ONE CHAMPION, MANY ONE CHAMPION, MANY LIVESLIVES

Douglas T. Miller Douglas T. Miller SymposiumSymposium

Donn Dexter, MDDonn Dexter, MD

Luther Midelfort, Mayo Health Luther Midelfort, Mayo Health SystemSystem

WHAT DOES IT TAKE WHAT DOES IT TAKE TO BE ATO BE A CHAMPION?CHAMPION?

You have to CARE!You have to CARE!

Case ReportCase Report

• 42 year old white woman with no serious 42 year old white woman with no serious health issues collapsed at 1550 hourshealth issues collapsed at 1550 hours

• To ER by ambulance where she had a To ER by ambulance where she had a cardio-respiratory arrestcardio-respiratory arrest

• Resuscitated and transferred by helicopter Resuscitated and transferred by helicopter to Luther Midelfortto Luther Midelfort

• When seen at 1800 hours she was When seen at 1800 hours she was intubated, ventilated and on multiple intubated, ventilated and on multiple pressors for blood pressure controlpressors for blood pressure control

Case Report - continuedCase Report - continued

• Neurologic exam – pupils fixed and Neurologic exam – pupils fixed and dilated, unresponsivedilated, unresponsive

• Marked papilledemaMarked papilledema

• Flame hemorrhagesFlame hemorrhages

• No brainstem reflexesNo brainstem reflexes

• No reflexesNo reflexes

• No pain responseNo pain response

Admission CAT Scan of Admission CAT Scan of BrainBrain

CAT Scan of Brain, at CAT Scan of Brain, at midbrainmidbrain

Case Report - continuedCase Report - continued

• CT Angiogram reports no cerebral CT Angiogram reports no cerebral blood flowblood flow

• Brain death exam completed but Brain death exam completed but patient too unstable for apnea testpatient too unstable for apnea test

• Based on exam and negative Based on exam and negative cerebral blood flow on CTA declared cerebral blood flow on CTA declared brain dead at 0100 hoursbrain dead at 0100 hours

Case Report - continuedCase Report - continued

• Met with family for over an hour to Met with family for over an hour to review history exam and finding of review history exam and finding of brain deathbrain death

• They wished to proceed with They wished to proceed with donationdonation

• Donation completed 2000 hours day Donation completed 2000 hours day after admissionafter admission

Case report - continuedCase report - continued

• Straightforward case, BUT…Straightforward case, BUT…• Over 24 hours from admission to OROver 24 hours from admission to OR• She was not just a case but a She was not just a case but a

wonderful young woman; co-worker, wonderful young woman; co-worker, friend, sister, daughterfriend, sister, daughter

• She had a caring, devastated family, She had a caring, devastated family, that had donated organs from her that had donated organs from her brotherbrother

• She saved 4 lives She saved 4 lives

You have to CAREYou have to CARE

• C – Commit: time and energy with C – Commit: time and energy with each patient and preparing for future each patient and preparing for future casescases

• AA

• RR

• EE

You have to CAREYou have to CARE

• C - CommitC - Commit

• A – Attend: to your current patient A – Attend: to your current patient and to your programand to your program

• RR

• E E

You have to CAREYou have to CARE

• C - CommitC - Commit

• A - AttendA - Attend

• R – Recognize: you need to R – Recognize: you need to acknowledge your coworkers, acknowledge your coworkers, patients, families; your successes patients, families; your successes and failuresand failures

• EE

You have to CAREYou have to CARE

• C – CommitC – Commit

• A – AttendA – Attend

• R – RecognizeR – Recognize

• E – Energize: you need to keep E – Energize: you need to keep everyone involved and enthusiastic everyone involved and enthusiastic about your program; institution, about your program; institution, community and regioncommunity and region

You have to CAREYou have to CARE

• ““Never believe that a few Never believe that a few caringcaring people can’t change the world. For, people can’t change the world. For, indeed, that’s all who ever have.” -indeed, that’s all who ever have.” -Margaret MeadMargaret Mead

• ““Three keys to more abundant living; Three keys to more abundant living; caringcaring about others, daring for others, about others, daring for others, sharing with others.” -William A. Wardsharing with others.” -William A. Ward

You have to CAREYou have to CARE

•I don’t care how much you I don’t care how much you know, until I know, until I know how much you care!know how much you care!