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Have weak heart. Had cardiac arrest. On ventilator. Treatment?

DOCTOR OF THE MONTH - May 2014
May 2014
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Radiologist
Practicing since : 2002
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Question
Hi doc my uncle had a weak heart since 7 months LCD 15 percent ,,, he refused to take medication and proper treatment ,,on 28 of aug he had a cardiac arrest at home and was revived and put on Ventilator ,, 30 th his ventilated was removed and oxygen was being given thru mouth ventilated pipe,,, now he s been opening half eyes since one weak with pain stimuli andir he cries sm tym ,,,, today again they be put him on ventilated ,,, wats happening we r confuses??and he moved his arms and legs very vigoursly when we go inside ,,why his arms and legs are tied?? Today they going to perform trachosomy ,,pl advise
Posted Tue, 1 Oct 2013 in Hypertension and Heart Disease
 
 
Answered by Dr. Vivek Chail 1 hour later
Brief Answer:
Ventilator to support brain, lungs and heart

Detailed Answer:
Hi XXXXXXX
Thanks for writing in to us.

Your uncle is going through an emergency situation with respect to his heart function. He is one of the few lucky ones who could be revived after a cardiac arrest. There are many paramenters to be monitored when a patient is in ICU. At the time of admission, ventilation was compulsory and hence done. The treating doctor might have felt an improvement on 30th and then decided to take him off the ventilator.

Presently, as you have said, he is opening his eyes half and responds to painful stimulus and cries sum times. There is a medical term known as GCS (Glasgow coma scale) which tells us the alertness and consciousness of a person. Normally it is 15/15 and this is calculated by scoring eye opening, verbal response and motor activity. This tells us about the brain function. In your uncle, if the GCS has gone slightly below in few days after taking him off ventilation, there is an urgent need to put him back on ventilation. This is to protect the brain, heart and lungs. If ventilation is to be given for a longer duration, a tracheostomy (making a small hole in the front of neck) is best. It will subsequently be taken care of.

Tying the hands and legs of patients (restrainment) becomes necessary so that the tubes are not disturbed and so that they don't turn over if patient gets violent. There are many medicines being given to him right now and if even a single medicine is stopped then his condition may worsen. There is no other reason to tie up hands and legs.

Coming to left ventricle ejection fraction, the normal range is 55 to 70% and decreases with age. If it is 15% in your uncle, he needs medical support at present which is being given to him I hope. They will regularly check this by doing echocardiography.

Hope your queries are answered.
Do write back in case of doubts

Wishing your uncle a quick recovery
Regards

Dr Vivek
Above answer was peer-reviewed by
 
Follow-up: Have weak heart. Had cardiac arrest. On ventilator. Treatment? 1 hour later
Is he conscious??
 
 
Answered by Dr. Vivek Chail 1 hour later
Brief Answer:
Consciousness is graded by GCS score

Detailed Answer:
Hi XXXXXXX
Thanks for writing in to us.

Your uncle is in conscious if he is trying to open his eyes, move his limbs and respond to painful stimulus. As I have said earlier, you and I will be having GCS of 15/15 which is completely alert and conscious. The comatose or brain dead patient is given GCS 3/15. The GCS is most important to factor to decide on his level of consciousness. Brain injury is classified according to GCS. Here brain injury may be due to lack of blood supply momentarily. A CT scan brain may be done only if felt necessary by the doctors.

Severe brain injury: GCS 3-8 (You cannot score lower than a 3.)
Moderate brain injury: GCS 9-12
Mild brain injury: GCS 13-15

If you request the ICU doctor to tell you the GCS, you can know what is his conscious level.

The problem at the moment I guess is that his heart is unable to pump enough blood with force. For this reason he needs to be under medical support for a while and hopefully the heart function will catch up soon.

Hope this answers your query.
Do write back in case of doubts

Wishing your uncle a quick recovery
Regards

Dr. Vivek
Above answer was peer-reviewed by
 
Follow-up: Have weak heart. Had cardiac arrest. On ventilator. Treatment? 44 minutes later
His gcs is 8 so pl tell me how conscious is he ?? I Hp he is not troubled by hands and legs tied?? Can he hear our presence around him thanx pl reply fast
 
 
Answered by Dr. Vivek Chail 32 minutes later
Brief Answer:
GCS 8 needs ventilator and tracheostomy

Detailed Answer:
Hi XXXXXXX
Thanks for writing in to us with an update.

Patients with a reduced GCS are at risk of being unable to maintain their airway (especially as GCS approaches 8 or below). They may require endotracheal intubation, providing supplemental oxygen and regular monitoring.

At GCS 8 this is a critical score which typically means the borderline between coma and decreased consciousness. He needs aggressive management at the moment. He is surely not troubled by hands and legs being tied. If he is opening his eyes and moving his limbs when any family member goes close to him, then I suppose he is partially aware of his surroundings.

Our prayers are with you, your family and wishing your uncle a quick recovery.
Do write back in case of doubts

Regards
Dr. Vivek
Above answer was peer-reviewed by
 
Follow-up: Have weak heart. Had cardiac arrest. On ventilator. Treatment? 2 days later
hi doc,, my uncle today have been relived from hospital ,, he has trachotomy tube and feeding tube ,,,and gcs score 9,,, i am not understanding if he still so unwell why hospital has left him??/
he is opening his eyes but smiling and crying on calling like a 6 month old baby
 
 
Answered by Dr. Vivek Chail 7 minutes later
Brief Answer:
Please attach discharge summary with query

Detailed Answer:
Hi XXXXXXX
Thanks for writing in to us.

If his GCS is 9, that shows his neurological has improved since the last time we discussed his condition. There must be discussions between treating doctor and your family with regard to his condition and the feeding tube with tracheostomy support. I would be able to give you a more precise reply if you can please attach the hospital discharge summary with your query.

The fact that he is smiling and crying like a 6 month old baby may be because he is glad to get home, more of an emotional response on seeing his family members and getting home.

Hope things are moving in the right direction for your uncle.
Waiting for an update shortly from your end

Regards
Dr.Vivek
Above answer was peer-reviewed by
 
Follow-up: Have weak heart. Had cardiac arrest. On ventilator. Treatment? 20 minutes later
but one of the duty doctor says he ll not improve ,,, wil stay vegetative like this,,, but he is behaving like a baby and cried constantly today morning ,,, will tell my cousin to forward u discharge summary,,, is there any chance of recovery???
 
 
Answered by Dr. Vivek Chail 31 minutes later
Brief Answer:
Please send CT scan MRI scan brain reports also

Detailed Answer:
Hi XXXXXXX
Thanks for writing in again.

I also would like to see any CT scan or MRI can brain report of your uncle.
This is because of the statement given by duty doctor concerning your uncle will not improve and continue to be in vegetative state. This is something not very clear to me at the moment. Any CT scan or MRI scan brain report will say if there has been any irreversible damage to his brain.

Regards
Dr.Vivek
Above answer was peer-reviewed by
 
Follow-up: Have weak heart. Had cardiac arrest. On ventilator. Treatment? 2 days later
hi doctor i saw my uncles discharge summary today it says"he suffering from hypoxia encephalopathy,and due to progonis not very good patient sent him with nasal tube and trachoscotemy"'as of now he is sometimes responding and mostly looking all around like a baby,, but in beween says how r u etc and scratching his body and nodding blinking as if normal and moments later same baby look returns ,,, the brother taking care of him says still his body not maintai g oxygen
 
 
Answered by Dr. Vivek Chail 12 hours later
Brief Answer:
CT scan or MRI scan brain reports please

Detailed Answer:
Hi XXXXXXX
Thanks for writing in with an update on your uncle.

From what you have mentioned, hypoxic encephalopathy is one of the conditions that was running in my mind too after having discussed his condition with you earlier.

When he had a heart attack, the blood supply to the brain had decreased. Following revival, the heart was able to function but damage to the brain might have occurred by that time. It would be important to know his brain CT scan or MRI scan report as I am an expert in the field of CT scan and MRI scan. I may be able to tell you the extent of damage to his brain by going through the reports if made available.

Coming to the other factors influencing his recovery, I strongly suggest you take care of your uncle like a small child. Check the skin throughout his body for bedsores. Have him treated at home by a good general care physician for even the slightest problems that he may have. Take care of his passing urine and stools regularly. Also monitor his oxygen saturation regularly.

Hope things are moving in the right direction for your uncle.
My prayers are with you.

Regards
Dr.Vivek
Above answer was peer-reviewed by
 
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