Subdural Hematoma: Insights and Prognosis After Brain Injury - Neurosurgery

Subdural hematoma

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Dear Dr.
Ding,
My father is 54 years old.
On December 13, he fell from a 2-foot high ladder, landing on his left side.
He was conscious during the fall and attempted to speak but was unable to.
He even tried to get up.
When the ambulance arrived, the paramedics first checked his blood pressure and secured his neck before transporting him to the hospital.
By the time they performed these actions, about 10 minutes had passed, and they did not use the siren to clear traffic at red lights (although they did have the lights on).
They waited for the green light before proceeding, so I estimate that it took nearly 15 to 20 minutes from the time of injury to arrival at the emergency room.
During the ambulance ride, my father seemed to have slipped into a coma.
The paramedics continuously tried to wake him and instructed him not to close his eyes.
Upon arrival at the emergency room, he was in a comatose state.
After a CT scan, it was determined that he had a left-sided intracerebral hemorrhage and required emergency surgery for subdural hematoma.
After the surgery, he was transferred to the SICU.
On December 15, the doctors removed his sedatives, pain medications, and drainage tubes, but he has not yet regained consciousness.

On December 16, due to cerebral edema, his intracranial pressure rose to over 30.
The doctors administered diuretics every six hours and informed us that the likelihood of my father waking up is very low, with a 90% chance of becoming a vegetative state.
The nurses mentioned that because my father had a stroke in the right hemisphere three years ago, his cerebral blood vessels are more fragile, which contributed to the severity of his left-sided injury.
By December 18, his Glasgow Coma Scale score improved to 4, previously it was 3.
On December 19, his intracranial pressure rose again, and the hospital administered antihypertensive medication every four hours, using two types of injectable drugs.
The doctors have now informed us that a tracheostomy is necessary to facilitate care and allow for gradual training for independent breathing.
I would like to ask Dr.
Ding the following questions:
1.
Given my father's current condition, can he be classified as being in a vegetative state, or does this require several months for a determination?
2.
If he does become a vegetative state, is the tracheostomy solely for the convenience of family care, or are there additional benefits?
3.
The attending physician has indicated that my father's left brain tissue is severely damaged, affecting the right side of his body and his speech area.
Is there still hope that my father will wake up one day and that rehabilitation could help him recover gradually?
4.
Considering my father's age, will the damaged brain tissue have the potential to repair itself, and how long might it take for the brain tissue to gradually return to normal?
5.
We know that my father has a strong sense of pride and does not want to be looked down upon.
We also do not wish for him to suffer as a vegetative state patient.
Under Taiwanese medical law, is there any way to allow my father to end his life early to avoid suffering?
6.
If my father unfortunately becomes a vegetative state patient, are there any surgical methods available in Taiwan's medical technology that could help him regain consciousness, or other methods such as family communication, playing music, or using any means to induce pain, such as acupuncture or squeezing his flesh, or gently twisting his hand to stimulate him to wake up?
7.
Does a delay in medical treatment for brain injuries lead to different outcomes? I believe that the 15 to 20 minutes already counts as a delay.
If we had reached the hospital within 10 minutes, would my father's condition have resulted differently?
Thank you.

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Zhuojí de jiārén, 30~39 year old female. Ask Date: 2009/12/19