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On ventilator post cerebral vascular accident. Bleeding at the back of head and in coma state. Suggest the treatment?

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General & Family Physician
Practicing since : 2009
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I currently have a dear aunt whom is on a ventillator post cva i reviewed the ct-scan a lot os bleeding on the right side and the back of her head also up into some of the spaces in the mid area of her brain. I WAS TOLD IF SHE WERE TO COME OUT OF THE COMA SHE WOULD REMAIN IN A VEGETATIVE STATE. I WAS ALSON INFORMED SHE WOULD HAVE NO COGNITIVE REASONING AT ALL. i was told this morning by her nurse whom was taking care of her late last week when my aunt was talking that she thought my aunt recognized her voice before giving her mouth care becasu she said my aunt opened her mouth. i saw my aut's pupils yesterday while talking to her moving from side to side while they were still closed. I DO NOT KNOW WHAT TO DO . M Y AUNT ALSO COUGHED A LITTLE YESTERDAY I TOLD THE R.T. GUY HE RESPONDED OH THEY DO THAT SOMETIMES. PLEASE HELP SIGNED SCHEDULE TO REMOVE VENTILLATOR TOMORROW. SHE IS CURRENTLY IN PALLIATIVE CARE. she had the procedure in which they placed a catheter in her skull at the top to drain the fluid due to the hydrocephalus, this past sat, i was told the procedure was successful she then took a turn for the worse. she had the procedure in which they placed a catheter in her skull at the top to drain the fluid due to the hydrocephalus, this past sat, i was told the procedure was successful she then took a turn for the worse.
Posted Wed, 21 Aug 2013 in Brain and Spine
 
 
Answered by Dr. Rene Gerard Cruz Galera Jr 1 hour later
Hi,

I am sorry to hear about your aunt. I'm sure she is a wonderful person and an excellent nurse professional.

The RT Guy is correct in saying that sometimes rapid eye movement can be observed in comatose patients. Her mouth opening prior to oral care ministrations can also be coincidental only. There are some standard tests that your physician can do (and might have completed already) such as a neurologic exam and to check brain activity through an electroencephalogram (EEG). You may ask her physicians to explain their results to the family in more detail, if needed.

In delicate matters such as these, we can only provide the family with the patient's current status and her prognosis. If the patient's wishes is unknown and there is no legal directive that she prepared before she turned for the worse, the next of kin and the closest relatives really have to decide on what the next step is. And it is one very hard decision to make.

If I may suggest, talk to her doctors first and get all the details and ask all your questions. Once you are satisfied with the information that you have, gather the family and talk about it. Try to map out all considerations including her quality of life before arriving at a decision.

I hope I was able to help, even a little. This is really a difficult situation - I was in the same position a few years back when my uncle developed diabetes complications. It will be hard and emotions will run high but I am sure, you, too can do it.

If you have any further queries, please let me know.


I wish you well, XXXX.


Take care,

Dr. Galera
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