Hi all! Im currently on prac in the ICU, and came across a patient who was being treated for liver and kidney failure. She was sedated and ventilated so was recieving routine chest care and passive ranges by physio. On assessment the patient had added sounds on auscultation and changes on her CXR. On suction there was large amounts of M2P2 and a moderate cough, however she was not coughing spontaneously. Therefore chest physio was indicated.
The next morning I went to see the pt, and the NS reported that the patient developed cerebral oedema as a result of global ischemia overnight, that her pupils were now fixed and dilated and she had no cough on suction. The cerebral perfusion test had not been done yet, but objectively the patient appeared to be brain dead.
The dilemma I came across was whether or not to treat the patient. What was the point if she was brain dead? (Although not officially declared dead yet).
From speaking to my supervisor I found out that normally, even when a patient is declared brain dead, they recieve 4 hourly chest physio, in case the family decide to donate the pts organs. However in this case the pt was aborigional, donating organs is against their beliefs, and the ns seemed to think that the pt s family would decide not to donate them. As a result the pt did not recieve phsyio. Later that day the pt was declared brain dead and the family decided not to donate the pts organs.
This was just an interesting situation i came across and learnt from it, so thought I d share the experience. :)
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Crikey kel, that is such a situation to be in... I can't imagine what that would have been like!
If that were me in that situation and there was no one around, first I guess I would look through the code of practise stuff for patient care and see if maybe that had anything in there about our legal responsibilities to treat.
My natural instinct would be to treat all other patients that were in need and then see if I had time left to treat that patient. I guess I feel that way because its what you're taught for swimming life saving- save the stronger ones first & then the weaker ones. If you start to rescue the weaker ones first, the stronger ones can get in trouble and then you're in double the striffe.
Dont know what everyone else thinks!
Anyway hope you are having a good prac
luv caris
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