I imagine children's has a fairly large ici, but this is the time of year when they're probably full to capacity.
So in addition to a vent, I'll speculate they're using a rack of iv pumps with all sorts of meds in a delicate balance which in turn means constant lab monitoring, continuous dialysis which means a dedicated nurse, internal monitoring of blood flow which will probably take up time from a tele nurse... That's before you get into basics like turning the body and using a specialized bed in a vain attempt at preventing skin breakdown. And remember, the skin is a organ, so toss it failing in the category of multiple organ failure that will begin to happen.
Oh I was just thinking it gives them one more week to say goodbye and make peace with the situation. I definitely do think they should take her off. Calm down.
But why should they get yet another week of wasting those resources? She was declared dead Dec 12. I feel what they're doing is the opposite of making peace.
What pisses me off too is that it looks like their normal procedure is to continue life support on brain dead children until family has a chance to come say goodbye and the parents have time to meet with grief counselors and begin to let go. Which is what they did here. From what I can tell, they could have removed life support immediately, without consent, once she was declared brain-dead. Is Children's going to change their policy now after this fiasco, so that other parents don't get the same consideration that this family used to completely inappropriate ends?
Oh I was just thinking it gives them one more week to say goodbye and make peace with the situation. I definitely do think they should take her off. Calm down.
And if every dead person's family wanted an extra two weeks....
Post by weardogbride on Dec 31, 2013 16:17:43 GMT -5
I've been following this story closely since we scheduled DS's tonsillectomy for next week. The only reason we booked it was bc of a sleep apnea "diagnoses" due to him snoring and being on the small side. There was no sleep study done on DS. Anyway, I canceled the surgery today. After reading the article below I wasn't comfortable going ahead with it.
Questions about tonsillectomies to treat sleep apnea after a child falls critically ill
Tonsillectomies fell out of favor in the 1980s, but the procedure has become more common again to treat a new diagnosis — sleep apnea, a breathing disorder — but not without controversy. And the surgery is sure to attract renewed scrutiny because of 13-year-old Jahi McMath of Oakland, Calif., who suffered sudden bleeding from her nose and mouth and cardiac arrest after a Dec. 9 surgery intended to help with her sleeping problem.
She has since been declared brain dead; a judge Friday granted a temporary restraining order preventing the hospital from removing her from a ventilator.
A neurologist who examined her told a judge in Oakland on Tuesday that tests show she is brain dead. “Unfortunately, the medical condition of Jahi — she meets all the criteria of brain death,” Paul Fisher said during an open court hearing before Alameda County Superior Court Judge Evelio Grillo.
The hearing continued after Fisher’s testimony, where Robin Shanahan of Children’s Hospital Oakland also was expected to testify.
Court documents show the hospital performed a tonsillectomy, in addition to other throat and nose tissue removal procedures.
Even before this case, the resurrection of tonsil removal surgery has spurred debate in the medical world. While some medical experts say the procedure is the most effective treatment for pediatric sleep apnea, others say there is a dearth of studies confirming that. One pediatrician has called the jump in procedures an “epidemic” and a “national embarrassment.”
David Goodman, professor of pediatrics at Dartmouth’s medical school, is a leading critic of tonsillectomies and points to Jahi’s case as an illustration of the problem.
“What gives me concern is she’s a 13-year-old child, and that’s an example of the population we know virtually nothing about (concerning) the value of the procedure,” Goodman said. “It doesn’t mean it’s not valuable, but we know nothing about it.”
There’s been only one randomized clinical trial studying the use of tonsillectomies in treating sleep disorders, but Goodman said it looked only at children ages 5 to 9.
“I would describe it as a national embarrassment that with over a half-century of having tonsillectomies often used, it’s irrational that we still don’t have high-quality evidence that children benefit from the procedure,” he said.
Between 1915 and the 1960s, tonsillectomies were the most common surgery in the United States, done largely to treat chronic throat infections, according to an American Academy of Otolaryngology report on the procedure.
Between 1977 and 1989, such surgeries dropped by half after it was determined they had limited success in treating throat infections. But tonsillectomies have resurged in the past three decades for treatment of sleep apnea.
About 530,000 children younger than 15 have the procedure annually, according to the study, about 90 percent of them for treating sleep apnea. The surgery rose 74 percent between 1996 and 2006, according to the academy, which represents 12,000 ear, nose and throat surgeons.
David Tunkel, director of pediatric otolaryngology at Johns Hopkins, says studies show a “benefit for most children, but not for all.”
“Often it’s the first step in trying to improve the severity of breathing problems,” he said. “But tonsillectomies have been under scrutiny for decades.”
Tonsils, the glandular tissue behind the nose, relax along with other throat muscles during sleep, which can affect breathing, Tunkel said. The removal of the tonsils and adenoids can clear breathing passageways.
“A growing body of evidence indicates that tonsillectomy is an effective treatment” for sleep apnea, concludes the American Academy of Otolaryngology guidelines released in 2011, the first official recommendations on tonsillectomy published in the United States. In addition, children have trouble tolerating CPAPs, or continuous positive airway pressure masks, often worn by adults to treat sleep apnea.
Only 1 to 4 percent of children have sleep apnea, according to the study, but 30 to 40 percent of those children exhibit behavioral problems that can affect school performance. Jahi McMath suffered one of the most common complications of the procedure, according to the report — primary or secondary hemorrhages that occur in 2 to 3 percent of cases.
Deaths are rare, according to studies, with mortality rates between 1 in 16,000 to 1 in 35,000 in the 1970s; there are no current estimates. With more than a half-million procedures each year, the odds point to occasional deaths.
“There will be mortalities each year in the country for this operation,” Tunkel said.
Goodman called the surgery spike a “unique American phenomenon,” and not a good one.
“It’s worth noting there are virtually no tonsillectomies done for sleep apnea in England,” he said.
“The quality of diagnoses are generally poor and we know little about the benefits, but it’s the most common procedure under general anesthesia in the United States for kids — that’s not a good combination,” he said. “It gained traction at a high level without any good evidence that it’s helpful.”
The academy released a second set of guidelines in 2011 directing physicians to refer patients to pre-tonsillectomy sleep studies in certain cases, including for obese children. Goodman goes further in his recommendations for tonsil surgeries for sleep apnea patients.
“It should only be done in patients who’ve had a formal sleep study,” he said.
The report found that only about 10 percent of children received such a sleep study before surgery, largely due to cost, accessibility and varied interpretations of results. Jahi’s uncle said she received a sleep study in advance of her surgery.
i jut want to add that i almost died when i had my tonsils removed when i was in third grade from a massive bleed.
Aaaaaaaand now I am officially going to have a nervous breakdown if I ever have a child who needs his/her tonsils removed.
It really is a tough surgery. I had mine out on the 17th and was rushed to the ER on the 25th with a major bleed that I could have died from. My family luckily reacted as soon as we saw blood, which saved my life.
So then, are pregnant women in Texas allowed to refuse other types of medical care? Is it a crime for a pregnant woman to knowingly avoid prenatal care?
This is the road the anti-choice movement takes us down with every step they take, with all legislation they pass.
"Not gonna lie; I kind of keep expecting you to post one day that you threw down on someone who clearly had no idea that today was NOT THEIR DAY." ~dontcallmeshirley
Post by statlerwaldorf on Dec 31, 2013 21:57:25 GMT -5
I regret having it done. Dd needed an adenoidectomy. Her adenoids were so large they were causing hearing loss. She had a sleep study and was diagnosed with sleep apnea and hypopnea, but because her tonsils were also large, they couldn't determine if her breathing issues were caused by the adenoids, the tonsils, or both. I figured I would have them done at the same time to avoid a possible second surgery, but if I could do it over again I would have taken that chance instead.
Oh I was just thinking it gives them one more week to say goodbye and make peace with the situation. I definitely do think they should take her off. Calm down.
They've had close to a month. I'm not saying it to be insensitive, but they've had plenty of time.
I regret having it done. Dd needed an adenoidectomy. Her adenoids were so large they were causing hearing loss. She had a sleep study and was diagnosed with sleep apnea and hypopnea, but because her tonsils were also large, they couldn't determine if her breathing issues were caused by the adenoids, the tonsils, or both. I figured I would have them done at the same time to avoid a possible second surgery, but if I could do it over again I would have taken that chance instead.
Our ENT said that they do not typically do sleep studies in children because there are not enough labs to handle the demand. It seems weird now that they are willing to do a pretty major surgery without an official diagnoses. This whole story just left me unsettled with the whole thing and we decided to wait.