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Vomiting and difficulty in breathing. Had stroke. Did hemicranietomy and tracheostomy. Need advice

My dad is 68 years old suffered massive stroke. He was in the ICU for 15 days and a week in VCU for close monitoring and finally discharged 3 days ago. He underwent decompressive hemicranietomy and tracheostomy because of brain swelling. Right now, even if he's at home already he breathe with the help of oxygen and a feeding tube for his food (NGT). He cant speak, cant move his right side leg and arm. Our problem now, hes bloated and constipated for 6 days already, he usually hiccups and he vomit in greenish color. Everytime he vomits his BP fluctuates and he has difficulty in breathing. We dont know what's going on with my dad? We dont know what are the causes of this problems? Please give me ideas and suggestions on how to alleviate dad's pain. Thank you.
Asked On : Fri, 29 Mar 2013
Answers:  1 Views:  56
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Critical Care Specialist 's  Response
Hi thanks for posting your query
First of all I want to give you some information regarding decompressive hemicraniectomy. It does not reverse the loss of brain occured in stroke. After massive or submassive stroke damage brain swells and further damages the normal brain therefor some part of bone over the brain is removed and allow the damaged barin to swell without damagging normal barin and saves the life. So neurological insult happened during stroke will not recover after decompressive hemicraniectomy.
To ensure clear breathig passage your father is tracheostomised and it prevent aspiration of saliva, food, vomited fluid. Feeding is given through tube therefore it will not go in to breathing passage. Episodes of vomiting can happen with tube feed if it is not tolerated or there is gastritis.
To control vomiting you can take the help of some medicine metoclopromide, domperidone, ondensatron but you should change the content of tube feed also specially if it is commercial formula feed(Resource, Impact, Kabipro), you can try kitchen mashed feed. Gastritis is also treated with pantoprazole, omeprazole, ranitidine etc
Regarding long term plan discuss with your neurologist up to what level of recover is expectingbecause we usually prefer PEG (Percutaneous Endoscopic Gastrostomy)tube for longterm safe and convenient method of feeding in the presence or in the absence of Tracheostomy. You should discuss about it by your treating doctor.
Blood pressure flutation is usual phenomenon happen during vomiting ignore this reading for 15 -20 minutes then remeasure blood pressure. If BP persistently high then only require evalution and treatment
Hope this information help you. Take care of your father
Dr Jeetendra Sharma
Critical Care Senior consultant
Answered: Mon, 20 May 2013
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