Patricia Gerritsen's guest appearances

Patricia Gerritsen

Coda Change

James Tooley

Chris Fox

Chris Nickson

John Hinds

Paul Marik

Zack Shinar

Joe Bellezzo

George Kovacs

Bryan Hayes

Rich Levitan

Karim Brohi

Sara Gray

Ashley Shreves

Jason Brooks

Darren Braude

OwlTail

How do you diagnose death? In Critical Care we deal with death on a regular basis and although it seems black and white, that is often far from the truth. Patricia Gerritsen discusses what it means to be dead and how that knowledge can aid you in stopping a resuscitation effort. Patricia presents the degrees of death in her eyes as:  Soon to be dead Reversibly dead Irreversibly dead Reversibly, irreversibly dead  Changes occur following death that can be proof of death. But not always. Pallor mortis, algor mortis, rigor mortis, livor mortis and decomposition can all indicate someone has died. There are other clues that can indicate a person is either dead or will soon be dead – with minimal chance of any life saving intervention. The varying ways death presents itself poses a challenge for the clinician. This is especially true when deciding when to stop a resuscitation effort. Consider the reversibly, irreversibly dead – also known as the Lazarus phenomenon. These patients achieve return of spontaneous circulation AFTER the resuscitation effort has been stopped. There are over 50 cases in the literature, with a wide and unpredictable array of clinical situations. Therefore, the question becomes - what are the limits that can be survived? Patricia suggests that we must know the extreme limits in order to make an educated decision about resuscitation. Patricia details some of the most extreme stories of survival in the literature. Submersion has been survived after 66 minutes in a child. An individual survived being in an ice stream after 40 minutes, with a recorded temperature of 13.7 degrees. A man with a potassium of 14 mmol/L made a good recovery. There is a case of someone with a pH of 6.33 recovery fully and someone surviving a CO2 level of 375mmHg. Patricia highlights these extreme examples to show what is possible whilst acknowledging the decision to stop resuscitation is a difficult and nuanced one. When to Stop Resuscitation in Critical Care: Patricia Gerritsen For more like this, head to our podcast page. #CodaPodcast

How do you diagnose death? In Critical Care we deal with death on a regular basis and although it seems black and white, that is often far from the truth. Patricia Gerritsen discusses what it means to be dead and how that knowledge can aid you in stopping a resuscitation effort. Patricia presents the degrees of death in her eyes as: <ol> <li>Soon to be dead</li> <li>Reversibly dead</li> <li>Irreversibly dead</li> <li>Reversibly, irreversibly dead</li> </ol> Changes occur following death that can be proof of death. But not always. Pallor mortis, algor mortis, rigor mortis, livor mortis and decomposition can all indicate someone has died. There are other clues that can indicate a person is either dead or will soon be dead – with minimal chance of any life saving intervention. The varying ways death presents itself poses a challenge for the clinician. This is especially true when deciding when to stop a resuscitation effort. Consider the reversibly, irreversibly dead – also known as the Lazarus phenomenon. These patients achieve return of spontaneous circulation AFTER the resuscitation effort has been stopped. There are over 50 cases in the literature, with a wide and unpredictable array of clinical situations. Therefore, the question becomes - what are the limits that can be survived? Patricia suggests that we must know the extreme limits in order to make an educated decision about resuscitation. Patricia details some of the most extreme stories of survival in the literature. Submersion has been survived after 66 minutes in a child. An individual survived being in an ice stream after 40 minutes, with a recorded temperature of 13.7 degrees. A man with a potassium of 14 mmol/L made a good recovery. There is a case of someone with a pH of 6.33 recovery fully and someone surviving a CO2 level of 375mmHg. Patricia highlights these extreme examples to show what is possible whilst acknowledging the decision to stop resuscitation is a difficult and nuanced one. When to Stop Resuscitation in Critical Care: Patricia Gerritsen For more like this, head to our <a href="https://codachange.org/podcasts/" rel="nofollow" target="_blank">podcast page</a>. #CodaPodcast

When to Stop Resuscitation in Critical Care: Patricia Gerritsen

 In Critical Care we deal with death on a regular basis and although it seems an ‘on or off’ issue where you are either dead or you are not, nothing is more true. Not only physicians but scientists, philosophers, writers and theologians have been debating about the subject for as long as we have become aware of the concept of death. To try to create order from chaos I divide the deceased in 5 categories: The soon to be dead, The reversibly dead, The irreversibly dead The walking dead (although this group I will leave to Hollywood to educate us about) and the most curious group The reversibly, irreversibly dead. They are the patients of whom we think they are irreversibly dead, we stop our resuscitation efforts, and then they have return of spontaneous circulation. This is known as the Lazarus phenomenon and although many case reports have been published about this phenomenon over the years, presumably it’s only the tip of the iceberg. In providing Critical Care we sometimes need to make immediate decisions on who’s dead and who’s not. Yet decisions about whether further treatment of patients is futile or not can only be made when one is aware of the limits of extremes in physiology that are survivable. Although not every patient should be treated up to these physiological limits, knowing these extremes can help in making an informed decision of whether to continue treatment.

In Critical Care we deal with death on a regular basis and although it seems an ‘on or off’ issue where you are either dead or you are not, nothing is more true. Not only physicians but scientists, philosophers, writers and theologians have been debating about the subject for as long as we have become aware of the concept of death. To try to create order from chaos I divide the deceased in 5 categories: The soon to be dead, The reversibly dead, The irreversibly dead The walking dead (although this group I will leave to Hollywood to educate us about) and the most curious group The reversibly, irreversibly dead. They are the patients of whom we think they are irreversibly dead, we stop our resuscitation efforts, and then they have return of spontaneous circulation. This is known as the Lazarus phenomenon and although many case reports have been published about this phenomenon over the years, presumably it’s only the tip of the iceberg. In providing Critical Care we sometimes need to make immediate decisions on who’s dead and who’s not. Yet decisions about whether further treatment of patients is futile or not can only be made when one is aware of the limits of extremes in physiology that are survivable. Although not every patient should be treated up to these physiological limits, knowing these extremes can help in making an informed decision of whether to continue treatment.

"I'm not dead" - Patricia Gerritsen