A 30 year old woman has been certifted "brain dead". While awaiting organ donation she ishypotensive, polyuric and hypothermic. Outline your management.
Efficient support of the potential organ donor is an integral part of IC practice. Since we know nothing of this patient's story a back to basics detailed approach to the patient should have included:
(a) Check airway patency, tube position.
(b) Ensure adequate ventilation:
• Examination, ABG, CXR (to exclude pneumothorax/lung injury, hypoxialhypercarbia) (c) Restore circulation with fluid challenge. Assess filling pressures and response to challenge.
• If diabetes insipidus is apparent (eg. urine output >300mlslhr, serum osmolality >300, urine osmolality <300 in the absence of diuretics) give lug ofDDAVP lV or SC
• If restoration of fluid status does not restore BP and organ perfusion, commence vasoconstrictor infusion (aramine or noradrenaline)
• Moderate hypothermia (35°C} may be well tolerated and require no specific therapy
• Persistent hypotension in the presence of impaired pituitary functiODt as evidenced by DI. It may be an indication for intravenous corticosteroids and T3. There usually is no time for a random cortisol level
• Maintain fluid and electrolyte homeostasis eg. replacing urine output ml for ml
This question discussess the generic principles of care for the brain-dead organ donor. This issue is explored in great depth in the answer to Question 1 from the first paper of 2012:
"Outline the Intensive Care management of a 25-year-old male who has fulfilled brain death criteria and is awaiting surgery for organ donation."
Non-clinical issues: (presumably, these have been dealt with now that the patient is "awaiting surgery for organ donation"
Summarized from the ANZIC statement on Brain Death and Organ Donation, Version 3.2
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