List Archives

Thu Dec 21 20:10:18 GMT 2006

I hear ya!  And so we all keep pluggin' away and hopin' for those "good
guys"!

Happy Holidays to you and yours,
Ron

>>> <rwolfer at aol.com> 12/21/2006 3:06 PM >>>
I know, just offering a what if.  most of them never survive, we either
end up "turning them off" or going to donation after familys say their
"goodbyes" and brain death has been determined.  We got lucky with this
guy, that was majority of the few that survive end up in nursing homes
with trachs, pegs, and diapers. It is just a never say never experience.
 He was actually traveling thru the area when the accident occured from
3 states away.  He has since come back to say "thanks" It was a very
rewarding experience and reinforces that sometimes the good guys make
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: Thu, 21 Dec 2006 9:33 AM
Subject: Re: head injury- termi ation of resuscitative efforts

Rebecca,
All of us have that anecdotal patient that we could cite.  The
question
is, however, what are the statistics, and given the fixed and dilated
patietn with the severe closed head injury, or the patient with a
transcranial GSW, how many of those will return to "normal" or
"meaningful" function?
Ron

>>> <rwolfer at aol.com> 12/21/2006 8:43 AM >>>
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