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What are the treatment procedures for Parkinson disease and aspiration pneumonia with pulmonary edema in old aged person?

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Pulmonologist
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My dad is in urgent care and in critical condition as I'm writing this and I'm desperately seeking for a second DETAILED opinion on his situation, please I'm not seeking general answers or half explanations of his condition, I understand is very difficult to get an answer over the internet but I'll provide as much information as I can on his condition. Age: 75 years old Weight; 160 (more or less) Height: 6 feet tall *********************Diseases and Cronic Health Issues*********** Parkinsons disease, taking levadopa/carbidopa, pramipexol, b complex among others. Cronic Constipation, he has taken and tried a LOT of medication, laxatives and other methods to help this problem, they work for some time then the problem is back **********************Broken bones due to fall**************** He broke his right leg ( femur ) and had a operation last year and since he has not been able to walk very well. Broken rib but he recovered fairly well from that one, no operation was needed. ***Current Situation and His Condition at this very moment***** He was rushed around 3:00 am est time to the hospital because he was having trouble breathing, apparently he vomited and swallowed part of his own vomit and that is what started the whole situation, he was given oxygen when he arrived at the hospital, but after a few minutes he began having more trouble breathing, then the only choice that we were given was to intubate him or he would have respiratory failure and cardiac arrest, after more tests and trying all sorts of medications to try and stabilize him but nothing is working, the latest thing that a group doctors discovered was a "tumor" in his intestine that is obstructing his intestine, BUT NO torsion or any signs that blood flow has been cut, basically just a severe obstruction in the intestine that is not letting anything pass or something similar to that AND I have not been given a clear explanation of what exactly is this thing, just a "tumor". The only choice that he has been given is to have major surgery and remove the obstruction (tumor or whatever it is) which at this moment is not possible due to his condition, or keep him in observation and see if his vital signs go back to normal and THEN do the operation. ****UPDATE*** Now they are saying there is no intestinal obstruction, and the major problem is the fluid in his lungs ***Vital signs*** Heartrate : has been going from 100-130 Temperature : Normal, hes been a bit cold Sugar levels and other blood tests/ signs I believe are ok. ******Questions************** Are the lungs able to recover with medication or some other operation lung transplant or something else, what type of medication or resources are out there for this kind of problem? Is there any chance for him to fully recover from this and he be able to breathe normally after this? What other tests can be done to know the exact situation of his lungs? What could be other possible symptoms that would tell me that something else is affecting his vital signs? Is it just a matter of waiting to see what happens or there is a possible solution out there that can help speed up his recovery process? From what I'm told the chances of surviving this are not very good, the doctor(s) keep saying that he is critical condition and he might not go through the night. All I want is a simple straight answer that can lead me to make the best possible choice for his health, I don't want him to suffer or just die in a hospital bed without knowing exactly was happened to him. Thanks
Posted Thu, 27 Mar 2014 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 2 days later
Brief Answer: Aspiration pneumonia with pulmonary edema. Detailed Answer: Hi, Thanks for posting the query on HCM. After going through the query , I would like to comment the following: 1. Your Dad currently seems to be suffering from aspiration pneumonia with pulmonary edema. Ventilator management is the cornerstone of treatment. The aim should be to maintain an oxygen saturation of more than 90%. 2. Considering the age of 75 years and comorbidity like parkinsonism, his ability of coming out of the condition will be seriously compromised. 3. Investigations that could help would be ABG analysis and CT scan thorax. 4. Infections should be avoided at all cost as any evidence of septicemia will further adveresely affect the outcome. 5. A good antibiotic cover, ventilatory management and supportive management to keep the vitals in normal range are the broad management targets. 6. Overall please remember that lungs are an extremely important organ in the body essential for oxygenation. Conditions whereby this organ is irreversebly damaged hamper oxygenation thereby affecting all other organs in the body. Currently the condition of the patient is extremely critical and chances of coming out are very difficult to predict. A lot depends on how his other organs are functioning eg. kidney function test, liver function test, cbc, electrolytes, etc. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist
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Follow-up: What are the treatment procedures for Parkinson disease and aspiration pneumonia with pulmonary edema in old aged person? 17 hours later
Dr. Gyanshankar XXXXXXX I appreciate your detailed answer, it really gives me and my family a much better idea of what my dad is going through and the options that he has and we can offer him at this time, I'd like to follow up with some more details and doubts that I have, which all of those I am asking to anyone I can, just to make sure that my dad is having all the care that he needs. I'll respond to the details you gave me and ask a few question or give you more information on each of them. 1. Your Dad currently seems to be suffering from aspiration pneumonia with pulmonary edema. Ventilator management is the cornerstone of treatment. The aim should be to maintain an oxygen saturation of more than 90%. After arriving to the hospital he was given oxygen and then immediately connected to the machine that helps him breath. From what I've seen on the monitors his oxygen saturation has been always maintained above 90%, I've seen it between 92-98%. 2. Considering the age of 75 years and comorbidity like parkinsonism, his ability of coming out of the condition will be seriously compromised. This is one of the things that worries me the most, but I agree that due to his previous condition among other this he will be in a tough situation, although I asked some of the doctors at the hospitals and they told me that his brain has not been affected in a serious way (ex. lack of oxygen ). 3. Investigations that could help would be ABG analysis and CT scan thorax. I understand that the doctors have been doing all sorts of analysis on him, blood tests and xrays but I would have to ask specifically of these 2 that you mention, although I hope this would be standard procedure on a case like his. 4. Infections should be avoided at all cost as any evidence of septicemia will further adversely affect the outcome. I know that he is on at least 2 antibiotics that are either fighting against current and future possible infections, the last day or so he presented a fever, then no fever and the last time I was with him today I felt his forehead and abdominal are very warm compared to other parts of his body like hands and feet. 5. A good antibiotic cover, ventilatory management and supportive management to keep the vitals in normal range are the broad management targets. Vitals signs have been the same for a while now, close to stable but they always vary. Heartrate around 110-130 Oxygen Sat. 92-98% Blood Pressure 85/56 was the number that shows on the monitor. 6. Overall please remember that lungs are an extremely important organ in the body essential for oxygenation. Conditions whereby this organ is irreversebly damaged hamper oxygenation thereby affecting all other organs in the body. Currently the condition of the patient is extremely critical and chances of coming out are very difficult to predict. A lot depends on how his other organs are functioning eg. kidney function test, liver function test, cbc, electrolytes, etc. At this time there has been no indication that any other of his other organs have been affected, I give you a list of the medication that I remeber, I may not have the exact names but I'll definitely can get the names. Blood serum / Saline Solution (Suero in spanish) Medicine to Control Pain / Sedative Dopamine Metronidazol Meropenem (antibiotic) Another Antibiotic This past day I believe a cocktail of more than 2, he was supposed to be given a combination with meropenem to amplify the spectrum of possible and current infections, but it was not given to him at first because they did not have it available at the time, this is a public hospital in mexico so that is why I'm being extremely careful of his care.) A few more that I need to remember the names and take note of them, I've been trying to get a copy of all the tests that they have performed on him but its been a difficult process since many doctors work on his case at different times. I was told by one of the doctors that there is around a 10% chance of him responding well to the medication that can bring his vital signs to normal and possibly breath on his own. I apologize for the long letter but this is extremely important for me and my dad, now the questions. Q.- The last day or so his eyelids seem to have a subtle movement, and a few tears running from one of his eyes to his nose, from what I understand he is completely sedated and in a sort of deep sleep state at all times. Could This Be a Sign That He Is Feeling or in a state of Consciousness that he could respond to me with his eyes? Q2.- Maybe is just the hope that I have to be able to talk to him one last time.. Is There Something Out There, A Medication (proven or experimental) That Could Bring Him Back For A Small Period Of Time Without Pain To Talk To Him And Let Him Know That I'm With Him? Q3.- What would be your recommendation and opinion as a doctor and a person if you where in my position, let him go or keep him in this situation if he could a have a decent outcome and recovery? The option to have him on this machine for who knows how many days or months and possibly come back to keep fighting with his parkinson disease and the chronic constipation plus all of this. Before this he was able to talk for periods of times, even walk with help but he would always be dizzy and confused. Thank you again for taking the time to respond.
 
 
Answered by Dr. Gyanshankar Mishra 12 hours later
Brief Answer: He is on complete ventilator support. Detailed Answer: Hi, Thanks for the follow up. 1. Your Dad currently seems to be on complete ventilator support. Patient is normally fully sedated in such conditions so as to avoid fighting the ventilator thereby avoiding barotrauma/respiratory fatigue. It is difficult to communicate with a sedated patient. 2. Proper ophthalmic care is required in such patients. You can discuss with your doctor, if prophylactic eye drops are required in the patient to keep the eyes moist/ prevent infection. 3. Right now if you decrease the level of sedation while on complete ventilator support, it will be difficult for the patient to sustain that. The level of sedation is reduced only at the time of weaning when the lungs begin to show signs of good functionality. Hastening this process can lead to adverse outcome hence at present sedation cannot be decreased. 4. I can understand your deep concern for your dad. As doctors, our aim is to do everything that we can in our capacity till the last possible moment, so as to facilitate any positive outcome if at all possible. You need to convey to your doctor your support and willingness to provide all possible requirements as required by them so that every best option for the patient can be considered by them. 5. Right now the aim should be to maintain all his vitals in a stable range. From the info, the BP seems to be on the lower side. Dopamine has therefore been started to maintain BP. If the all targets as mentioned in previous post, are maintained, then there will always be a ray of hope, even though it is very bleak at present. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist
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