Do you have documentation of comatose? I query for comatose on our head injured patients, won't be a MCC, but may increase your SOI/ROM. With the information you provided I don't think I would query for resp failure. Cindy
If he was not able to ventilate himself on his own and being acidotic, I would definitely query for respiratory failure. Also, What about CT scan? Any midline shift for brain compression or swelling for cerebral edema? Probably not enough time to get two H/H for blood loss. Was he in shock? Think about the resources used on this patient and how to capture diagnoses that contributed to his death. I always maintain that if patient had died in the field, then these diagnoses are not needed, obviously. But instead he died in our ICU, and I want to reflect that severity appropriately and legitimately. I also want the hospital to be reimbursed for services/treatment administered. These kinds of efforts cost the hospital $. I look forward to hearing other thoughts.
right. I dont think we have evidence of edema. I mean, I'm sure it existed but no CT scan was done here, nor was he treated for it. There was a CT scan done at an outside hospital but i dont have a report. Just that there was no evidence of herniation. His injury was determined nonsurvivable immediately. He had visible brain matter extending from the wounds. We DO have the ABG for teh resp failure, so that is the one favorable thing.I agree that these patients are resource intensive and I definitely try to look at it that way.
Nope. None documented. The patient "maxed out" pressors though. That means shock to me but the documentation is poor so its hard to pull together good clinical indicators besides that he simply continued to require more pressors. I sometimes see this in truamas where we know the patient will die. I think the dr's just arent very specific because they are not really treating any of these issues.
I missed the original question, so may be out of line, but... Did EMS say why they intubated? Was it to protect the airway, manage secretions, because the patient was agitated and combative, or had a respiratory arrest? If it was due to a respiratory arrest and the patient was continued on the vent while in ICU on pressor support, seems like a query would be warranted. If intubated only to manage secretions, protect airway, or because patient was agitated and combative I would say no to respiratory failure.
Sharon Cole, RN, CCDS CDI Specialist Team Leader Providence Health Center 254.751.4256 Sharon.cole@phn-waco.org
Not out of line Sharon! Good question. EMS does not say. This was a GSW (through-and-through)to the head. Visible brain matter extending out both wounds. I think intubation was an automatic response. The patients WAS over-breathing the vent in the H&P.
Comments
Cindy
Think about the resources used on this patient and how to capture diagnoses that contributed to his death. I always maintain that if patient had died in the field, then these diagnoses are not needed, obviously. But instead he died in our ICU, and I want to reflect that severity appropriately and legitimately. I also want the hospital to be reimbursed for services/treatment administered. These kinds of efforts cost the hospital $.
I look forward to hearing other thoughts.
We DO have the ABG for teh resp failure, so that is the one favorable thing.I agree that these patients are resource intensive and I definitely try to look at it that way.
Thanks for your help!
Katy Good
Katy
Sharon Cole, RN, CCDS
CDI Specialist Team Leader
Providence Health Center
254.751.4256
Sharon.cole@phn-waco.org
Katy