amanara

[amanara @amanara11]

@KeatonSmetana @neurocritical @CaseyMayPharmD @abhaykjha @icubraindoc @DianaGCMD @tchaaban1 @karenccrx @anahinduja #NCSTJS Pharmacists are however integral parts of the ICU team in the UK. They advise on multiple areas of practice and are crucial at reducing drug errors and ensuring safe and effective prescribing

[amanara @amanara11]

@KeatonSmetana @neurocritical @CaseyMayPharmD @abhaykjha @icubraindoc @DianaGCMD @tchaaban1 @karenccrx @anahinduja #NCSTJC Concerns about sedative are the reason for not testing in just 6% of those who could be Not common to use pharmacistsIn general any concerns leads to delaying the test till confident or undertaking ancillary test like CT angio

[amanara @amanara11]

@neurocritical @CaseyMayPharmD @abhaykjha #NCSTJ DBI parhway not primarily a donation one Hospital donation committees develop hospital pathways based on national guidelines Input from physician donation specialist, donor coordinator, ICU nurses&physicians, theatre rep, lay rep, Transplant rep, donor familly, recipient

[amanara @amanara11]

@gdomeni @tchaaban1 @AngelE____ @CaseyMayPharmD @neurocritical @abhaykjha #NCSTJC One must also consider the end of life care of patients and their families, giving them time and moving them to the ICU environment rather than ED has many advantages

[amanara @amanara11]

@gdomeni @tchaaban1 @AngelE____ @CaseyMayPharmD @neurocritical @abhaykjha #NCSTJC except that one of our good outcomes was a lady aged 77 with large pot fossa ICH: Multiple biases involved in making decision to WLST. Once we decide to WLST at an early stage our prognosis of death always justifies the decision. Only delaying it may prove us wrong

[amanara @amanara11]

@tchaaban1 @AngelE____ @gdomeni @CaseyMayPharmD @neurocritical @abhaykjha #NCSTJC HOW devastating - definition says that a decision to WLST is being considered ie the perception of how devastating is made by us! Hence we talk of perceived DBI. Admit all intubated patients, less than 72 hours needed in most caseS-option to WLST not lost by ICU admission

[amanara @amanara11]

@gdomeni @AngelE____ @CaseyMayPharmD @neurocritical @abhaykjha @tchaaban1 #NCSTJC NCS already produces guidance on this - see Souter et al Neurocrit Care 2015, 23: 4-13.. similar guidance in UK Brit J Anaesth 2028, 120: 238-45. Our paper shows aims of DBI guidelines can be achieved

[amanara @amanara11]

@CaseyMayPharmD @neurocritical @abhaykjha #NCSTJC 72 hours based on experimental, work, the out of hospital cardiac arrest prognostic model and pragmaticallyto be workable

[amanara @amanara11]

@neurocritical @CaseyMayPharmD @abhaykjha #NCSTJC the pathway is for a maximum of 72 hours - but decision to treat actively, WLST or testing for brain death made much earlier - median length of stay of 1,14 days

[amanara @amanara11]

@tchaaban1 #NCSTJC That was meant to be csf not coffee!

[amanara @amanara11]

@tchaaban1 That was csf drainage not coffee

[amanara @amanara11]

@tchaaban1 @CaseyMayPharmD @neurocritical @abhaykjha #NCSTJC good question. No surgical interventions like coffee drainage, no cpr or renal replacement but cardio respiratory support used

[amanara @amanara11]

@gdomeni @neurocritical @CaseyMayPharmD @abhaykjha #NCSTJC Pathway developed primarily to improve prognostication and EOL life care. Donation an important but secondary outcome

[amanara @amanara11]

@gdomeni @neurocritical @CaseyMayPharmD @abhaykjha #NCSTJC absolutely correct. Hope are article males a good argument that DBI pathway ethical and cost effective

[amanara @amanara11]

@CaseyMayPharmD @neurocritical @abhaykjha We observed unexpected survivors in patients admitted to facilirate donation. Main barrier initially concerns of colleagues #NCSTJC

[amanara @amanara11]

@CaseyMayPharmD Looking forward to it too.