Szpital Uniwersytecki w Krakowie
Oddział Kliniczny Neurochirurgii i Neurotraumatologii
ul. Botaniczna 3
Sick patient was admit to hospital because of bleeding from a lot of aneurysms situated in extracranial segment of left arteria carotis internal (back posterior nasal packing was put - choanal tamponade) and of another nasopharynx tumor with invasion of base of skull. During the admission sick patient was sedowany (sedation making), intubated, put back tamponade of Cavitas nasi because of bleeding.
Panangiografia, embolisation of above-mentioned aneurysms with spirales GDC (9/11/7) was done and patient was moved to intensive care unit. As planned sedowany (sedation making) i zwiotczany. (atony making)
Artificially vented in CMV mode. Haemodynamical competent. After removing of tamponady at 13.11.2007 nasopharynx apoplexy (bleeding) appeared, tamponade again, blood transfusion.
The patient was in very bad condition, falling of RR was observed. Aminy presyjne (.... amines) was given in enema i.v.
In 16.11.2007 embolisation was done again – both Arterias Carotis external.
For the next days patient was still in bad condition. In 19.11.2007 stopped sedation and (atony making)- patient regained consciousness and was able to get intouch with others, was doing simple, basic commends.In 20.11.2007 re-entry bleeding from nasopharynx; consultant laryng didn`t find a place of bleeding. Blood transfusion. In 21.11.2007 tracheostom was put and patient was connected to the respirator. The following thay the respirator was disconnected, patient regained condition of basic consciousness. In 26.11.2007 scheduled operated – partly removed nasopharynx tumor from incision paranasales (cięcie przynosowe) and because of bleeding from smaller aneurysms - trapping and wrapping of left arteria carotis internal. After operation the condition of the patient was very bad – artifical vented, sedowany (sedation making) , the patient had high temperature. In 30.11.2007 awaked - recovered, vented with SIMV mode, with basic contact with others.
In 2.12.2007 the patient breathing function has deteriorated – again sedation and artificially vented in CMV mode. In 4.12.2007 because of being patency in monitoring angiography, ligated arteria carotis internal left. The patient condition was very bad, (sedation making) artificially vented - at the beginning in CMV mode, and from 8.12 – SIMV. In 11.12.2007 junctional (nawrotowy) bleeding from nasopharynx – provided with laryng .
In 14.12.2007 another embolisation of vessels (naczynia) of tumor with klej histoakrylowy (histoacryl glue or adhesive) was done. Patient was still in bad condition, was (atony making) zwiotczany and vented in CMV mode.
In 22.12.2007 reoperated – nasopharynx tumor was resectioned . For the next days the patient was in bad condition , vented in CMV mode and from 27.12.2007 – SIMV.Little by little health improved, the patient the basic regained basic condition of consciousness, was able doing simple, basic commends. In 12.01.2008 the trial of disconnected from respirator was failed. Gradually healfh imroved – basic condition of consciousness, was able doing simple, basic commends. Actually the general condition of the patient quite good. Conscious, with logical contact. Self Breathing by tracheotomy tube. Passive Oxygen therapy.Cardiovascular stable on enema of Dopamina. Doesn’t have temperature.Feeded intestinal and parenterally. Discharge from the intensive care unit of child’s hospital in Prokocim.
[ Dodano: 2010-06-26, 21:06 ]
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