Regional Collaborative November 2015. NDT Case study Paediatric - H Bethan Thomas Specialist Nurse – Organ Donation.

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Presentation transcript:

Regional Collaborative November NDT Case study Paediatric - H Bethan Thomas Specialist Nurse – Organ Donation

Regional Collaborative November Background 10 yr old Cerebral Palsy Global developmental delay Microcephaly Epilepsy Scoliosis Quadriplegia PEG fed- no swallow Previous abdominal compartment syndrome with bowel ischaemia leading to bowel resection Worsening T2RF (normal pCO reported by paediatrician) Recurrent LRTI Home O2 Recent discharge from hospital after admission for chest infection

Regional Collaborative November Day 4 BSDT Preconditions CVS stable on noradrenaline and dopamine –BP map 66 pCO pO pH 7.41 GCS 3 - unsedated Temp 39ºC (>24 hours) Lab results: Na 153 K+ 3.2 PO Mg 0.69

Regional Collaborative November Day 4 Pupils 2mm-fixed BSDT started- breathed during apnoea test Test done by 2 PICU consultants 2 nd set not done. Test 1 Time Pre Apnoea Test 14:13 Post Apnoea Test 14:20 pH pO pCO HCO ABE

Regional Collaborative November Day 5 BSDT Preconditions CVS stable on noradrenaline and dopamine –BP map 80 pH 7.33 pCO pO GCS 3 - unsedated Temp 38.7ºC (>24 hours) Lab results: Na 173 K+ 3.1 PO Mg 0.79

Regional Collaborative November Day 5 Repeat BSDT ‘Gasped’ at the end of the second set of tests. Test 1 Time Pre Apnoea Test 13:14 Post Apnoea Test 13:22 Test 2 Time Pre Apnoea Test 19:09 Post Apnoea Test 19:28 pH pH pO pO pCO pCO HCO HCO ABE8.15.8ABE6.53.1

Regional Collaborative November Parents given the option of withdrawing treatment after these tests

Regional Collaborative November Day 6 BSDT Preconditions CVS stable on noradrenaline and dopamine –BP map 65 pH 7.36 pCO pO GCS 3 - unsedated Temp 36.8ºC (>24 hours) Lab results: Na 160 K+ 3.7 PO4 0.8 Mg 0.94

Regional Collaborative November Day 6 Third set of BSDT were performed H breathed on the first set but after a prolonged time off the ventilator (around 7 minutes) Test 1 Time Pre Apnoea Test 15:46 Post Apnoea Test 16:07 pH pO pCO HCO ABE3.51.1

Regional Collaborative November Outcome Parents at this time were told that neurological death was now very unlikely to occur due to the amount of time past since her hypoxic event. H’s parents remained positive about organ donation and proceeded as a DCD saving 4 lives.

Regional Collaborative November Discussion points No CT scan was done. Known aetiology was history and clinical presentation. EEG day 2- very low amplitude with no convincing cerebral activity H was a known CO 2 retainer with normal CO 2 sitting around kPa and prior to admission kPa H’s usual oxygen levels on facemask of 1l SaO2 >95% and on 2l via nasal cannulae >90%