Advances in medicine throw up so many ethical dilemmas. I remember watching a programme years ago about babies born at 23 weeks discussions about medical interventions.
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Re the pro bond thing, the solicitors might be working for free but there will still be disbursements which need to be paid for covering their travel expenses, any court fees or expert costs.
I'm in disbelief that it is almost July and this is still going on from the 7th April.
She tried in the May court case to not let them do the brain stem test, as she thought it would give them the green light to declare Archie dead, and disputed the validity of the tests. She also thought the apnoea part of the test would further damage Archie's brain. She wanted an MRI scan instead. The hospital said an MRI would actually be more dangerous, as there is lots of potential for human error when moving a person attached to so much equipment down the hospital into the scanner. Hollie lost, and the brain stem death test was performed, although the test wasn't able to be completed anyway.
Then the hospital wanted to do an MRI scan to examine Archie's brain, which Hollie now fought, after learning that it was dangerous. She lost again and the MRI was performed, showing catastrophic damage, and some necrosis to the brain stem and spinal cord.
Forgive me for being stupid, what was the situation with the brain stem testing (BST) that meant he couldn't be tested? I thought originally they didn't agree with it so the hospital had to gain permission to go ahead and do the testing, and then when they did the testing 'Archie failed on one area'. What did he fail and how? I'm not understanding that bit.
From my experience (sorry to keep referring to it, but it's so close which is why this case is interesting me) BST should take place >6 from the loss of the last brain stem reflex (so this could be a cough, triggering the ventilator, blinking, etc), electrolytes and vital signs must be within range (as much as able given the patients condition), and the patient should be clear of all sedative, muscle relaxing and opiate medications. BST is then undertaken by two senior clinicians and is done slowly, thoroughly and in numerous stages. And then repeated for clarity.
All of the cranial nerves are then tested. So light shone into pupils to test reactivity, ice water syringed into ears to test vestibulo-ocular reflex, gag and coughing tested, reaction to pain is tested with more pain then we would usually use in day to day/hourly assessments, doll's eyes response, and more. All sounds cruel but it is vital and necessary. And then the apnoea test is undertaken, which yes does mean coming off the ventilator for a short period of time, to see if they breath spontaneously, but is mostly about testing CO2. The patient is monitored throughout, pre-oxygenated beforehand and has a bagging circuit attached to their ETT/trachy so they can receive manual breaths if they become compromised.
Anyway, I've gone way off my question. Which bit is the poor boy said to have failed? I'm just curious, because if he 'failed' any of the BST then it may be his brain stem was marginally in tact at the time, but 'passing' 90% of the test is hardly a big win and paints a pretty grim picture - and by now, this many weeks on, I imagine what little he did have of his brain stem has been completely compressed and has gone?
From my experience (sorry to keep referring to it, but it's so close which is why this case is interesting me) BST should take place >6 from the loss of the last brain stem reflex (so this could be a cough, triggering the ventilator, blinking, etc), electrolytes and vital signs must be within range (as much as able given the patients condition), and the patient should be clear of all sedative, muscle relaxing and opiate medications. BST is then undertaken by two senior clinicians and is done slowly, thoroughly and in numerous stages. And then repeated for clarity.
All of the cranial nerves are then tested. So light shone into pupils to test reactivity, ice water syringed into ears to test vestibulo-ocular reflex, gag and coughing tested, reaction to pain is tested with more pain then we would usually use in day to day/hourly assessments, doll's eyes response, and more. All sounds cruel but it is vital and necessary. And then the apnoea test is undertaken, which yes does mean coming off the ventilator for a short period of time, to see if they breath spontaneously, but is mostly about testing CO2. The patient is monitored throughout, pre-oxygenated beforehand and has a bagging circuit attached to their ETT/trachy so they can receive manual breaths if they become compromised.
Anyway, I've gone way off my question. Which bit is the poor boy said to have failed? I'm just curious, because if he 'failed' any of the BST then it may be his brain stem was marginally in tact at the time, but 'passing' 90% of the test is hardly a big win and paints a pretty grim picture - and by now, this many weeks on, I imagine what little he did have of his brain stem has been completely compressed and has gone?
How long can somebody survive if
their brainstem is gone? I know nothing about this type of nursing as I was only a care home nurse. What are the processes involved in keeping his heart beating?
their brainstem is gone? I know nothing about this type of nursing as I was only a care home nurse. What are the processes involved in keeping his heart beating?
this is what I am wondering as well x
I found the Evans case gobsmacking.I’ve just read on another site that he went into cardiac arrest twice on June 6th and that the judge reiterated today that the solicitors fees are pro bono - meaning there are no legal fees. Therefore the go fund me is not being used for that.
Many other things are mentioned but I feel a bitbringing them up here. I felt the previous Gard/Evans cases were ‘uncomfortable’ but this one is on another level. I believe the naive feel this case is similar but there are so many underlying issues, suspicions, lies that what the mother is trying to present to the public is so so very far from the truth.
Edited. wrote July meant June
Medical staff were advised to not use the main entrance and not indicate they were staff because the main car park was just full what could generously be called rabble harassing them.
Three doctors were served with private prosecution papers for murder.
they were adamant the scans were for a different person.
At one point the staff were accused of starving him, so people were in All seriousness talking about buying a Maccy D milkshake and sneaking it in to feed him with … as well as the possibility of using pre chewed crisps to feed him.
Ambulances were targeted for their equipment.
A request was put out for a CPAP machine … because highly calibrated pieces of kit are so amenable to a jaunt in a car boot … to ‘storm’ Alder Hey and sneak it into his room
at one point there were 11 policemen guarding the main entrance.
And that‘s just off the top of my head
I can’t imagine anything good. Organs will still start to fail and I understand they are having to adjust his medication hourly.
I don’t know why people are still blindly believing this poor child is just going to pop his eyes open and carry on like he did before. This family aren’t the brightest sparks, but can they be that deeply in denial? The court case today seemed to indicate they want him to die of his own accord rather than having the machine switched off, but they don’t ever seem to say that to his army? They seem to carry on egging everyone on that he’s going to make a recovery.
I’ve seen the rumours about his home life and going by how his family behave online, it doesn’t make it that unbelievable tbh. They seem to revel in drama and conflict.
I don’t know why people are still blindly believing this poor child is just going to pop his eyes open and carry on like he did before. This family aren’t the brightest sparks, but can they be that deeply in denial? The court case today seemed to indicate they want him to die of his own accord rather than having the machine switched off, but they don’t ever seem to say that to his army? They seem to carry on egging everyone on that he’s going to make a recovery.
I’ve seen the rumours about his home life and going by how his family behave online, it doesn’t make it that unbelievable tbh. They seem to revel in drama and conflict.
Firstly, you were not ONLY a care home Nurse! X
It takes a looottt. It's only done in situations where family are waiting for other members to arrive and say good bye, the family just need an extra day or so, or the patient is donating their organs and the matches etc are being sorted out (usually 48hrs absolute maximum).
Firstly, A & B, you have to ventilate the patient as their brainstem is gone so they cannot breathe or initiate breaths for themselves. So everything that comes along with ventilation. Clearing secretions, chest care, managing how much oxygen/CO2 etc goes in and out.
C, supporting everything cardiovascular wise. Making a patient breathe will of course initiate some cardiac response but it'll need to be backed up by medications such as inotropes/vasopressors which after a while are pretty nasty to your body. They will be being titrated regularly. Turning someone, adjusting someone's O2, anything, can affect their BP meaning they need more/less medication. Also temperature needs managing. And then things like potassium, sodium, bicarb, blood, everything.
D, if you are brainstem dead you are GCS 3, no response at all. You might still have 'flickers' so maybe a toe jerk or what looks like a spasm but this usually stops after a day or so.
E, skin will become mottled and vulnerable. Pressure sores, skin breaking down, etc.
F, kidneys will begin to fail so clearing toxins will become difficult and fluid won't shift as it should. Won't produce as much urine etc.
G, need feeding via a tube in nose/stomach, but this is usually stopped as their isn't any 'point' but I imagine in this case the family aren't allowing it to stop. Bowels will stop working, stomach will stop absorbing the liquid feed.
I, lots of infection as the body just can't fight anything any more. Not sure if they're giving antibiotics, there isn't any point in doing so (sorry to sound so harsh) but again I imagine the family won't allow anyone not to.
P, unsure if anyone can feel pain at this point but obviously as humans you like to think people can, so pain relief is often given as a kindness. So that's something.
Just awful really. X
Sorry, super quick explanation and I definitely missed loads out.
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So (someone correct me if I’m wrong btw!) the brain stem is responsible for all vital bodily functions, breathing, digestion, heart beat, consciousness etc).
In the last hearing, there was evidence of ‘coning’ and the brain stem decaying down Archies spine. (Trigger warning, it’s a sad and in-depth read https://www.judiciary.uk/wp-content/uploads/2022/06/Archie-Batteresbee-judgment-2-1.pdf)
He is unfortunately never going to wake up, or walk out of that hospital. The ventilator is keeping him alive, and at some point the heart will stop beating all together even on the ventilator.
(Quote also from GOSH - The child’s heart has an inbuilt mechanism for pumping as long as it has a supply of oxygen and blood - this does not need the brain to continue working. While the ventilator continues to blow air into the child’s lungs, their heart continues to receive oxygenated blood and the child may also be given medicine to maintain their blood pressure. The heart will continue to beat for a period of time after brain death - this does not mean that the child is alive, or that there is any chance of recovery.)
I truly hope he has peace soon.
In the last hearing, there was evidence of ‘coning’ and the brain stem decaying down Archies spine. (Trigger warning, it’s a sad and in-depth read https://www.judiciary.uk/wp-content/uploads/2022/06/Archie-Batteresbee-judgment-2-1.pdf)
He is unfortunately never going to wake up, or walk out of that hospital. The ventilator is keeping him alive, and at some point the heart will stop beating all together even on the ventilator.
(Quote also from GOSH - The child’s heart has an inbuilt mechanism for pumping as long as it has a supply of oxygen and blood - this does not need the brain to continue working. While the ventilator continues to blow air into the child’s lungs, their heart continues to receive oxygenated blood and the child may also be given medicine to maintain their blood pressure. The heart will continue to beat for a period of time after brain death - this does not mean that the child is alive, or that there is any chance of recovery.)
I truly hope he has peace soon.
This is horrifying. I had no idea of the extent of it. My husband works at Alder Hey - it's such a wonderful hospital.
These people honestly need locking up. Absolute knuckle-draggers, spurred on by churlish self-righteousness.
I don't understand why Hollie is putting her son through all of this. Let him go.
Oh oops, an actual answer to your first question! If your brainstem is gone, you are dead. So that very second you are gone. We call it coning. You can see it super clearly on monitors etc when it happens. HR/BP etc are all over the place, electrolytes are off and usually pupils are already fixed / the patient has stopped making any effort to breath. It's the biggest emergency in Neurology. So as soon as a patient 'cones', we class them as gone sadly. x
God, that group is an absolute cesspit. Are they wilfully ignorant or are they just downright stupid, commenting tit like ‘come on Archie, will today be the day you wake up?’ the poor kid’s brainstem is literally decaying! He’s not going to wake up!
Given that the Alder Hey mob were touting for a CPAP machine, I wonder which one of the thick morons was volunteering to oversee its operation together with that of all the other huge amount of sophisticated and technical equipment in use in ICU. The idiots probably think it’s just like plugging in their toaster.
I'd like to know which idiot was going to donate it to them... Then get home and realise they couldn't breathe!
Absolutely baffled as to how they have won their case now
what is going to change with this latest ruling 
For your last q...
The heart is myogenic, which means it generates it's own electrical activity and can beat independently of the brain as long as it's provided with oxygen. So as long as someone is ventilated, the heart will carry on working. You can probably find some crazy videos on youtube of a heart being held by a surgeon whilst beating.
What the brain does do is communicate with the heart to control how fast and hard it beats, so they will be using various drugs to regulate this along with blood pressure. This is all a huge strain on the body and he's sadly had two cardiac arrest but been resucitated.
Also second the comment that you weren't "only" a care home nurse. You and your collegaues kept my granny alive and comfortable in her last couple of years (she had lots of conditions that needed managing) and for that I'm so grateful
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Are the courts just passing it around like a hot coal?
Thanks for the in depth explanation about life support. I remember learning about coning. It sounded horrific and there was definitely no sustaining life after that when I was training back in the early 90s.
Thanks for the in depth explanation about life support. I remember learning about coning. It sounded horrific and there was definitely no sustaining life after that when I was training back in the early 90s.
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