Patient: shock, had cramps, January 25, 2009 night s9c wallow r down coma so far (r the clothes, but] there is a drenching on the fall, estimated s half a small r before the family lF fell to the ground). Human life is at stake, urgently hope that many public morality o amount of t life to save. 2-3 days before the coma has a l Touche. In 2004 Shashi had lu tatuzhao qu brown commission due to urinary toxic bacterial infection. Has been relying on x device oxygen, playing anti-inflammatory, but still I coma B. Until yesterday, February 2, 2009, the patient] have l, five K six internal organs are normal. Previously the patient] had underlying diseases such as heart disease or a history of epilepsy. How to save/resuscitate the patient, or how to destitution Xe water p The patient F is at the North Street t Hospital in Jiang T. If patient Y information is needed, inform, L to the hospital. Three days ago the hospital had invited a visiting professor linden √z check at the Pearl River t hospital in V city, ow my family: @N viral X water [, Fr] there is a specific special effect can be cured immediately, can only rely on the patient’s vitality how to resist the virus, the patient’s life force X in the scarlet areal anti-inflammatory, can be a big step ~ ^. The hospital said that the virus invaded the nerve center of the brain, causing cerebral edema and compression of the nerves, leading to coma and cerebral herniation. Patient: Mr. Shih, hello! Thank you for your time and attention. Yesterday, after my family visited the patient, he had a weak respiration and a pulse rate of only 40 beats per minute. As you said, the patient is suffering from brain herniation. It’s been 10 days and the patient is not waking up. I’ll send you the information you need. Mannitol is already in use at the hospital. Patient: Mr. Shih, ^family members, the hospital has linden ^ “gammaglobulin shock therapy”. Is there any other treatment? Patient: gammaglobulin shock therapy has been used for 3 days, now the medication is: meloxicillin c sulbactam, ciprofloxacin lactate c, acyclovir, methylprednisolone bitartrate c, B12, mannitol, etc. Patient: last night there was a low-grade fever of more than 38 degrees Patient: the pulse was once more than 40 per minute yesterday morning, and it returned to normal after using the medication Patient: Mr. Shih, I would like to ask you to understand a little bit. The patient is sick in V Southwest Pingnan People’s Hospital for 2 days, and then I was discharged on February 2, 2009 from the downtown hospital (i.e., Beijie Hospital).” Discharged” was presented by Binh Namh People’s Hospital. The patient is still using a ventilator to assist her breathing and has a fever of more than 38 degrees. Patient: Mr. Shi, hello! Thank you and r back. The patient is still on ventilator-assisted respiration. There is no lung infection, no gammaglobulin, from the 30th to the 1st used 3 days of albumin. In the last 3 days the patient had some spontaneous respiration, no high fever, and in the last 3 days he had a fever of more than 38°C. Today he has no fever, and his heart rate is still high. Today, there is no fever, and the heart rhythm is stable. The day before yesterday, the heart rate was 40 beats/minute and recovered after cardiotonic injection, and today, the heart rate is 80-90 beats/minute, and the patient has been using “Thymopeptide 1.6mg” since February 3rd! Patient: Albumin was used for 3 days in total, 1 bottle of 50ml on Jan. 30, 2 bottles on Jan. 31, and 2 bottles on Feb. 1. Patient: this is the discharged toad in Pingnan Patient: this is the list of medication on January 31st Patient: Mr. Shi, hello! Thank you for your time and attention. The patient was sick in Binh Nam People’s Hospital in Southwest China and was saved for 2 days, then I was discharged on January 27, 2009 to the Downtown Hospital (i.e. North Street Hospital). It’s been 12 days since then, but is it okay to use gammaglobulin only now? Patient: Is it still effective to use Gammaglobulin only now? Patient: Can Thymosin be used instead of Gammaglobulin? Thank you! Patient: The patient has no fever today (physical cooling with ice machine), stable heart rhythm, some spontaneous respiration, but there is Staphylococcus aureus found in the sputum today, is this bacteria harmful? Patient: Mr. Shih, hello! Thank you! The patient has not yet improved, still using ventilator-assisted breathing, continues to be comatose. Yesterday she was treated with vancomycin, but I don’t know if it’s because she was given too much mannitol, but yesterday she had a diarrhea. Is this viral encephalitis contagious? What should the family pay attention to? Patient: Mr. Shi Tisheng, hello! We would like to contact you directly, can you provide us with your cell phone or landline number? Patient: Jiang T city center hospital (i.e., North Street hospital) today proposed to give the patient a blood transfusion, did not say the reason, this is not a sepsis syndrome? In addition, the family told the patient six months before the onset of the disease, had often to the afternoon on the headache, and a few times with a fever, by eating with the “Bili Tong” to eliminate pain. Tried once to the hospital for headache injection. Patient: the patient’s sister’s cell phone is 15815750070, you can send a text message to her! Thank you! Patient: Shi t sheng, hello! Thank you for your return. The patient’s condition is not good, continue to coma. Fever, (is using ice machine physical cooling), but also with a respirator to assist breathing, heart rhythm 110 – 120, with vancomycin antibacterial has not yet seen the effect. Yesterday, the amount of mannitol was reduced, and there was no dysuria. Patient: Mr. Shih, hello! I am grateful for your return. I heard that you can’t come to Jiangmen, can you tell this patient’s condition to Dr. Zheng Dong, can you ask him to come to Jiangmen, and provide us with his cell phone or landline number if convenient. Thank you! Patient: Shi T Sheng, Hello! Thank you very much for your help! The patient seems to be a bit better today, his hands move a bit. His eyelids also move sometimes. Patient: Mr. Szeto, hello! Thank you so much for your help. Gammaglobulin has been used for 5 days, is it necessary to continue using it? Patient: Mr. Szeto, hello! Thank you! I heard from the doctor of JiangT downtown hospital that the patient’s condition has improved, from severe coma to moderate coma, pupil reaction, has stopped using mannitol, changed to glycerol fructose, also stopped using vancomycin, changed to another antimicrobial agent, I heard that there is a fear of resistance, and is now continuing to use thymosin alpha 1 (1.6mg once every 3 days). I have not used the prophylaxis again, is this okay? Patient: Hello! I’d like to send you the hospital photographs (attached), which show a blurred demarcation of gray and white matter in the cerebrum and cerebellum bilaterally, and extensive subcortical streaks of slightly high-density shadows on the SCT. Patchy low-density shadows are seen in the bilateral basal ganglia region with poorly defined borders. The size, morphology and location of the ventricles and cerebral pools were still acceptable. The sulcus and fissure are slightly widened. The midline structure is centered. No abnormality was seen in the skull. Bilateral pterygoid and sieve sinuses are hyperdense. COMMENTS: consistent with changes after treatment of viral encephalitis, cerebral edema, brain herniation improved significantly compared with the previous; bilateral cerebral softening in the basal ganglia region, not excluding the possibility of subcortical hemorrhage. MRI is recommended for further examination. Patient: Mr. Shi, hello! JiangT downtown t hospital SCT scanning photo here can not send to you, can you provide your e-mail address, we can send directly to your e-mail. Thank you! Patient: Because the patient is still on ventilator-assisted respiration, only SCT can be done, MRI cannot be done yet. The SCT scanning photo shows that cerebral edema and brain herniation have improved compared with the previous one, but the cranial pressure is still very high. The patient is still in a coma. Patient: The photo attachment has been sent to your e-mail address, did you receive it? Patient: Yesterday’s SCT and today’s lumbar puncture showed that the cranial pressure is still high. Patient: Mr. Shi, hello! After looking at the SCT scanning photo, do you think the judgment of JiangTu City Center Hospital is correct? What do you think is the chance for this patient to revive? In the past two days, the patient has been assisted in breathing with a ventilator (8-10 breaths/minute), and her family has used a tape recorder to record the voices of her family members and play them back to her repeatedly, and she has had a great response, with her hands, feet, and eyelids moving and her heartbeat and breathing speeding up. Patient: Mr. Shi, hello! The patient has regained independent breathing and was transferred to the general ward today, but has not yet awakened. The lung infection is still not cured and he has a lot of sputum. Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: Please provide us with the information of MR or CT of the skull and EEG. Viral encephalitis with cerebral edema leading to coma is also very common, mostly caused by herpes simplex virus. I have treated patients with encephalitis who were in coma for a month. Cerebral edema is treated medically with hormones and mannitol, along with antiviral and neurotrophic drugs. The condition is treated with gammaglobulin shock therapy, which is more expensive. If there is brain herniation, it can be treated surgically. Prevention of complications: pneumonia and decubitus ulcers. Thank you. Shi Haisan, Neurology Department, Guangzhou Brain Hospital? Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: The patient is young and resilient, so as long as he can hold on, he can usually get over it, and the effect of using prophylaxis will be better. However, it will cost a lot of money. Our hospital has more experience in treating various kinds of encephalitis. Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: Is the patient on a ventilator now? Is there any lung infection? Gammaglobulin can be used for 5 days, 6 vials per day according to the patient’s kilograms of body weight. Is the patient’s respiration regular? Is there any persistent high fever over 40 degrees? Is the heart rhythm stable? How long has the heart rate been 40 beats/minute? Hormones can be added to mannitol to enhance dehydration. I’m sure the doctors at the hospital are very experienced, but sometimes the condition is so severe that it’s hard to get it under control all at once. I estimate that her coma time will continue for a while. The main thing now is for the family to have strong financial support. Albumin treatment can be purchased. Thank you! Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: The precision of your scanning result is so high that I didn’t open it for half a day. Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: Looking at your CT scan result, it is only cerebral edema, and there is no brain hernia. There is no displacement of the midline. Shi Haisan, Neurology Department, Guangzhou Brain Hospital: Albumin is used to replenish nutrition and dehydration, and gammaglobulin is used to enhance the body’s immunity. The treatment of viral encephalitis is to use high-dose hormone and gammaglobulin shock therapy. Looking at your description, the patient’s current condition has improved somewhat, and I still recommend treatment with gammaglobulin. The course of viral encephalitis is time-consuming, and sometimes patients recover miraculously. The family should have patience, and perseverance. Trust the doctor! Thank you. Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: It’s not too late to use gammaglobulin, which is very useful for these critically ill patients. However, it is very expensive, a course of treatment costs more than 10,000 yuan, and it is not easy to buy. It is a bad sign to find aureus inside the sputum, this bacteria is very strong and resistant. The only way to treat it is with vancomycin, this drug is not cheap either and the course is about 4 weeks. Beware of having sepsis. Propecia can also strengthen your body to fight the bacteria. Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: Blood transfusion is not used to treat sepsis; sepsis is still treated with antibiotics. It depends on whether the doctor asks for whole blood or plasma transfusion or component transfusion for different reasons. I believe that the doctor will not ask the patient to have a blood transfusion for no reason. Using too much mannitol usually does not cause urosepsis, but only impairs kidney function. I guess it is the virus invading the hypothalamus that caused the uremic syndrome. The patient used to have frequent headaches and fever, it seems that her health is not very good, which is also a reason for today’s coma. Viral encephalitis itself is not contagious. However, if the family members around her are also in poor physical condition, they may be infected by contact with the patient’s sputum or secretions. My cell phone: 13113331901 Guangzhou Brain Hospital Department of Neurology Shi Haisan: not so fast to get well, vancomycin treatment to 4 weeks. It is normal for a feverish patient to have a fast heart rhythm. The first thing you need to do is to get a good deal of money to pay for it. My last patient with encephalitis was in a coma for a month. He had bedsores. Shi Haisan, Neurology Department, Guangzhou Brain Hospital: I have already told Director Zheng about the patient’s condition. Viral encephalitis is self-limiting and will improve naturally when the time comes. The tracheotomy was done to facilitate suctioning, which is helpful in treating pneumonia and also reduces the lack of oxygen to the brain. Now we can’t relax the treatment to prevent complications. Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: I personally think that although the dosage of propecia is on the low side this time, but after five days of using it, you can stop it for observation, and then shock treatment can be given for another three days if necessary. Shi Haisan, Neurology Department, Guangzhou Brain Hospital: I believe that the doctors in Jiangmen also have experience. Of course, the doctors in each hospital have different means of treatment and different habits of medication, but the purpose is to cure the patient. Changing antibiotics depends on sputum culture and drug sensitivity, and on clinical experience. As long as the patient’s condition is good, there is no problem. After reading about the treatment over there, the doctors are also very active and attentive in treating the patient, and the result is also good. The patient is now in the recovery period, and we must pay attention to preventing the complication of decubitus ulcer. Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: [email protected] After reading the CT report of the patient’s head, I think the condition is quite serious. Generally, brain lesions in patients with encephalitis can only be shown by cranial MRI, and this patient even had so many lesions in the CT report, which showed that the nerve cells of the brain had been severely injured. Recovery is difficult. I don’t know if she has recovered her breathing? Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: The email has been received. She may still be in coma for a while. Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: According to the condition of the patient, the diagnosis of viral encephalitis should not be a problem, and the treatment is also very active. Now look at the patient, I think the possibility of awakening is very high, but I am afraid that there will be sequelae. Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: The recovery of independent breathing is a big step forward. Anti-decubitus ulcer. Prevent sputum from blocking the airway causing asphyxia.