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http://www.cnn.com/2013/12/17/health/california-girl-brain-dead/index.html?hpt=hp_c2

(CNN)
-- Before 13-year-old Jahi McMath went into a surgery meant to improve her quality of life, she had a terrible premonition.

"The worst thing about all of this is that Jahi told my sister, 'I don't want to get this surgery, something bad is going to happen. I'm not going to wake up,' " Jahi's uncle Omari Sealey told CNN Monday in a phone interview.

Jahi went in to have her tonsils taken out. Now, the Oakland, California, girl is brain dead, her family says, and they are fighting to keep her on a ventilator.

They have presented the hospital with a cease-and-desist letter aimed at preventing the hospital from taking her off of life support, family attorney Chris Dolan told CNN Tuesday.

Melinda Krigel, a spokeswoman for Children's Hospital & Research Center Oakland, acknowledged receipt of the letter.

Jahi suffered from pediatric obstructive sleep apnea, which caused severe snoring, stop-and-go breathing in her sleep, a lack of an attention span and urinating on herself.

"When you have obstructive sleep apnea, there is a cessation of breathing, so you are not getting enough oxygen to the brain. This can affect your energy levels, your attention span; you can grow poorly and have problems with obesity," said Dr. Lisa Thebner, a pediatrician whom CNN consulted for this story.

Jahi's mother, Nailah, and stepfather, Marvin Winkfield, had a sleep study done on Jahi and got two medical opinions on her case. Both times, doctors recommended a tonsillectomy to improve her condition.

"They said that she would have more energy, focus more, lose weight and the urinating would stop," Sealey said.

On the morning of December 9, Nailah and her mother, Sandy Chatman, took Jahi to Oakland Children's Hospital. Chatman, Jahi's grandmother, is a nurse in Kaiser Oakland's Surgery Department with more than 30 years of experience in the medical field. On that day, she took an active role in watching her granddaughter's progress.

"After the surgery, (Jahi) was fine. She went into the recovery room. She was alert and talking, and she was asking for a Popsicle because she said her throat hurt. As part of the procedure, she was meant to spend the night in ICU," Sealey said. "When she got moved to ICU, there was a 30-minute wait until any family member could go see her. Upon entry, they saw that there was way too much blood."

"She lost four pints of blood. She had to have four blood transfusions. She had two liters of blood pumped out of her lungs, not including what was in her stomach," Sealey said. "There was an enormous amount of blood, and we kept asking, 'Is this normal?' Some nurses said, 'I don't know,' and some said 'yes.' There was a lot of uncertainty and a lack of urgency."

Thebner says complications can arise during a tonsillectomy because the affected area has a lot of blood vessels.

"Anytime you go into surgery, it is unusual to have these complications, but they are real despite the fact that they are low-risk," she said. "This was a highly unusual complication."

Back in the intensive care unit, Jahi quickly took a turn for the worse.

Sealey said that when Chatman noticed that her granddaughter's oxygen levels were dangerously low, she called for help.

Jahi went into cardiac arrest. The medical staff did chest compressions in an attempt to revive her and tried different medicines to clot her blood, but nothing seemed to work.

On Tuesday, a CT scan revealed that two-thirds of Jahi's brain was swollen.

"During the resuscitation, she lost a lot of oxygen to the brain, and now she was brain damaged. (Doctors) feared that it could progress and get worse, and it did. Now she is 100% brain damaged. Medically dead," Sealey said.

CNN could not independently confirm the medical facts and timeline provided by Sealey.

Hospital spokeswoman Krigel cited privacy laws when asked about the case.

A statement provided by Krigel and signed by the chief of pediatrics, Dr. David Durand, read: "Jahi's family has requested that we not share any details of her case with the media. We can say that, as whenever we see a medical or surgical complication, we are reviewing her case very closely. Our hearts go out to her family, and we want to support them during this extremely difficult time."

A sweet girl

Jahi was an eighth-grade student at E.C. Reems Academy of Technology and Arts.

Her uncle described her as "the sweetest most pure, innocent girl there was."

"She always smiled," Sealey said. "She would just smile and giggle. She had a personality everyone wanted to be around. She was your favorite person. She was a big sister and she had a little sister in kindergarten class, and every day, she would drop her off first before going to her classroom."

When told that his niece was brain dead, he said, the entire family went into "complete devastation."

"Shocking disbelief. We have never had to deal with a death of anyone close in our family, and we have a big family. I was in complete shock, my heart was racing as I was running down the hallways of the hospital," Sealey said.

He said that by Thursday, Jahi had been declared medically dead. Additional testing confirmed the tragic news on Friday.

All along, Jahi's family has been by her side.

"We pray over her daily. We kiss her. I charge her iPod and make sure it is in her ears every night when I sleep next to her," Sealey said.

But on Monday, Jahi's family realized they would be forced to say goodbye.

"On Monday, we had to come to grips that she is legally dead and we do not have the option to say we want her to stay on the ventilator and on life support. The coroner is coming for Jahi," Sealey said.

Medically dead

An official from the Oakland coroner's office told CNN that Jahi's death was reported to the office Thursday.

"Once a death is reported to us, we have a duty and responsibility to immediately proceed to where the body lies, examine the body, make identification, make inquiry into the circumstances, manner, and means of death, and, as circumstances warrant, either order its removal for further investigation or disposition, or release the body to the next of kin," the official said, quoting California Government Code Section 27491.

Sealey said his family hoped Jahi could be kept on life support, but hospital representatives told them Monday that would not be an option.

According to the coroner official, "in this case, this office has been very gracious. Technically, we can go where the body lies and we can begin our investigation as to the causes of death. We have been gracious and we have allowed the parents and the hospital to maintain the child on life support."

Krigel, the hospital spokeswoman, said in an e-mail that the hospital does "not have a policy re: terminating life support. We work with the family to determine when that will happen. There are instances when the coroner may request termination, but we always work with the family to respect their wishes."

The official at the coroner's office said the main concern is giving the family the answers they seek, and in order to do that, time is of the essence.

"The larger issue is that when the body is on a ventilator, the body is healing," the official said. "If a medical misadventure occurred, and the body is healing and covering up traces of that misadventure, the coroner pathologist has a more difficult time rendering a cause of death."

"In my opinion, that is the bigger issue we are grappling with here: the balance between giving the parents time to grieve and determining the causes of the child's death before the body heals."

"This child is deceased. From a medical standpoint, this child will never recover. There is a careful balance between letting the parties investigate and allowing the parents to grieve," the official said. "We know the parents want answers, and it is our office that will provide answers if they are available to us. The longer we wait, the less susceptible we are to getting the evidence we need to render a cause of death. Time is not on our side, from a medical investigation standpoint."

But the family has hope.

"We are fully aware that the longer that we wait, any type of evidence can be lost, but my sister has faith that her baby can wake up more than anything else," Sealey said. "She believes that against all odds, against what every doctor has said, yes, she believes."
 

pgg

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That sucks.

When I first saw this reported, I was thinking OSA --> postop apnea --> death related to anesthesia/PACU monitoring. But this was an unrecognized surgical bleed that apparently didn't go back to the OR for definitive treatment. Or maybe it did and that's not being reported.

Odd legal angle to it too, re: withdrawal of care and autopsy.
 

urge

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Unfortunate. Tonsils are to be respected.
 
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e30ftw

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Sounds like a post-op bleed that was unrecognized (maybe didn't have gag reflex 2/2 CNS meds/topical anesthesia? forgive an EM resident at guessing..) bled into lungs causing respiratory arrest with hypoxic brain injury.

Sad case, but things like this will happen 1/10000 times. Unfortunately that is not safe enough for 'murica.

Are the 4 D's met? probably not, but somewhere an attorney will emerge to vilify all involved and ruin many physicians lives along with any associated RNs/staff...

The fact that CNN makes this their top story is ridiculous. kind of disgusting the way they present it as well..

There is a healthy grieving process which all humans must at some point attempt to undergo. Involving attorneys and national news media in that process detracts from natural healing as it glorifies the law and financial gain rather than sincere memory.
 

IlDestriero

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I cannot fathom the post-op course as described by the article, unfortunately we will never see the medical record and/or hear from those involved in her care.
Yes.
I'm sure it all happened quite quickly with a big pumper opening up followed shortly later by aspiration while they were trying to decide what to do and call an ENT, then hypoxia and failed resuscitation and challenging intubation in the PICU. The article implies there was no concern, prolonged delay, etc. but that's not likely the case. I'm sure things went from bad to dire very quickly or were hastened by botched suction attempts making a bad bleed a fatal one.
 

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Sad case, but things like this will happen 1/10000 times. Unfortunately that is not safe enough for 'murica.
I don't know about that, sure, bad things happen, risk is not just a word.

But I'd hope we'd all be able to agree that a kid shouldn't bleed out in the PACU from a tonsil. We're allowed to call some things outside the standard of care, aren't we?

(Recognizing that the 'facts' we have are from CNN at this point.)
 

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Outside of the postop bleed, are you guys ever keeping your tonsils overnight if they have a diagnosis of OSA? We do alot of outpatient tonsils at our ASC and most are pretty routine. Anybody keeping the really obese kids overnight? I have never observed anyone overnight but at the same time have not really had any really large kids with diagnosed OSA.
 

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Outside of the postop bleed, are you guys ever keeping your tonsils overnight if they have a diagnosis of OSA? We do alot of outpatient tonsils at our ASC and most are pretty routine. Anybody keeping the really obese kids overnight? I have never observed anyone overnight but at the same time have not really had any really large kids with diagnosed OSA.
We keep all T&A patients under 3 years old, any with a known diagnosis of severe OSA, and some who have a clearly rocky post op course with apneas, desaturations and O2 requirements after opioids. We don't keep them just for obesity, but they tend to be the ones with severe OSA.
If a patient has no issues with emergence or with post op opioids in the PACU and is 3 or over and not DX with severe OSA, they go home.
 

e30ftw

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I don't know about that, sure, bad things happen, risk is not just a word.

But I'd hope we'd all be able to agree that a kid shouldn't bleed out in the PACU from a tonsil. We're allowed to call some things outside the standard of care, aren't we?

(Recognizing that the 'facts' we have are from CNN at this point.)
Seemed from the article that she was "doing okay" then crumped in the ICU. Likely a more thorough exam prior to leaving PACU would've discovered the bleed. Of course it's outside standard of care. We know nothing of the real story...

quote from the article:

"I don't want her off life support because I really feel like she can wake up," Nailah Winkfield told CNN's Piers Morgan. "I feel like it's just been a rough week for her and, if they just give her some more time, then she'll be able to wake up."

sad, tragic case. the family needs to go through the grieving process. Mom is clearly in denial.. making this national news will not aid family in the sincere remembrance of their daughter. CNN is exploiting the issue and probably the family, probably someone said to family, "If we make this our top news story it will strengthen the case for keeping her on life support." which just complicates and muddles the process. The girl is dead, family need to progress to acceptance without involving lawyers/media/etc. jmo
 

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Unfortunate. Tonsils are to be respected.
Yep.

For the trainees here, rigid fiberoptic devices (Glidescope, C-Mac, etc) don't work on them, because the blood will get on the camera lens and make it impossible to see.
 
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This whole situation sucks for everyone involved. Everyone involved wanted a good outcome, and a catastrophic bleed from the tonsillar bed occured in the PACU. I'm sure there was anesthesia and ENT involved doing their best. There is nothing worse in Anesthesia than having that sinking feeling that whatever you do won't fix the situation, especially in a basically otherwise healthy pediatric patient who just walked into the hospital for their tonsil.

Now, we will have a bunch of lawyers involved trying to exploit cash from these hardworking medical personal who only did their best. And I'm sure they will find some piece of garbage anesthesiologist who hasn't practiced in 20 years to testify against the unlucky soul who was involved.

Look, with surgery, there is risk. There is only so much we can do. In this situation, there was just too much you know what hitting the fan. Just be thankful every day you leave work you don't have some disaster.
 
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caligas

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So do you rsi this patient? Anybody handled a massively bleeding tonsil?
 

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If hospital and physicians are involved. Writing a 1-2 million dollar check will settle this very quickly.

There are no winners here.

Insurance companies know they will spend $200-300k alone in legal fees.

If they lose the case in addition to award money (which will be reduced to 2-4 million). They will be asked to pay for opponent legal fees as well. That's another $200-300k.

Had former colleague settled a case (airway fire young mother of 3). A 1 million dollar payment.

You got a dead supposedly "healthy 13 year old for tonsil). Even though we know she's chunky. Going to look bad in front of jury.
 

IlDestriero

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So do you rsi this patient? Anybody handled a massively bleeding tonsil?
Yes. Recuss if there's time, RSI, secure airway, followed by surgical management, labs, blood, etc. They can throw stitches, burn it, etc. but you need to secure the airway. You need a double suction set up with 2 yankauer suctions and 2 assistants to hold them in place over the bleeder(s).
She sounds like she would have gotten Sux tube and scopolamine if the situation was that dire. Ketamine if not grossly hypovolemic.
She also might have aspirated a large clot which can be very difficult to clear. That will kill you quick.
 
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pgg

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So do you rsi this patient? Anybody handled a massively bleeding tonsil?
There are post tonsil bleeds, and then there are post tonsil bleeds ... Classic oral board question with a few good answers and some bad ones. My board answer was

“If the bleeding is not severe, then a RSI with continuous suctioning is an option. In the event of more severe bleeding, my goal is to maintain spontaneous respiration. Options here include an awake look, ketamine or mask induction, both of which risk aspiration and laryngospasm, or awake tracheostomy. In any case I would proceed with the surgeon scrubbed and ready to establish a surgical airway.”
 

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I also wonder about the pre-op diagnosis.

Tonsils or pediatric obesity OSA?

Death after unnecessary procedures are the worst.

HH
 

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Bleeding tonsil in the PICU-- every PICU fellow's nightmare-- we drill our fellows with this case scenario in simulation over and over again-- My bet is she had a delay in definitively securing the airway in the setting of a functionally difficult airway (i.e. bloody mess) aspiration and resultant ALI/ARDS, leading to hypoxic ischemic injury from hemorrhagic shock combined with respiratory arrest- horrible situation. As said above, these are very very rare, but they happen. Sounds like her RDI was sky-high, and she was high risk-- we get about 3-4 of these severe RDI postop tonsils in the PICU per week--vast majority do fine. But respect the post-op tonsil.
 

Mman

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I see several people in this thread mentioning the PACU and her observation there. The quotes in the article say she was fine in the "recovery room" and was alert and talking and eating a popsicle. It also mentions the ICU admission was planned preop, I'm assuming because of bad OSA, though I admit I've never planned a kid to the ICU after tonsillectomy. It says she was fine when she went to the ICU and then something bad happened which sounds like bleeding to aspiration to arrest.

Doesn't sound like a PACU problem. I mean if they kid is talking and eating a popsicle, there was nothing seriously wrong at that point. I'm wondering if when they got to the ICU she said her throat hurt and she got a relatively big dose of narcotics.
 

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Yes. Recuss if there's time, RSI, secure airway, followed by surgical management, labs, blood, etc. They can throw stitches, burn it, etc. but you need to secure the airway. You need a double suction set up with 2 yankauer suctions and 2 assistants to hold them in place over the bleeder(s).
She sounds like she would have gotten Sux tube and scopolamine if the situation was that dire. Ketamine if not grossly hypovolemic.
She also might have aspirated a large clot which can be very difficult to clear. That will kill you quick.

I brought this case up with a couple of my attendings (peds trained). In addition to having double suction ready, both mentioned having Magill forceps for pulling clots out. One of them had a particularly bad case where someone recommended pressing on the child's chest to imitate exhalation, causing air bubbles to form over the glottis (where she then stuck the ETT).

I haven't seen an extreme post-tonsillectomy bleed yet, but I want to be fully prepared when I do. This case is very unfortunate for all involved.
 

Mman

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I brought this case up with a couple of my attendings (peds trained). In addition to having double suction ready, both mentioned having Magill forceps for pulling clots out. One of them had a particularly bad case where someone recommended pressing on the child's chest to imitate exhalation, causing air bubbles to form over the glottis (where she then stuck the ETT).

I haven't seen an extreme post-tonsillectomy bleed yet, but I want to be fully prepared when I do. This case is very unfortunate for all involved.
While pressing on the chest can make the patient exhale, I'm not a big fan of pushing oxygen molecules out of their lungs when I'm in a bad airway situation. I'd like to have all the reserve they've got in case bad goes to worse.
 
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I see several people in this thread mentioning the PACU and her observation there. The quotes in the article say she was fine in the "recovery room" and was alert and talking and eating a popsicle. It also mentions the ICU admission was planned preop, I'm assuming because of bad OSA, though I admit I've never planned a kid to the ICU after tonsillectomy. It says she was fine when she went to the ICU and then something bad happened which sounds like bleeding to aspiration to arrest.

Doesn't sound like a PACU problem. I mean if they kid is talking and eating a popsicle, there was nothing seriously wrong at that point. I'm wondering if when they got to the ICU she said her throat hurt and she got a relatively big dose of narcotics.
We can all only guess, but the initiating event here seems to be bleeding, not apnea. As I mentioned in previous post, its not unusual to admit kids to the PICU after because RDI is so horrendous. That also means these kids generally aren't even written for opioid post-op because the risk of apnea is so significant. A large slug of narcotic is unlikely here. Acute bleeder-- Bleeding leads to more obstruction than the already bad baseline, more hypoxia, more hypotension-- unfortunate combination. If a child in the PICU post-tonsillectomy gets a large dose of opioid, that would officially be outside the standard of care-- we do as well as we can with non-opioid analgesics, and use tiny titrated doses of opioid when conservative methods aren't effective for analgesia. Sounds mean, but it saves lives. It's also possible that in order to avoid opioid, she got a dose of ibuprofen or ketoralac, which may have worsened things in the setting of an acute bleeder...
 

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We don't give toradol to any of our T&A patients.
If they don't have severe OSA they get morphine and oxycodone routinely in the PACU. The OSA folks get morphine as well, just smaller doses titrated to effect.
For the PICU severe OSA patients, the intensivists write all the post op orders. I'm not sure what they usually write for, other than not using toradol.
Ibuprofen is a standard post op home med for these patients.
 

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We don't give toradol to any of our T&A patients.
If they don't have severe OSA they get morphine and oxycodone routinely in the PACU. The OSA folks get morphine as well, just smaller doses titrated to effect.
For the PICU severe OSA patients, the intensivists write all the post op orders. I'm not sure what they usually write for, other than not using toradol.
Ibuprofen is a standard post op home med for these patients.
So why is ibuprofen ok but toradol is not?
I give toradol to my patients without problems all the time. So far anyway. If there was a lot of bleeding involved in the OR, then no. I didn't in residency, but startedworking with an attending here who was ok with it, and was involved in some research about post operative toradol in his residency; Did some research on it and and started giving it. The nurses did look at me funny at first because they weren't used to it but give it now without problems. Give opioids too. Smaller doses.
 

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While pressing on the chest can make the patient exhale, I'm not a big fan of pushing oxygen molecules out of their lungs when I'm in a bad airway situation. I'd like to have all the reserve they've got in case bad goes to worse.
Based on apenic oxygenation and mechanics, it seems to me that pressing on the chest is more likely to ventilate out CO2 and perhaps help identify the glottis with bubbles and not effect oxygenation much, if at all.

HH
 
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So why is ibuprofen ok but toradol is not?
I give toradol to my patients without problems all the time. So far anyway. If there was a lot of bleeding involved in the OR, then no. I didn't in residency, but startedworking with an attending here who was ok with it, and was involved in some research about post operative toradol in his residency; Did some research on it and and started giving it. The nurses did look at me funny at first because they weren't used to it but give it now without problems. Give opioids too. Smaller doses.
Toradol seems to totally be a culture/style thing-- one of our ENTs doesn't mind it, the others hate it-- I personally stick to ibuprofen
 

calvnandhobbs68

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The most interesting thing about this case is the fact that she is being kept on "life support" after being declared dead by two separate physicians. The fact that a judge hasn't immediately thrown this case out and is in fact allowing the family to have a THIRD physician do an evaluation doesn't sit well.
 

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The most interesting thing about this case is the fact that she is being kept on "life support" after being declared dead by two separate physicians.
Every time people wonder why European healthcare is much cheaper... that's why! There is no way in hell a brain-dead patient would be kept 10+ extra days in ICU, worth tens of thousands of dollars, so that the family can cope with it. I am extremely sorry for them, but that's the truth.

By the way, that looks like a BMI 35+ kid.
 
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calvnandhobbs68

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Every time people wonder why European healthcare is much cheaper... that's why! There is no way in hell a brain-dead patient would be kept 10+ extra days in ICU, worth tens of thousands of dollars, so that the family can cope with it. I am extremely sorry for them, but that's the truth.

By the way, that looks like a BMI 35+ kid.
Absolutely. All I could think of is how many alive people could get treatment with that money and time. My feeling is that this sets a bad precedent by even allowing the case to get this far...we can't keep dead people in a hospital bed just because their family wants to.
 

chocomorsel

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I just did a "google" search on patients who've been declared brain dead but actually weren't and actually came up with two or three stories. Check it out.
As a physician though of course pull the plug. But before you do, if you are getting a third opinion, get it ASAP. Like why is this taking days to get done?
 

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Because it's a court-appointed "expert".

P.S. There must not be enough fair and ethical neurologists in Oakland Children's Hospital. </sarcasm>
 
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No nuc med brain death scan? Can't think of a more convincing picture than an empty skull sign.
 

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As I mentioned in previous post, its not unusual to admit kids to the PICU after because RDI is so horrendous.
Where I practice and where I've trained it's far less common than unusual.
 

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that doesnt mention pacu at all
From the article. You're right, it is unclear whether "recovery room" is PACU or PICU. I assumed it was PACU.


"After Jahi underwent what the family called a routine tonsillectomy to help with her sleep apnea and was moved to a recovery room, her mother, Nailah Winkfield, began to fear that something was going wrong.

Jahi was sitting up in bed, her hospital gown bloody, and was holding a cup full of blood, she said. “Is this normal?” Ms. Winkfield repeatedly asked nurses."
 
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No nuc med brain death scan? Can't think of a more convincing picture than an empty skull sign.
If 2 independent brain death exams using pediatric brain death guidelines and a confirmatory apnea test all confirmed brain death, there is really no question. Nuc Med scans and other confirmatory testing can be used in lieu of the 2nd brain death exam or in the event that an apnea test cannot be performed (i.e. won't tolerate apneic oxygenation due to severe lung disease). If the concern is that the hospital is trying to cover something up, then a nuc med scan with a read by an independent radiologist would be useful-- or a 3rd brain death exam by independent neurologist as it seems where this is headed.

Brain death is legal death. The kink here is the malpractice question and the fact that the parents are denying the diagnosis of death. The irony is that it's not in the best interest of the hospital to declare death, so it would be unlikely they would be "covering up" by declaring brain death when it's not actually existent.

PICUs differ in how they approach this, but in our unit we enlist the pediatric neurologists to do the brain death exam even though the intensivists are qualified and capable to perform them. The last thing you want is for their to be any perceived conflict of interest when you are directly caring for the patient and other critically ill children in the unit. Organ donation makes this perceived conflict of interest even more significant. A very charged and controversial topic.

Although brain death= death-- families are given time to come together and grieve, and withdraw support in a way that suits them from a personal and cultural standpoint. Some parents want to hold their child when the vent/pressors/ECMO are discontinued, others want to lay in bed with them, others want to say their goodbyes before everything is discontinued-- this can take some time, and if the family decides to donate, that can take a few days while the organ donation process continues (if the child is stable on total support). I agree with OP that this has turned into a ridiculous, exploited media circus.
 
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The fact that CNN makes this their top story is ridiculous. kind of disgusting the way they present it as well..
Not to change the subject (but I'm not really), but it appears CNN has made sensationalizing end-of-life withdrawal issues their thing this holiday season: http://www.cnn.com/2013/12/23/health/pregnant-life-support-texas/index.html?hpt=hp_t2

"Complicating an already difficult situation is that Munoz is also pregnant, about 18 weeks along, WFAA reported. Texas state law prohibits withdrawing or withholding life-sustaining treatment from a pregnant patient, regardless of her wishes." Sigh.
 

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From the article. You're right, it is unclear whether "recovery room" is PACU or PICU. I assumed it was PACU.


"After Jahi underwent what the family called a routine tonsillectomy to help with her sleep apnea and was moved to a recovery room, her mother, Nailah Winkfield, began to fear that something was going wrong.

Jahi was sitting up in bed, her hospital gown bloody, and was holding a cup full of blood, she said. “Is this normal?” Ms. Winkfield repeatedly asked nurses."
i assumed that they would not send her from PACU if she was covered in blood and still hemorrhaging
 

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Winkfield told CNN Monday that she's seen recent improvements in her daughter's condition. A hospital monitor suggests her daughter is trying to breathe on her own, she said.

"They told me without your brain, you can't take your own breath," Winkfield said. "Well, she's trying, so that means something's working."
http://www.cnn.com/2013/12/23/health/jahi-mcmath-girl-brain-dead/

I'm speechless. I can accept the fact that the mother is uneducated, or in denial, but the sensationalist monkeys who call themselves reporters should know better.

There should be clear laws about this kind of stuff.
 
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calvnandhobbs68

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No decision on the case till Dec 30th? Who is this idiot judge? What, he doesn't want to interrupt his Chirstmas break?
 
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