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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is The Patient Getting Better If Trying To Grab Tubes While In Coma?

Hi My 22 yrs old nephew met with a car accident on 18th Apr 2014. GCS 3. He is in coma since then. He has acquired ICU infections, Klebsiella fever 104 , but better now , put on collistine, he has had slight infection in blood and urine as well; Motor movement: left hand , yawn, spomtaneous eye movement; it is E3VtM4 since May 2nd week; last 1 week hand raising and grabbing the tubes once in a while. Right frontal lobe, facial fractures; Do u think he is getting better? Is it advisable to move him to another hospital, he need venti support now and then; CT scans are better doc says; No surgery was required.
Thu, 26 May 2016
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Physical Therapist or Physiotherapist,  's  Response
hi,

Thank-you for providing the brief history of you.

As it was a ETA and serious injuries leading to low GCS score, he needs a thorough attention. CT is always good for helping Doctor for planning further medical management. As his hand movement are recovering there will be a positive sign as well. Grabbing the tube is due to the irritation happening to the trachea and the brain is trying to perform some activity for hand to move and grab the tubes out. This is a positive reaction but by grabbing the tube and pulling it out may lead to serious issues.

Now since we have to only wait and see how his brain is recovering from the TBI as it's all time framed reactions. Also if the ventilator is advised than there is a serious brainstem issue for which an MRI or CT has to be performed.

Surgery for anything may not be of a good choice since the patient is in comatose state.

Also, having the urine and lung infection he may need a good oxygen supply for allowing the body to heal. As oxygen is a major source of energy supply for the normal human physiological functions

to keep in mind that many of the infections are due to hospital acquired and he need to be kept completely hygienic for each and everything.

Frontal lobe injury will take its own time to injury and since the brain will be still in a shock state this comatose state will come down as the inflammation in the brain comes down.

Important to mention that shifting the patient in this situation for more than 20 kilometers will not be good

Regards
Jay Indravadan Patel
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Is The Patient Getting Better If Trying To Grab Tubes While In Coma?

hi, Thank-you for providing the brief history of you. As it was a ETA and serious injuries leading to low GCS score, he needs a thorough attention. CT is always good for helping Doctor for planning further medical management. As his hand movement are recovering there will be a positive sign as well. Grabbing the tube is due to the irritation happening to the trachea and the brain is trying to perform some activity for hand to move and grab the tubes out. This is a positive reaction but by grabbing the tube and pulling it out may lead to serious issues. Now since we have to only wait and see how his brain is recovering from the TBI as it s all time framed reactions. Also if the ventilator is advised than there is a serious brainstem issue for which an MRI or CT has to be performed. Surgery for anything may not be of a good choice since the patient is in comatose state. Also, having the urine and lung infection he may need a good oxygen supply for allowing the body to heal. As oxygen is a major source of energy supply for the normal human physiological functions to keep in mind that many of the infections are due to hospital acquired and he need to be kept completely hygienic for each and everything. Frontal lobe injury will take its own time to injury and since the brain will be still in a shock state this comatose state will come down as the inflammation in the brain comes down. Important to mention that shifting the patient in this situation for more than 20 kilometers will not be good Regards Jay Indravadan Patel