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Is It Safe To Have Tracheotomy While Being On Induced Coma?
Question: Hi... a friend of mine who is only 42 yrs old male... had a stroke. He apparently injured on the job ( swat police dept) and saw a Chiropractor, like he always did & had a stroke right then. Ironically... this happened in my Chiro office at the hands of another Dr. who rents space from me. My question pertains to prognosis. He had an ischemic event of the cerebellum and went unconscious at the scene. He's been in induced coma for 14 days today... and intubated. He now will need a tracheotomy. I've read a few disturbing things...1. he did have a fever day 1 2. the duration of coma is unclear 3. tracheotomy can cut the life span to 50% within 30 days! I obviously don't have all the details, as his wife has texted me daily with little medical details. I'm very concerned...
I didn't mention that the stroke did follow a cervical adjustment. Very rare... but obviously happens!
I didn't mention that the stroke did follow a cervical adjustment. Very rare... but obviously happens!
Brief Answer:
Prognosis is guarded...
Detailed Answer:
Hi,
Yes, it's not easy to give a prognosis with limited clinical details and without physically examining the patient. However based on your description I will give him a guarded prognosis. At this point of time the challenges are:
1. To try and identify the cause of fever. It might be from respiratory or urinary source. Once we isolate the cause, treat it with higher intravenous injections.
2. Make sure there are no bed sores.
3. Maintain tracheosotomy aseptically.
4. Give him proper support nutritionally and with physiotherapy techniques.
With respect to tracheostomy, what you read is not entirely true. Tracheostomy can be a life saver in such situations. It not only aids in his breathing, but the caretakers have good access to his respiratory track. Most unconscious patients are unable to bring out pooled secretions which invariably gets collected in the lung leading to high percentage of mortality. Tracheostomy gives access to clear those pooled secretions. Yes, there are some issues like preventing infections, but with aseptic techniques and proper maintenance we can prevent infections.
Therefore considering this patient is still unconscious and need ventilatory support, tracheostomy seems valid.
If he is a very good friend of yours, I would recommend that you along with his wife talk to the treating doctor regularly. His doctors will not mind discussing his situation with close friends and family.
In such cases prognosis keep changing. At this point of time it looks guarded. However with time and right support, it can change. Keep up hope and discuss with treating doctors.
God Bless!!
Prognosis is guarded...
Detailed Answer:
Hi,
Yes, it's not easy to give a prognosis with limited clinical details and without physically examining the patient. However based on your description I will give him a guarded prognosis. At this point of time the challenges are:
1. To try and identify the cause of fever. It might be from respiratory or urinary source. Once we isolate the cause, treat it with higher intravenous injections.
2. Make sure there are no bed sores.
3. Maintain tracheosotomy aseptically.
4. Give him proper support nutritionally and with physiotherapy techniques.
With respect to tracheostomy, what you read is not entirely true. Tracheostomy can be a life saver in such situations. It not only aids in his breathing, but the caretakers have good access to his respiratory track. Most unconscious patients are unable to bring out pooled secretions which invariably gets collected in the lung leading to high percentage of mortality. Tracheostomy gives access to clear those pooled secretions. Yes, there are some issues like preventing infections, but with aseptic techniques and proper maintenance we can prevent infections.
Therefore considering this patient is still unconscious and need ventilatory support, tracheostomy seems valid.
If he is a very good friend of yours, I would recommend that you along with his wife talk to the treating doctor regularly. His doctors will not mind discussing his situation with close friends and family.
In such cases prognosis keep changing. At this point of time it looks guarded. However with time and right support, it can change. Keep up hope and discuss with treating doctors.
God Bless!!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
His fever was on day 1 & was controlled. No fever now... However I read fever can be increased metabolic syndrome?? Is it normal to be in induced coma for 14 days? Warming him up causes increase bp & brain wave issues. I won't be able to get specific info from anyone... Which I why I'm asking you!
Brief Answer:
Answers below..
Detailed Answer:
Apologies for the late reply. It's festive season in my country and I was away from internet. Well, answers to your questions are:
1. If the fever was just for a day, it may or may not be due to infection. Since he has no fever now, lets not ponder about the causes. Should he develop fever again, I would first think of infection and not increased metabolic syndrome.
2. Induced coma is not natural. It's a state produced by the effect of medicine. His treating doctor have put him in that state to have easy ventilation management, prevent convulsion and reduce brain swelling. We do not have strict guidelines as to how long he may be in coma.
Without specific details and opportunity to examine him, I really cannot be able to answer how log will he be in this state. I can only tell you that patients have recovered after months of being in coma (natural or induced).
Hope I have answered your questions. Let me know if you need any more details.
Regards
Answers below..
Detailed Answer:
Apologies for the late reply. It's festive season in my country and I was away from internet. Well, answers to your questions are:
1. If the fever was just for a day, it may or may not be due to infection. Since he has no fever now, lets not ponder about the causes. Should he develop fever again, I would first think of infection and not increased metabolic syndrome.
2. Induced coma is not natural. It's a state produced by the effect of medicine. His treating doctor have put him in that state to have easy ventilation management, prevent convulsion and reduce brain swelling. We do not have strict guidelines as to how long he may be in coma.
Without specific details and opportunity to examine him, I really cannot be able to answer how log will he be in this state. I can only tell you that patients have recovered after months of being in coma (natural or induced).
Hope I have answered your questions. Let me know if you need any more details.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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