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Thu Dec 21 13:43:18 GMT 2006

fellow american college of chest physicians.  We get bad head trauma in all the time. Occasionally when they code in ER, we get them back.  We do this even in the case of exposed gray matter fixed and dilated.  If they are later declared brain dead ( most of the time) we refer to organ donation.  We have over a 90 % rate of families agreeing.  We also had a case last year of severe head injury with full arrest. He was fixed and dilated and coded.  we got him back.  He remained fixed and dilated in SICU.  His head ct was horrid.  His GCS was 3 for a week.  He had no gag no corneals and only breathed over the vent.  One week later his pupils reacted. he was trached and weaned off vent, made a dnr by family.  NS said, "he will be in persisent vegatative state".  2 days later he looked at me.  2 days after that started following commands.  A few days later said "HI"  Went to rehab and returned to work 4 months later as a counsellor.  You never know.  Families of those who do not survive typically write us back thanking us because they feel that everything was done.  they also feel that "their loved one lives on in someone else"  Its just our experience. 

Rebecca Wolfer, MD, FACS, FCCP
Associate Professor, Marshall University School of Medicine
Dept of Surgery
Director Thoracic Surgery
Director, Surgical Critical Care Cabell Huntington Hospital
Director, Trauma Cabell Huntington Hospital

-----Original Message-----
From: tangentcarrot at hotmail.com
To: trauma-list at trauma.org
Sent: Thu, 21 Dec 2006 3:47 AM
Subject: RE: head injury- termi ation of resuscitative efforts

Oh, I know that. I googled it the minute I saw the mail 

>From: "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za> 
>Reply-To: "Trauma & Critical Care mailing list" ><trauma-list at trauma.org> 
>To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org> 
>Subject: RE: head injury- termi ation of resuscitative efforts 
>Date: Wed, 20 Dec 2006 07:31:01 +0200 
> 
>Oded 
> 
>FCCP - Fellowship of Critical Care Physicians or Fellow or College of Chest >Physicians, depending on country of origin. 
> 
>Tim 
> 
>-----Original Message----- 
>From: trauma-list-bounces at trauma.org 
>[mailto:trauma-list-bounces at trauma.org]On Behalf Of oded private 
>Sent: Tuesday, December 19, 2006 8:55 PM 
>To: trauma-list at trauma.org 
>Subject: Re: head injury- termi ation of resuscitative efforts 
> 
> 
> 
> 
>Hi Rebecca 
>You made teach myself something new today- what's "FCCP" 
> 
>I'm not sure I understand you- you say you'd call a code just so the family 
>will be more likely to agree on donation? 
> 
> >From: rwolfer at aol.com 
> >Reply-To: "Trauma & Critical Care mailing list" 
> ><trauma-list at trauma.org> 
> >To: trauma-list at trauma.org 
> >Subject: Re: head injury- termi ation of resuscitative efforts 
> >Date: Tue, 19 Dec 2006 13:20:58 -0500 
> > 
> >I would do a code. Nothing heroic. I agree about organ donation. I have 
> >actually gotten a couple of donations because of this. The family always 
> >seems to "feel better" that everything was done and donation occurred. 
> >They state " atleast something good will come of it" 
> > 
> >Rebecca Wolfer, MD, FACS, FCCP 
> >Associate Professor, Marshall University School of Medicine 
> >Dept of Surgery 
> >Director Thoracic Surgery 
> >Director, Surgical Critical Care Cabell Huntington Hospital 
> >Director, Trauma Cabell Huntington Hospital 
> > 
> > 
> >-----Original Message----- 
> >From: Rgross at harthosp.org 
> >To: trauma-list at trauma.org 
> >Sent: Tue, 19 Dec 2006 12:18 PM 
> >Subject: Re: head injury- termi ation of resuscitative efforts 
> > 
> > 
> >I treat the family. The patient is dead, and will stay dead, regardless 
> >of what you do. Now is the time to help the family honor the patient's 
> >wishes, if known, and to call the organ donation service in your region. 
> > Lastly, thoracotomy IS indicated - to procure the heart and lungs for 
> >transplantation. (so there - I did come forward and admit it!) 
> > 
> >Take care, 
> >Ron 
> > >>> "oded private" <tangentcarrot at hotmail.com> 12/19/2006 11:47 AM >>> 
> >Hello list 
> > 
> >I'd like to hear your opinion about deciding to terminate treatment for 
> > 
> >isolated TBI resulting in cardiac arrest. 
> > 
> >What if the pateint is still in PEA? Will you attempt to defibrilate 
> >VF, if 
> >it happened for some reason? 
> > 
> >If you do treat him- what will you do? ET intubation and ventilation 
> >alone? 
> >CPR? Does anybody here practice thoractomy in the scenario and is ready 
> >to 
> >"come forward" and admit to it? 
> > 
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head injury- termi ation of resuscitative efforts