Please let me know if my father is treated in the right way.

Question

Hi doctor,

The patient is a 65 year old, slim and athletic body male. He did not have diabetes or any health issues in the past. He was a little unwell for about last one week. He had a slight fever for about three to four days, following which he only had some cough without any fever for two days. He used some over the counter medicine (OTC) cough syrup during the last two days. About 20 hours ago, he started developing some difficulty in breathing and was taken to a local hospital. An Electroencephalogram (EEG) suggested to the local doctor that he may have had a heart attack and was given some Heparin along with some antibiotic and moved to a bigger hospital. A few quick tests and a bit more revealed to the neurologist that the heart is not the issue. I just got to know that the newbie general physician prescribed some unwanted medications. I was informed by the nurse that the diagnosis was septic encephalopathy and bronchopneumonia. I managed to get a picture of the patient's current chart. All vitals are holding for the last 10 hours since his admission at the current hospital. The patient has been unconscious for the last 15 hours. The neurologist is unavailable for a few more hours. I have attached all the prescriptions and findings of the hospital visits since the first admission. Please let me know if this coma is deepening and whether I should request that the patient to be moved to an even better hospital.

Answer 1

Hi,

Welcome to icliniq.com. It ispossible to have such clinical picture after heavy chest infection in an elderly male (attachment removed to protect patient identity). But, a few things which do not fit into classic case scenarios of septic encephalopathy are he did not have continuous fever before the brain got affected and did not show other (at least clinical) signs of heavy infection. In such case scenarios, we would rely heavily on the investigations. These investigations would include CT brain, chest x-ray, arterial blood gas analysis, electrocardiogram (ECG), echo, troponin I, renal function test, liver function tests and blood, sputum and urine cultures. This bunch of tests gives us information about function of all the body systems and also the possible cause of the problem. Sepsis can affect all the major organs of the body and that is why we need to screen the patients with multiple tests. As you mentioned that vitals are stable, I can say that the patient is not worsening. About shifting, if your current hospital has taken the blood, sputum and urine cultures and sent for analysis or the analysis reports have come already and they have started proper antibiotics as per culture and sensitivity reports, then you do not need to change the hospital. If that is not done and they are still treating the patient experimentally, then you can think of shifting. Sometimes, cultures do not reveal any growth and that is acceptable.