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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest better treatment for my sister who is in coma

Dear Doctor, I am seeking help from you, since my sister is in coma for last 27 days and being treated at Critical Care Unit of Tata Main Hospital, Jamshedpur. I am enclosing her brief case summary given by the doctor on our personal request. I sincerely request you to have a look at the case summary and suggest. I am also enclosing the list of medicines and blood report for your information. Case summary Mrs Sharmila Sen 37/f was to undergo planned hysterectomy on 28/12/11.she is a known asthmatic on MDI(metered dose inhalers).as her hemoglobin was low preop packed cell transfusion was decided(Hb was 7gm/dl) by her treating doctor.She developed sudden onset uneasyness followe by shortness of breath after getting about 70 ml of blood and then had a cardiac arrest on 27/12/11 evening.she was attended by the anaesthesist who intubated and cardiac resuscitation was done .she was then shifted to CCU where she had refractory status epilepticus which was managed with inj midazolam ,inj leveteracetam etc. she was put on ventillatory support soon after shifting to ccu. tracheostomy was done on 05/01/2012. she had once developed pulmonary oedema which was taken care of. at present she is on ventillatory support and is comatosed.she is noticed to have myoclonic jerks off/on.signs of decorticate rigidity were also noticed . she had developed fever last week which has settled down. at present on anti-epileptics,suppurtive care.she is off ionotropes . clinically looks post cardiac arrest hypoxic brain damage. Additional information # She is an old patient of asthma and used to take Tab - Derifyline (Theophyline) and inhaler Asthalin regularly, & Tab - Prednisolone occasionally. # She had brain hypoxia lasted for approx 6 - 7 minutes. # She is presently maintaining Glasgow coma scale at 4. # Her present hemoglobin level is 9.1 after one pack of ( Leuco reduce ) Blood (Hb was 6.6 before transfusion). Examination : MRI BRAIN WITH MR ANGIO WITH MR VENO (NCMR)Multiplanar multiecho MR of the brain has been performed. The study shows normal frontal, temporal parietal and occipital lobes of both cerebral hemispheres. Intervening inter-hemispheric and sylvian fissures and cerebral sulci are also normal. Basal ganglia are normal. No ventricular dilatation seen. Basal cisterns brain stem and cerebellum are normal with normal cerebellar peduncles. Vessels visualised at base of brain reveal normal flow void on all sequences. No abnormality of cranial nerves that could be defined and seen. Cranial vault shows normal outer and inner tables and diploic space. IMPRESSION : NORMAL MRI OF BRAINMRA – 3T TOF MRA shows normal flow signal in the “Circle of Wills”. No morphological abnormality is seen. No steno sing lesion is seen. Regards, Samrat
Wed, 29 Jan 2020
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Internal Medicine Specialist 's  Response
Hello,

I will agree with the diagnosis because it is consistent with the sequence of events. A good aspect out of all the information is that she is having brain activity in the form of fits and myoclonic jerks.

Recovery from hypoxic brain injury maybe there, maybe slow, maybe good being young.

The micro colts which are there during an allergic reaction (highly expected in allergic asthma patient) had traveled to lungs and brain and heart leading to cardiac arrest, coma and pulmonary edema. Nature will take its course.

If her brain has activity as I already mentioned. She definitely has positive chances of getting out of coma.

Meanwhile, you need to keep pelvic area more or washed thrice a day, passive exercises thrice a day, feeding via tube regularly, changing her postures every 2 hours so that when she is out of coma, she is physically in a good condition without any complications of being in coma.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Muhammad Faisal Bacha, Internal Medicine Specialist
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Suggest better treatment for my sister who is in coma

Hello, I will agree with the diagnosis because it is consistent with the sequence of events. A good aspect out of all the information is that she is having brain activity in the form of fits and myoclonic jerks. Recovery from hypoxic brain injury maybe there, maybe slow, maybe good being young. The micro colts which are there during an allergic reaction (highly expected in allergic asthma patient) had traveled to lungs and brain and heart leading to cardiac arrest, coma and pulmonary edema. Nature will take its course. If her brain has activity as I already mentioned. She definitely has positive chances of getting out of coma. Meanwhile, you need to keep pelvic area more or washed thrice a day, passive exercises thrice a day, feeding via tube regularly, changing her postures every 2 hours so that when she is out of coma, she is physically in a good condition without any complications of being in coma. Hope I have answered your query. Let me know if I can assist you further. Take care Regards, Dr Muhammad Faisal Bacha, Internal Medicine Specialist