Leah is a 30 year old woman who was found after a fall from a considerable height. She was initially unconscious, then regained consciousness and was transported to hospital. It appears to be an isolated TBI.
When assessed in the emergency department she is awake and interactive with no apparent neurological deficits but is obstructive and won’t allow a detailed neurological exam to be performed and refuses a CT brain. She is deemed to have capacity and self-discharges from hospital.
She subsequently collapses and is brought back to hospital unconscious, GCS 3 with a fixed dilated pupil.
A CT brain reveals a large extradural haematoma.
She is empirically treated for EICP and taken to theatre for urgent evacuation of the EDH.
She is then brought to ICU sedated, intubated and ventilated with an EVD in situ.
Her family want to meet to discuss what has happened.
Who should attend this family meeting? What should be considered before going to the meeting?
In ICU Leah continues to deteriorate. Despite the EDH evacuation her ICP’s are > 30 mmHg.
She receives all the tiers of EICP management including a thiopentone infusion.
As part of this she has a repeat CT which shows severe cerebral oedema, loss of grey-white differentiation and uncal herniation on the right and early signs of tonsillar herniation.
Her ICP remains 30 mmHg.
On examination she is GCS 3, has fixed dilated pupils and is not triggering the ventilator.
She has become coagulopathic and the neurosurgical team feel a decompressive craniotomy is not appropriate.
Is she dead?