X-Message-Number: 6103
From:  (Brian Wowk)
Newsgroups: sci.cryonics
Subject: Dead While Alive (again)
Date: 19 Apr 96 00:21:21 GMT
Message-ID: <>

	Further to my recent posts about how patients in
irreversible cardiac arrest (clinical death) can sometimes remain
conscious during CPR, Mike Darwin has sent the post below
which details a tragic neurological analog.  Locked-in 
syndrome occurs when the brain stem is destroyed by stroke
or other injury, leaving the patient's brain conscious
but incapable of sustaining life. 
 Brian Wowk          CryoCare Foundation               1-800-TOP-CARE
 President           Human Cryopreservation Services   

Date: 18 Apr 96 19:22:03 EDT
From: Michael Darwin <>
To: Brian Wowk <>
Subject: Re: Locked in - what to do..
Message-ID: <>
Status: R
Content-Length: 5013


I thought you might like to forward this message to the unwashed and uneducated
masses who long for knowledge of the shores of lethe.  Such messages are common
on medical forums relating to critical care and neurology.  They should put to
rest any doubt that cryonicists are "making up" stories about people still
conscious during CPR --  or worse still, people with lock-in syndrome, most of
whom outside the West are simply sedated and turned off -- any many in the US

---------- Forwarded Message ----------

From:	"Thomas P. Bleck", INTERNET:
TO:	Critical Care, INTERNET:
CC:	(unknown), INTERNET:
DATE:	4/18/96 11:13 AM

RE:	Re: Locked in - what to do..

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Date: Thu, 18 Apr 1996 11:02:07 -0400
From: "Thomas P. Bleck" <>
Message-Id: <>
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To: Critical Care <>
Subject: Re: Locked in - what to do..

On Apr 18, 10:03, Critical Care wrote:
> Subject: Locked in - what to do..
> I am interested in what you have *actually done* in this circumstance (which 
> I guess must be familiar to many of you). I will share our experiences after 
> some replies.
> Middle-aged patient, normally well, fronts to St Elsewheres after collapse - 
> is intubated and ventilated for hypoventilation and apparent coma and has CT 
> (normal). Transferred to the final common pathway - and found to have the 
> locked-in syndrome. Neurologists agree, no improvement takes place, repeat 
> CT shows brainstem infarction (and calcified vertebro-basilar system) and 
> the patient is awake and alert, almost (not quite) apneic when temporarily 
> disconnected at normocarbia, can blink (once for "yes" -  twice for "no") 
> and cry (frequently). There are no other motor responses. Some time passes. 
> The family are informed that the prognosis is for no further CNS recovery to 
> take place.
> 1) How much do  you engage the patient in the discussions that follow ?

Haven't dealt with this since last month.  The patient (a woman in her
30s with a basilar artery aneurysm) returned from clipping with a
pontine infarct.  Her family said she would not want to remain in this
state, but she very clearly expressed her desire to stay on the
ventilator.  We had many meetings with the family, trying to explain
to them that we were bound by the patient's wishes, not her family's.
We fully expected to go to court over this, although they would have
lost (Virginia law is very clear about this issue).  After three days,
however, she decided that she didn't want support any longer.

As difficult as this is, I think that the patient needs to be involved
in the discussion.  I tell them that part of the withdrawal of
ventilation (for example) is enough sedation and analgesia that they
won't be uncomfortable.  The worst one I've been involved in was a
patient who was awake during CPR but who could not support a blood
pressure without chest compression.

> 2) How does the patient leave the ICU ?
I usually try to extubate them before sending them out.  If they die
in a few hours, they stay in the unit.  If they survive for a while
longer, I try to put them out on the regular ward, where the family
can be more comfortable (we let families stay in the ICU as well, but
the chairs are more comfortable out there, and the family has more

Hope this helps.

> Stephen Streat FRACP
> Intensivist
> Department of Critical Care Medicine
> Auckland Hospital, Auckland, New Zealand
> V +64 9 307 2892
> F +64 9 307 4927
> -- End of excerpt from Critical Care <>

Tom Bleck    (Thomas P. Bleck, M.D.)   
Departments of Neurology, Neurosurgery, and Medicine
University of Virginia School of Medicine

	Don't tell me the U.S.A. went down the drain because
of Leftism, Knotheadism, apostasy, pornography, polarization,
etcetera etcetera.  All these things may have happened, but
what finally tore it was that things stopped working and 
nobody wanted to be a repairman.

		--Walker Percy, _Love in the Ruins_
 (the only novel about an electroencephalographer)
 Today's message from AIX on avery.med (I don't pick 'em):

Pascal Users:
	To show respect for the 313th anniversary (tomorrow) of the
	death of Blaise Pascal, your programs will be run at half

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