like 'How can we be sure our loved one is actually dead', 'will the hospital still do everything they can to save the person if they know they're an organ donor', 'will the wishes of the family still be respected if the person is registered as an organ donor', and so on. We usually just refer them to what is stated on sites like Donate Life America, The Mayo Clinic, or Donate Life Australia, and try to ease their concerns/reassure them as much as possible. Unfortunately some people do have this image of Organ Procurement specialists as these shadowy figures, waiting in the wings with scalpels at the ready the moment a person flatlines. It's interesting, and helpful, to get a more direct viewpoint on the ethics related to Organ Donation. :)
 
virtually all of the head can be removed but leaving the medulla, which would control (mostly) the autonomic functions. That would be like a little stump on top of the neck, but the rest of the gourd being gone.

Okay, in this situation most of the head is gone, there's only a stump left with the medulla attached to control the autonomic functions, there's no mouth or nose, where does the ventilator get attached? Do you just rig it up directly into the trachea from the top of the neck (I'm assuming a standard tracheotomy couldn't be performed, because wouldn't the air escape somehow)?

Sorry, morbid curiosity. :oops:
 
Okay, in this situation most of the head is gone, there's only a stump left with the medulla attached to control the autonomic functions, there's no mouth or nose, where does the ventilator get attached? Do you just rig it up directly into the trachea from the top of the neck (I'm assuming a standard tracheotomy couldn't be performed, because wouldn't the air escape somehow)?

Sorry, morbid curiosity. :oops:

Ha ha, literally!

The tube would go in the trachea - the trick would be securing it. At the same time, if you can see the cords (because everything above is torn/shorn off), you know you're in.
 
Ha ha, literally!

The tube would go in the trachea - the trick would be securing it. At the same time, if you can see the cords (because everything above is torn/shorn off), you know you're in.

Right, so kind of like fitting a vacuum cleaner together, one hose into another (sorry that's a really bad analogy). :)
 
You ask quite an interesting question. First, though, you can't be completely decapitated and still have vital signs, although virtually all of the head can be removed but leaving the medulla, which would control (mostly) the autonomic functions. That would be like a little stump on top of the neck, but the rest of the gourd being gone.

The ethical question then arises. It is acknowledged that it is the brain, and not the heart, that makes us people. Moreover, losing the cerebrum is incompatible with life. When someone is declared "brain dead", that is when the head is intact, and the person appears a whole person (even though not responsive). Very frequently, once the determination of brain death is made, the life support systems (like the ventilator) will be disconnected, allowing the body to die. Keeping those people on the ventilator to buy time until the organs can be harvested is a well-known and accepted situation.

So, what becomes of such a body? It still has vital signs, but most certainly has ceased being a person (still human, yes, but not a person). Therefore, where does it stand? If it is not a person, are you actually "keeping it alive"? What is it, exactly, that you are keeping alive? I have training and some small specialization in ethics, so I know what I would do. The next of kin would be contacted. Even if the body has been dismembered, the memory of the person is maintained, and the question of donation can be much more easily addressed, as, in this case, there is absolutely no possibility in any regard, even accounting for the supernatural and unknown, of a "miraculous" recovery, or any other, more tangible, recovery. Immutable and unavoidable. The question of removing life support will occur soon, irrespective of harvesting organs and tissues. If there is no next of kin, the hospital can obtain an ethics consult (and I believe would come to the same conclusions as I have). There would still be brain death testing, which would, prima facie, be concluded as brain death being present (due to the absence of all the structures which would be tested - ipso facto, those are dead). Then, evaluation of suitability for organ donation would occur. The balance of the dignity of the patient, likelihood of recovery, and prognosis would be balanced against premortem wishes and the greater good of organs for transplantation. My interpretation is that the equation tips strongly towards the greater good, and away from the dignity and prognosis. However, if the patient or next of kin made or makes known a specific desire for organs to not be used, and/or to "do everything", that would lead directly to "pulling the plug", as everything had been done. The head is gone, and that person is gone save for memories.


I know this thread is on crazy traumas, but the topic of organ donation has been broached here. If brain death is established (by whatever means), what conditions preclude organ donation? I am sure the conditions of MRSA, Hep I, etc (contagious diseases all) would be considered, but what about EtOH levels, age of donor and so on. I guess some tissues may still be usable in some of these conditions. My 30 yo roomie recently passed with above the legal EtOH levels and donated some of his tissues (but no organs), however I am 60 and generally healthy (and a healthy registered donor). When would you just not bother to call out for donation services?
 
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