Question

A 52-year-old woman with a history of diabetes mellitus, hypertension and uterine fibroids experiences a catastrophic intracranial hemorrhage. She is admitted to a tertiary care center following activation of the emergency medical services center following activation of the emergency medical services system by her family who witnessed the event, including her loss of consciousness. She had been independent with activities of daily living and worked as an account full-time. Following stabilization in the emergency department, including intubation and mechanical ventilation, her emergent head computed tomography (CT) scan shows massive intracranial hemorrhage, significant midline shift, brain edema, and blood within the ventricles. Her neurologic examination is declining despite aggressive care to maximize recovery. a. At what point is it appropriate to initiate a referral to the local organ procurement organization? She continues to experience decline in her neurologic assessment to the point that her pupils become fixed, dilated and midpoint, and she has lost all brainstem reflexes. What is the optimal strategy to communicate this change b. with the patient's family?

Answer 1

Intracranial hemorrhage is the condition where there is bleeding in the skull or the cranium. It is the emergency situation for the patient as all other organs are influenced by it, resulting in mortality if not treated well in time.

Answer a) : The patient in this case study has massive hemorrhage, brain edema, etc but is stii in somewhat stabilised condition. Her brain functioning has stopped due to excessive blood accumulation and loss of oxygen supplied to the brain. The point when she is completely brain dead but her body is kept connected to the ventilator, only then the local organ procurement organisation can be referred to, but that too with the full consent of the family.

Here, the family has witnessed each and every declining step of their patient, they should be talked about the organ donation aspect.

Answer b) : When a family comes to know about their patient's de ling and ending stage, it ibecomes hard for the staff to discuss this part with them. Though the family is always made aware of each and every change happening their loved ill patient, still they keep praying or hoping for the betterment. It is mandatory to have a clear talk with them.

For that, many things are taken into consideration. The professionals who have been regular contact on daily basis with the patient and his/her loved ones by shis/her side are supposed to do this job. The main reason for this is their trustworthiness. Family tends to believe what they have been saying throughout. That professional could be a doctor, an assisting nurse or a nurse.

Usually the difficult message is given by starting with a metaphor and then slowly clearing the situation to the patient's family. The professional who has to give away the message has to first configure his/her talk and structure it before delivering. It somehow creates a relieving affect for the loved as they are listening and making them prepare for the final statement.