InstantForum.NET / Procurement / Procurement / Donor Management

ACLS Training

John Belcher — Tue, 03 Nov 2009 15:05:11 GMT

NATCO is considering offering ACLS recertification at the Annual Meeting. This would likely consist of two components. An on-line component offered by the AHA. As well as a testing component at the meeting. I would appreciate any feedback.

Thanks

John

Rapid herniation and DIC ??

Adam Bell — Tue, 04 Aug 2009 16:29:24 GMT

In my practice I've found a correlation with rapid herniation + blood loss ( GSW head) but perhpas without massive transfuion requirements, and DIC. Many of my donors who herniate fast esp with trauma have DIC.

Anyone know of research or care to comment on pathophysiology?

Or is it all in my head ?!

Vent modes

Adam Bell — Tue, 04 Aug 2009 16:22:08 GMT

I'm curious how many of us use PCV in some form, and how many inverse the I:E ratio to obtain higher mean airway pressures on a given PEEP.

IVF Choices

Mindy Zoll — Fri, 04 Sep 2009 11:29:00 GMT

I'm seeking opinions regarding choice of IVF when managing donors. We're debating this and would like outside input. Does everyone use a set preferred IVF for all donors or do you select one accordingly once you've evaluated labs and donor status?

Brain Death Testing

John Belcher — Fri, 24 Jul 2009 14:04:03 GMT

There was an article published yesterday regarding a worldwide shortage of Technetium-99. The facilities that provide the isotope are aging and are either shut down, or in need of repair. Curious if this has trickeled down to cause a problem in your DSA's?

http://www.nytimes.com/2009/07/24/science/24isotope.html

Do you monitor CPKs in all donors

Susan Cassidy — Thu, 08 Jan 2009 19:46:21 GMT

Has anyone had the experience of having a young donor crash after hours of intense fluid and electrolyte replacement? Have you ever had a donor with a potassium of barely 1 for hours and then then after hours, it is 6 and the patient crashes? Every donor we have has the potential of developing Rhabdomyolysis. Don't forget to check CPK levels in non-cardiac donors. Any level over 5000 needs to be treated, although this value will vary depending on which article you read. These patients develop renal failure and are very hard to manage so don't forget to keep an eye on CPKs!

I would lover to hear comments on your experience with donors in rhabdo!

Urine replacement in DI??

Adam Bell — Tue, 04 Aug 2009 16:15:46 GMT

At my OPO most DI donors are given vasopressin 0.5-2 units/hr, ittrated to urine output and spec grav >1.01, however , we've noticed that this often doesn't go well in the ECD population. We've experimented some w/ CC:CC & 1/2 CC:CC + IVF @ around 200ml/hr usually with the IVF and replacement usually bening 1/4 NS.

So here are some ??s:

1) What do you normally use for DI?

2) If you use urine replacemnt what ratio and + what other IVF /hr?

3) If you use urine replacemeny what fluid do you replace with/ why?

4) what are your experience/ considered opionion overall about urine replacement?

5) If ypu use urine replacement will you do so on potential lung donors and if not why not?

6) how do you feel about DDAVP? (I've personally had a few disaterous episodes using only 1mcg and having no urine X 12 hrs despite obvious DI before hand)

pleural effusions

Susan Cassidy — Sat, 20 Dec 2008 06:12:25 GMT

Most of donors will have small effusions and they are typically not a big deal. I was involved with 2 cases recently in which they were big deals. If they are large enough, they act like a pneumo. The problem is that typical AP xrays don't identify them or if they do, only show them, but can't really quantify them.

The first donor was a 3 month old that was labile the entire time. We couldn't wean pressors, she had high PIPs and had periords of low sats. They did an emergent bronch which was clean, xrays were clear, but she had lower PO2s. During the recovery, the thoracic surgeon found that she had large pleural effusions that were the cause of all of our problems. In her case, they weren't identified on chest films.

The second case was a 47 year male who had an MI and had about 40 minutes of down time so he started off with acute renal failure, but was making some urine. He was fluid overloaded per xray and also had small effusions per the xray we ordered. He was not responding well to diuretics, had high PA pressures, high wedge and CVP, his SPB was in the low 100's on pressors and his PIPs were 33. He was on 100% and 15 of PEEP to keep an adequate PaO2. When the intensivist rounded he checked in with us and asked if we wanted to review his xrays, which we did. He noted small effusions and fluid overload on the xray but then showed us his admit CT (from 3 days earlier) and half of his thoracic space was filled with effusions. He did an ultrasound to confirm the large effusions and placed chest tubes. One drained 800cc and the other 700cc. Not too surprising, he had an immediate improvement in his BP, compliance improved, we quickly weaned his FiO2 to 50 and PEEP down to 5. His PIP decreased to 22, his wedge and CVP came down and the diuretics started to work.

The lesson learned is never underestimate the effect effusions can have on your donor. An AP film will generally not give good details of an effusion. The best way to look at them is with an ultrasound or a lateral film.

Narcan use in Lung Donors

Russ Ruszczyk — Wed, 04 Feb 2009 09:38:14 GMT

we are looking for why/how does Narcan improve lung donation.

trial

Susan Cassidy — Tue, 29 Jul 2008 16:03:47 GMT

Just seeing how this all works:P

Instructions - How to Use Instant Forum

Janene Dawson — Mon, 14 Jul 2008 16:43:20 GMT

Welcome - attached are a set of instructions on how to get started with the NATCO Instant Forum. Enjoy.