Donor Management Flashcards
A 4yr old girl is admitted to the PICU with an ICH from a ruptured AVM. She has been declared brain dead and her parents have consented for donation of all organs and age-appropriate tissues. She has no past medical history and all immunizations are up to date. She is 40 inches tall and weighs 25 kg. Hemodynamics: HR 110, BP 66/50, UOP 20ml/hr. A central line has been placed and CVP is 6. Based on this data, what sould the procurement coordinator do next?
- start levophed at 0.05mcg/kg/min
- start dopamine at 4mcg/kg/min
- start neosynepherine at 0.5mcg/kg/min
Start Dopamine (pt fluid status is adequate so next intervention for hypotension is dopamine at low dose)
A 23yr old man presents to the ER after being involved in a MVA. He has massive facial fractures, a SDH, bilat pulmonary contusions, and a stable pelvic fracture. He has no significant PMH. He is 5’10” and weighs 70kg. The vent settings are: AC 10, Vt 650, FiO2 70%, Peep 7.5, Peak airway pressure 45, and plateau pressure 40. Upon auscultation he has diffuse crackles and rhonchi throughout all lung fields. ABGs reveal pH 7.40, PaO2 76, PaCO2 30, HCO3 23, and SpO2 90%. Hemodynamics: BP 100/70 (80), CVP 6, PAP 45/22, PCWP 10. Of the following interventions, which would be most appropriate?
- change PEEP to 10
- change Vt to 10-15 ml/kg
- change Vt to 6-8 ml/kg
Change Vt to 6-8 ml/kg
A 23yr old man presents to the ER after being involved in a MVA. He has massive facial fractures, a SDH, bilat pulmonary contusions, and a stable pelvic fracture. He has no significant PMH. He is 5’10” and weighs 70kg. The vent settings are: AC 10, Vt 650, FiO2 70%, Peep 7.5, Peak airway pressure 45, and plateau pressure 40. Upon auscultation he has diffuse crackles and rhonchi throughout all lung fields. ABGs reveal pH 7.40, PaO2 76, PaCO2 30, HCO3 23, and SpO2 90%. Hemodynamics: BP 100/70 (80), CVP 6, PAP 45/22, PCWP 10. CXR shows diffuse bilat interstitial and alveolar infiltrates. Given the above findings, you would conclude that the donor has which of the following conditions?
- Acute Respiratory Distress Syndrome
- Aspiration pneumonia
- Pulmonary edema
Acute Respiratory Distress Syndrome (ARDS)
(ARDS defined as PaO2/FiO2 less than 200. Also need absence of CHF - PCWP less than 18. Diffuse bilat alveolar infiltrates on CXR.)
Which area of the lung is targeted through lung recruitment maneuvers?
Alveolus (functional unit of the lung where gas exchange takes place)
A 38yr old male s/p MVC presents as a potential multi-organ donor. He is 6ft tall and 100kg. He has no significant PMH and his injuries include mult rib fxs and SAH. CT of abdomen reveals no abnormalities. The donor is currently being maintained on dopamine at 5mcg/kg/min and his VS are: HR 110, BP 105/80, CVP 1. Serum Na is 164. What is his free water-deficit?
8.5 L Formula to calculate: 0.6 x kg body wt = total body water (current Na x total body water)/140 = X X - total body water = fluid deficit in liters
A 44yr old male who suffered a self-inflicted GSW to the head has been declared brain dead. Consent has been obtained for organ and tissue donation. He is 6ft tall and weights 100kg. PHM significant for 10 pack-year smoking hx and high cholesterol. VS: HR 132, BP 90/60, CVP 1, SaO2 96%. Vent settings: IMV 10, Vt 1000ml, FiO2 50%, peep 5 with corresponding ABG: pH 7.36, pCO2 38, PaO2 75, HCO3 21. When deciding the most appropriate intervention for improving this donor’s oxygenation, what should the procurement coordination consider?
- increasing vent rate with decrease pCO2 and increase PaO2
- increasing PEEP may compromise cardiac function by decreasing venous return
- diuresing the donor may improve oxygenation and improve volume status
Increasing PEEP may compromise cardiac function by decreasing venous return.
(increasing vent rate would DECREASE pCO2 and NOT impact PaO2, pt is already ‘dry’ so diuresing isn’t a good idea at this time)
A 17yr old male has been admitted to the ICU after a MVA. Injuries include SDH and bilat rib fxs. Chest tubes have been placed for bilat pneumothoraces. He had no downtime. He has been declared braindead and consent has been obtained for organ and tissue donation. Medical/behavioral hx includes: IDDM since age 2, once-weekly marijuana use, and 12 pack of beer on weekends. Based on the attached CXR and donor profile, what should the procurement coordinator suspect?
- -Pneumonia
- -Pneumothorax
- -Widened mediastinum
Widened mediastinum
A 44yr old male who suffered a self-inflicted GSW to the head has been declared brain dead. Consent has been obtained for organ and tissue donation. He is 6ft tall and weights 100kg. PHM significant for 10 pack-year smoking hx and high cholesterol. VS: HR 132, BP 90/60, CVP 1, SaO2 96%. Vent settings: IMV 10, Vt 1000ml, FiO2 50%, peep 5 with corresponding ABG: pH 7.36, pCO2 38, PaO2 75, HCO3 21. What should the procurement coordinator know about the mechanism of injury to aid in management decision making?
GSW to the head may lead to coagulopathy (due to the intrinsic TPA released from destroyed brain tissue)
What is the most common cause of instability in the organ donor?
Hypotension
.A 4yr old girl is admitted to the PICU with an ICH from a ruptured AVM. She has been declared brain dead and her parents have consented for donation of all organs and age-appropriate tissues. She has no past medical history and all immunizations are up to date. She is 40 inches tall and weighs 25 kg. Hemodynamics: HR 110, BP 86/50, UOP 20ml/hr. The donor has a hematocrit of 25% and a hemoglobin of 6 g/dl. The procument coordinator makes the decision to transfuse her with 250ml PRBCs. What are the expected hematocrit and hemoglobin for this donor after transfusion?
Hct 27.5% and Hgb 9 g/dl.
A 4yr old girl is admitted to the PICU with an ICH from a ruptured AVM. She has been declared brain dead and her parents have consented for donation of all organs and age-appropriate tissues. She has no past medical history and all immunizations are up to date. She is 40 inches tall and weighs 35 kg. Hemodynamics: HR 110, BP 86/50, UOP 30ml/hr. Of the following interventions, which would be most appropriate?
- -proceed with organ evaluation
- -start Neosynepherine gtt
- -start dopamine gtt
Proceed with organ evaluation
What is the first step in managing hypotension in an organ donor?
Fluid bolus
A 44yr old male who suffered a self-inflicted GSW to the head has been declared brain dead. Consent has been obtained for organ and tissue donation. He is 6ft tall and weights 100kg. PHM significant for 10 pack-year smoking hx and high cholesterol. Labs results reveal serum glucose of 220. What should the procurement coordinator do?
- remove dextrose from all fluids and re-check glucose in 4hrs
- remove dextrose from all fluids and give 16 units SubCu insulin
- -remove dextrose from all fluids and give 20 units regular insulin IV
Remove dextrose from the donor’s IV infusions and give 16 units SubCu insulin
A 23yr old man presents to the ER after a MVA. He has massive facial fxs, SDH, bilat pulm contusions, and stable pelvic fx. No significant PMH. He’s 5’ 10” and 70kg. Hemodynamics are: BP 100/70 (80), CVP 6, PAP 45/22, PAOP 10. Recent labs reveal: Na 140, K 3.7, Cl 136, Hgb 8, Hct 28, Bun 34, Cr 1, amylase 220, lipase 10, HgbA1C 5, glucose 225. Given these findings you would conclude which of the following?
- panceas is unsuitable for transplant
- amylase is elevated due to the facial fxs
- donor has previously undiagnosed DM
Amylase is elevated due to the facial fractures
What is the circulating blood volume of a toddler?
75 ml/kg
A 25yr old female has been admitted to the ICU after falling from a second-story balcolny. Injuries include SDH and skull fxs. She has been declared BD and consent has been obtained for organ and tissue donation. As part of the donor evaluation process, the procurement coordinator obtains a urinalysis. Results are positive for protein, hemoglobin, leukocytes, and nitrites. Urine WBC is 10-20. What treatment would be most appropriate?
- ABX
- Beta Hcg
- Fluid bolus
antibiotics (ABX)
