Patient in Coma After Brainstem Hemorrhage: Ongoing Care Challenges

Q: Patient in Coma After Brainstem Hemorrhage: Ongoing Care Challenges

Hello Sir： I suggest that you invite the family members of your aunt and her attending physician to hold a "family meeting." Discuss the desire for aggressive treatment with the medical team to reach a consensus between your needs and the available medical options. <br>If financi

The patient has suffered a brainstem hemorrhage and remains in a coma post-surgery (for over 70 days)?

The aunt has been in a coma (Glasgow Coma Scale score of 8) following a recent brainstem hemorrhage and subsequent brain surgery.
At one point, her heart stopped but was revived.
The hospital has informed the family that after every 28 days of hospitalization, she must either be transferred or discharged (she has already been transferred from a hospital in Nantou to a hospital in Zhubei).
Currently, the hospital in Zhubei is also insisting on discharge, but the patient is still undergoing treatment for pneumonia.
The family has inquired with various rehabilitation and neurology departments in the Tucheng and Miaoli areas about the possibility of transferring her, but all have responded that they cannot accept her.
The family is unsure of what to do next, especially since the patient is a single parent with two minor children, and they hope to pursue aggressive treatment if possible.

A Le, 30~39 year old female. Ask Date: 2024/06/25

Dr. Jiang Junyi reply Neurology

Hello Sir: I suggest that you invite the family members of your aunt and her attending physician to hold a "family meeting." Discuss the desire for aggressive treatment with the medical team to reach a consensus between your needs and the available medical options.
If financial resources allow, you may also consider medical centers that offer stem cell therapy.
Generally, the golden period for rehabilitation is 8-12 weeks.
If you pursue active rehabilitation, home rehabilitation could be an option, allowing the primary caregiver to learn rehabilitation techniques.
The rehabilitation journey can be challenging, so it is crucial to discuss the next steps in treatment and management with your aunt's attending physician (such as risk factor control, post-stroke rehabilitation plans, etc.).
Wishing you and your aunt good health, peace, and joy.
Thank you for your inquiry, and feel free to discuss further.
Wishing you good health, peace, and joy.
Dr.
Jiang from Taoyuan Medical Center/Hua Medical Center cares about you.

Reply Date: 2024/06/25

More Info

The situation you are describing is indeed complex and challenging, particularly given the patient's condition following a brainstem hemorrhage. The management of a patient in a coma, especially after such a significant neurological event, requires a multidisciplinary approach and careful consideration of ongoing care options.

First and foremost, it is important to understand that brainstem hemorrhages can have severe consequences, including loss of consciousness, respiratory difficulties, and autonomic dysfunction. The brainstem is responsible for many vital functions, including heart rate, breathing, and blood pressure regulation. A Glasgow Coma Scale (GCS) score of 8 indicates a moderate level of impairment, where the patient may exhibit some responses but is not fully conscious. The fact that the patient has experienced a cardiac arrest further complicates the clinical picture and may indicate a poorer prognosis.

In terms of ongoing care, it is crucial to ensure that the patient receives appropriate medical attention for any complications, such as pneumonia, which can be common in patients who are immobile or have impaired consciousness. The management of pneumonia may include antibiotics, respiratory therapy, and possibly interventions to assist with breathing, such as mechanical ventilation if the patient's respiratory status deteriorates.

The issue of transferring the patient to another facility or discharging them from the current hospital is a significant concern. Many hospitals have policies regarding the length of stay for patients who are not showing signs of improvement, particularly when they require extensive rehabilitation services. It is essential to communicate with the healthcare team about the patient's current condition and the family's desire for continued aggressive treatment. If the current facility is unable to provide the necessary care, the family may need to advocate for the patient by requesting a case manager or social worker to assist in finding an appropriate rehabilitation facility that can accommodate the patient's needs.

Given the patient's status, it may also be beneficial to explore palliative care options. Palliative care focuses on providing relief from symptoms and improving the quality of life for patients with serious illnesses. This approach does not necessarily mean giving up on treatment but rather ensuring that the patient is comfortable and that the family receives support during this difficult time.

Family involvement is crucial in the care of a patient in a coma. It is important for family members to be educated about the patient's condition, potential outcomes, and the available treatment options. They should also be encouraged to participate in discussions with the medical team to express their wishes and concerns regarding the patient's care.

In summary, the ongoing care for a patient in a coma following a brainstem hemorrhage involves addressing medical complications, advocating for appropriate rehabilitation services, and considering palliative care options. The family should remain engaged with the healthcare team to ensure that the patient's needs are met and that they receive the best possible care during this challenging time.

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