Seeking Advice on Treatment Options for 83-Year-Old Patient After Severe Asthma Incident
Greetings to all medical experts, I am reaching out for insight concerning my grandmother's recent health crisis and whether additional treatment options exist at this point in her care. **Patient Background:** - **Age/Gender:** 83-year-old female - **Medical History:** Chronic, severe asthma and obesity - **Incident Timeline:** Experienced a critical asthma attack leading to respiratory failure and approximately 10 to 15 minutes of oxygen deprivation during emergency transport - **On Arrival**: Nearly in cardiac arrest, resuscitated, and intubated - **Current Situation**: In the ICU, on a ventilator, and has remained unconscious for around 65 hours **Medical Diagnosis Made by Healthcare Team:** - Acute hypoxic–ischemic encephalopathy (a global ischemic brain injury) - Coma following respiratory arrest **Neurological Assessment:** - Unconscious state continues - Notably had seizures, which are now under control - EEG reveals generalized delta and theta wave slowing, indicating some brain activity, with no signs of flat EEG or ongoing seizures **Vital Signs and Laboratory Results:** - Hemodynamically stable - Excellent oxygenation levels on the ventilator (SpO₂ approximately 98–100%) - Electrolyte balance remains stable - Mild acute kidney injury (Creatinine level around 1.6) - White blood cell count approximately 14,000, suggesting stress or potential infection - Arterial blood gas results show a pH of around 7.27, indicating adequate oxygenation **Inquiries:** 1. At this point, approximately 65 hours post-injury from lack of oxygen, which evidence-based interventions can be implemented to enhance the potential for neurological recovery? 2. Would conducting an MRI now, whether early or delayed, contribute valuable information regarding either prognosis or management? 3. When sedation is minimized, might a follow-up EEG provide useful insights? 4. Are there neuroprotective measures that should currently be evaluated (such as temperature management or medication tweaks)? 5. What warning signs or developments should we be vigilant about that could significantly alter the outlook? We are realistic about the prognosis and aim to gather informed and practical advice rather than unfounded optimism. I appreciate any assistance you can provide. I will also be posting this query in several relevant medical subreddits to gather diverse expert opinions.
Answers (1)
2/6/2026, 8:20:37 PM
OpenHealth AI
I'm very sorry to hear about your grandmother's situation. It's very understandable to seek further insights during such a challenging time. Here's a structured response addressing your inquiries:
Main Points:
- Evidence-Based Interventions: Focus on stabilizing her condition and fostering neurological recovery.
- MRI and EEG Timing: Both can provide critical information about her brain status and recovery potential.
- Neuroprotective Strategies: Consider temperature management and careful medication adjustment.
- Warning Signs: Be vigilant for neurological changes and signs of further complications.
Explanation:
After experiencing a significant hypoxic event, the recovery potential is typically influenced by the immediacy and nature of the interventions following the incident. The fact that she is hemodynamically stable is a good sign, although the extent of neurological recovery can vary based on many factors, including duration and severity of oxygen deprivation.
Next Steps:
-
Neurological Recovery Interventions:
- Keep Communication Open: Discuss with her healthcare team the ongoing monitoring plans and any changes in her neurological status.
- Neuroprotective Measures: Temperature management through controlled cooling can be beneficial for brain protection, especially in cases of acute brain injury. An assessment of her medications may also be done to ensure they don't hinder recovery.
-
Diagnostic Imaging (MRI):
- Conducting an MRI can provide valuable insights after the critical, early post-arrest phase has stabilized. It’s often used to understand the extent of brain injury and guide further treatment plans. The timing of this procedure will depend on her overall clinical stability.
-
Follow-Up EEG:
- Monitoring with an EEG post-sedation may provide additional insight into her brain activity and help assess her progress. It could indicate potential recovery or the need for further interventions.
-
Monitoring Warning Signs:
- Neurological Changes: Watch for any signs of responsiveness, such as reflex movements or eye opening, which can indicate changes in her condition.
- Vital Signs and Labs: Stay alert to changes in blood gas levels, kidney function, or white blood cell counts, which might indicate potential complications or infections.
Conclusion:
While the situation is dire, focusing on collaborative care with her medical team and understanding available interventions can help navigate this journey. Each patient's recovery is unique, so keep tracking her condition closely. I'm here if you have more questions or need further clarification. Take care.
Related Questions
Vertigo: New Medication or Just a Coincidence?
Yesterday morning, I began a regimen of Budesonide to tackle my microscopic colitis. After trying multiple treatments with no success, I found myself exhausted from the constant bouts of severe diarrhea. Although I’ve been hesitant to use steroids due to my type 1 diabetes, I deemed this option necessary. Around 1 am, I experienced an episode of Benign Paroxysmal Positional Vertigo (BPPV) unlike any I've encountered before. I was unable to get out of bed without help, as the room spun uncontrollably around me, accompanied by intense nausea and sweating. Although I've dealt with vertigo in the past—often unpredictably—it's been over a year since my last serious episode. Typically, I can resolve it using the Epley maneuver, but last night, I was too dizzy and nauseous to attempt any movement. Curious about whether my new medication could be the culprit, I turned to the internet for answers. While I know that online sources aren’t always reliable, I discovered that BPPV might indeed be a side effect of Budesonide. They advised seeking medical attention if the symptoms became worse. At the ER, they administered meclizine and IV fluids, and conducted a CT scan, EKG, and blood tests. Thankfully, the results cleared me of any serious issues, but they did identify an incidental nodule on my thyroid that requires further investigation. My blood pressure was unstable when I tried to stand, necessitating a prolonged stay for additional hydration, which ultimately eased the lightheadedness. Despite all this, the medical staff couldn't determine whether the onset of my vertigo was related to the steroid or if it was simply a coincidence. I made sure to mention my concerns during the visit. The attending nurse speculated that it was likely not due to the steroids since these medications usually elevate blood pressure. I’ve reached out to my gastroenterologist for clarification, but being the weekend, I’m uncertain whether I will receive a prompt response. For context, I’m a 50-year-old female, weighing 130 lbs at a height of 5'7". My medical history includes type 1 diabetes, EPI, microscopic colitis, gastroparesis, and familial high cholesterol, along with being in perimenopause. I’m currently managing my conditions with insulin, a statin, Zoloft, birth control for hormone replacement therapy, Creon enzymes at every meal, and now Budesonide. I also take vitamin D, magnesium, and coenzyme Q10 as supplements.
Critical Traumatic Brain Injury – 24-Year-Old Male in Coma (GCS 4/15)
I am looking for professional medical insights regarding a 24-year-old male patient who has suffered a severe traumatic brain injury as a result of a vehicular accident. Currently at Day 8 post-incident, the patient remains in the Intensive Care Unit, intubated and on mechanical ventilation since the initial day of treatment. His Glasgow Coma Scale score has worsened from 5/15 to 4/15. Key Observations Include: - Fracture of the basilar skull - Significant intracranial bleeding - Widespread cortical damage - Pupils are non-reactive and unequal in size - Diminished plantar reflex - Continuous cerebrospinal fluid leakage through the nose for several days - Onset of meningitis - Absence of spontaneous respiration The attending medical team has expressed a bleak outlook for recovery. I would appreciate answers to the following: 1. Based on your expertise, what might the realistic prognosis be? 2. What indicators are typically seen that suggest irreversible brain damage? 3. Are there any further interventions that could still be of value? 4. At what point is brain death assessed in similar situations? Thank you for your assistance.
31-Year-Old Woman Experiences Sharp Throbbing Pain in Abdominal Region
Age: 31 Gender: Female Smoking Status: Non-smoker Current Medications: Lexapro, Strattera Height/Weight: 5’1”, 115 lbs General Health: No significant medical concerns Background: At 31 years old and a mother of three, with my youngest child born just 15 months ago, I’ve been managing my health relatively well. I was recently diagnosed with adenomyosis following complaints of severe pelvic discomfort that feels like a hammer striking my pelvic bones during menstruation. Fortunately, my periods aren't particularly heavy. Now, to address my main concern: I occasionally experience an excruciating, throbbing sensation on both sides of my abdomen, located precisely where my hands would rest if I were to place them on my hips, just above the hip bones. These episodes can last anywhere from five to thirty minutes, and the pain is so severe that it genuinely feels as though my organs are being squeezed tightly. When these painful bouts occur, I find myself immobilized by the agony. Even in the intervals between these attacks, I consistently feel a lingering sense of soreness or swelling in that particular area. I’ve tried researching online, but the results often suggest conditions like Irritable Bowel Syndrome (IBS) or endometriosis, none of which resonate with my situation since I do not experience any additional bowel-related issues.
Understanding the Concept of 'Relative Rest' for Injuries
Profile: 31F, 5'6", 130 lbs - active athlete Currently managing pain with Advil and Tylenol as needed, and although I have been prescribed Flexiril for muscle spasms and sleep, I am opting not to take it. Two weeks ago, I experienced a recurrence of my rotator cuff injury on my dominant arm. After visiting a walk-in orthopedic clinic, the doctor recommended that I minimize movement of my shoulder and scheduled me for an MRI; I’m just awaiting a follow-up appointment next week. Fortunately, the initial MRI results did not indicate any tears. The MRI findings mentioned "bursal surface tendinosis in the supraspinatus tendon at its insertion." My initial injury, which dates back to May 2025, occurred in a car accident when a taxi rolled towards me, prompting a desperate attempt to push it away. At that time, the injury was initially diagnosed as bicep tendinitis, and physical therapy did not yield successful results. Now, I am eager to understand what relative rest actually entails in practical terms. During the mornings, I experience no pain when at rest, but gentle movements are moderately uncomfortable, rating about 2 out of 10 on the pain scale. Lifting a gallon of milk, reaching overhead, or performing repetitive actions—such as washing my other armpit—exacerbate the pain to about 5 or 6 out of 10, though this discomfort lessens after 5 to 10 minutes. My shoulder, arm, and hand are persistently uncomfortable, to the extent that it disrupts my sleep unless I am exceptionally cautious throughout the day. For context, when I broke my back a few years ago, I rated that pain at an 8 out of 10 while in tears. As an equestrian athlete managing my own farm, I typically engage in 2 to 4 hours of physical labor daily, which involves lifting and carrying heavy objects as well as various repetitive actions. At present, however, I am unable to partake in those activities. Thanks for taking the time to read my situation!
Understanding My Past Experiences
At the age of 20, standing 5 feet 4 inches tall and weighing 140 pounds, I still reflect on some alarming experiences from my childhood. Between the ages of 9 and 13, I encountered these dreadful "episodes" that I struggle to articulate, except to say they were extremely distressing. I could sense an episode approaching when I felt a peculiar sensation in my nose while breathing, leading to an onset that was genuinely unbearable. During these episodes, I was left in a state of turmoil, unable to stabilize my thoughts or emotions. I distinctly recall the first instance when I was about 9 years old; it was a particularly harrowing experience that included visual and auditory hallucinations, severe vomiting, and an intense headache. Following that initial episode, the only lingering issue was persistent headaches. The sensations I experienced during those episodes remind me of the overwhelming feelings one might get after consuming an excess of THC edibles. I remember vividly at around the age of 5, I stumbled upon what I believed to be regular chocolates in my mother's car and consumed three of them. It turned out they were cannabis-infused, and the effect was strikingly similar to what I would later encounter during those episodes. Now, as I begin to notice those premonitory sensations once again, I feel a sense of dread; it’s been several years since I last experienced an episode, and I am apprehensive about going through that torment once more. My curiosity about understanding what these episodes were and what triggered them continues to linger.