1. ONE CHAMPION, MANY LIVES Douglas T. Miller Symposium Donn Dexter, MD Luther Midelfort, Mayo Health System

2. WHAT DOES IT TAKE TO BE A CHAMPION? You have to CARE! You have to CARE!

3. Case Report 42 year old white woman with no serious health issues collapsed at 1550 hours 42 year old white woman with no serious health issues collapsed at 1550 hours To ER by ambulance where she had a cardio- respiratory arrest To ER by ambulance where she had a cardio- respiratory arrest Resuscitated and transferred by helicopter to Luther Midelfort Resuscitated and transferred by helicopter to Luther Midelfort When seen at 1800 hours she was intubated, ventilated and on multiple pressors for blood pressure control When seen at 1800 hours she was intubated, ventilated and on multiple pressors for blood pressure control

4. Case Report - continued Neurologic exam – pupils fixed and dilated, unresponsive Neurologic exam – pupils fixed and dilated, unresponsive Marked papilledema Marked papilledema Flame hemorrhages Flame hemorrhages No brainstem reflexes No brainstem reflexes No reflexes No reflexes No pain response No pain response

5. Admission CAT Scan of Brain

6. CAT Scan of Brain, at midbrain

7. Case Report - continued CT Angiogram reports no cerebral blood flow CT Angiogram reports no cerebral blood flow Brain death exam completed but patient too unstable for apnea test Brain death exam completed but patient too unstable for apnea test Based on exam and negative cerebral blood flow on CTA declared brain dead at 0100 hours Based on exam and negative cerebral blood flow on CTA declared brain dead at 0100 hours

8. Case Report - continued Met with family for over an hour to review history exam and finding of brain death Met with family for over an hour to review history exam and finding of brain death They wished to proceed with donation They wished to proceed with donation Donation completed 2000 hours day after admission Donation completed 2000 hours day after admission

9. Case report - continued Straightforward case, BUT… Straightforward case, BUT… Over 24 hours from admission to OR Over 24 hours from admission to OR She was not just a case but a wonderful young woman; co-worker, friend, sister, daughter She was not just a case but a wonderful young woman; co-worker, friend, sister, daughter She had a caring, devastated family, that had donated organs from her brother She had a caring, devastated family, that had donated organs from her brother She saved 4 lives She saved 4 lives

10. You have to CARE C – Commit: time and energy with each patient and preparing for future cases C – Commit: time and energy with each patient and preparing for future cases A R E

11. You have to CARE C - Commit C - Commit A – Attend: to your current patient and to your program A – Attend: to your current patient and to your program R E

12. You have to CARE C - Commit C - Commit A - Attend A - Attend R – Recognize: you need to acknowledge your coworkers, patients, families; your successes and failures R – Recognize: you need to acknowledge your coworkers, patients, families; your successes and failures E

13. You have to CARE C – Commit C – Commit A – Attend A – Attend R – Recognize R – Recognize E – Energize: you need to keep everyone involved and enthusiastic about your program; institution, community and region E – Energize: you need to keep everyone involved and enthusiastic about your program; institution, community and region

14. You have to CARE “Never believe that a few caring people can’t change the world. For, indeed, that’s all who ever have.” -Margaret Mead “Never believe that a few caring people can’t change the world. For, indeed, that’s all who ever have.” -Margaret Mead “Three keys to more abundant living; caring about others, daring for others, sharing with others.” -William A. Ward “Three keys to more abundant living; caring about others, daring for others, sharing with others.” -William A. Ward

15. You have to CARE I don’t care how much you know, until I know how much you care! I don’t care how much you know, until I know how much you care!