Management
This clinical presentation is characterized by low specific gravity, high serum sodium and loss of free water in the urine.
What Diabetes Insipidus
-Treat with Vasopressin @ 0.03u/min
Nurses should maintain their patient's temperature to this degree if they know brain death testing will be occurring.
What is greater than or equal to 36 C
Withdraw of care for DCD patients most often occurs here.
What is the OR
-Can also occur in the ICU or PACU is certain situations
This is the time frame to refer all deaths to Infinite Legacy for tissue donation.
What is 60 minutes
Surges of catecholamines can often cause these symptoms in brain dead donors
What is hypertension, tachycardia and dysrhythmias
-minimizing tactile stimulation, turns and suctioning can decrease these occurrences
This ancillary test is considered the gold standard if apnea exam cannot be completed.
What is a Nuclear Medicine study or Cerebral Blood Flow study?
Palliative/comfort measures are dictated by this team.
What is the ICU/medical team.
-Infinite Legacy can NEVER have any direct involvement or guidance of palliative medication administration
Name 2 of the 6 clinical triggers that ensure all deaths and imminent deaths are referred to Infinite Legacy as a potential donor.
What are:
Prior to anticipate family meeting to discuss:
End-of-life options
De-escalation of life-sustaining therapies
Palliative care/hospice consults
DNR for purposes to not escalate care
OR GCS less than 5
OR Family mentions donation
Infinite Legacy completes these donor specific types of testing at the start of every organ donation case. (Name all 3)
What are:
1. Infectious disease testing (serologies)
2. Blood on hold for recipient cross matching
3. Human Leukocyte Antigen (HLA)
Spinal movements have these 3 features to differentiate them from normal movement.
What are:
1.They do NOT occur with cranial nerve stimulation
2. They are often triggered by stimulation below the foramen magnum
3. The spinal movement is often precisely repeatable
Name the medication, dose and route that must be given 5 minutes prior to terminal extubation.
What is Heparin 30.000units IV push
Infinite Legacy will request a call should any of these things occur (name 3)
What are:
1. Change in code status
2.Acute neuro decline/ HD instability
3. Plans for brain death testing
4. Plans for Withdraw or deescalation of care
5. Prior to family meetings discussing goals of care
5% Albumin is used in conjunction with lasix administration during brain dead donor cases with this intended effect
What is diuresis of third spaced fluid, specifically in the lungs
-Albumin increases intravascular oncotic pressure to pull fluid from the tissues back into the vasculature, Lasix is administered so the patient pees it out.
Name 3 indicators of a POSITIVE apnea test
What are:
1. No visualization of respiratory effort
2.Final PaCO2>60mmHg and/or PaCO2 increase >20mmHg
3. pH<7.3
Name the term defined as the time between when organs stop receiving oxygenated blood and the time hypothermic preservation is initiated
What is Warm Ischemic Time (WIT)
-The longer this time, the more damage organ can incur, effecting recipient outcomes
When patients are referred, this Infinite Legacy employee does a chart review and evaluation prior to dispatching appropriate onsite responders
What is the Referral Triage Coordinator
-Please remember to refer patients in a timely manner to allow for a full evaluation and staff activation (~2 hours).
Dobutamine dosed at 0.5mkm-0.75mkm is used during brain dead donor cases for this effect.
What is Lusitropic effect
-This is the heart muscle's ability to efficiently relax during diastole
This pH range is recommended by the American Academy of Neurology (AAN) to help ensure acid base imbalance does not confound brain death testing
What is <7.3 and >7.5 (may vary based on hospital policy)
At YOUR facility, policy states that patients have to pass within this timeframe to be eligible for organ donation.
-What is (90-120mins)
This computer system is imbedded in Epic to assist nursing staff with quick referral placement, reducing their phone interactions with Infinite Legacy staff
What is Copernicus