Hi,

Thanks for the query.

I am not sure if there are any nurse available to answer your query. So let me try and address your concern.

This is a patient that has a left brain hemotoma or secondary to an embolic considering his heart medical history. The key aspects in the management of this patient now that needs to be documented during hospitalisation include a good oxygenation generally at more than 3 litres per minutes, appropriate monitoring of blood glucose level, monitor temperature for fear of hypothermia, moblization every two hours to prevent thromboembolic disease, use of low molecular weight heparin, controlling of clotting factors and times, Prothrombin times and coagulation times, proper care with respect to urinary catheter to avoid infections, regular changing of the catether, a good positioning of the body and regular auscultation of lungs to exclude aspiration pneumonia early enough if any and measurement of pulse oxygen pressures.

In addition vital signs (BP, Respiratory rate, Pulse) are of utmost importance. A regular neurologic examination by the caring physician shall be important to monitor the evolution of this patient (Glasgow Coma Score). Patient should be on an ECG monitor.

As far as differentials are concerned, apart from left brain hematoma, embolic infarcts, sub arachnoid hemorrhage, metabolic/infective encephalopathy, seizure disorder etc., can produce similar clinical symptoms. However all these conditions can be easily ruled out with relevant investigations.

I hope this helps. Will be pleased to answer any of your queries.

Best ragards,
Luchuo, MD.

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Hi,

I am glad to known that pneumonia has been ruled out. Thick brown sputum is very frequent in heart failure and other chronic obstructive bronchopneumopathies. Considering the risk factors in our patient (mitral valvulopathy / pace maker), the probable cause therefore of the thick brown sputum should be of cardiac origin (a heart failure MUST BE EXCLUDED IN THIS CASE).
What about jugular vein distension, pedal oedema, hepatomegaly?
I suggest a good clinical examination and maybe a cardiac ultrasound, measurement of Artrial Natriuretic factor could be good indicators to ascertain normal cardiac output or not.

However, adequate and frequent mobilization remains necessary as his clotting profile and anti coagulant therapy and control remain the key issues in the management pf the patient.
I suggest patient be examined by a cardiologist and heart failure ruled out.

Thanks as I hope this helps. If you need more help, do not hesitate, will be honored answering more questions.

Best regards,
Luchuo, MD.

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