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Re: After catastrophic event in labor and delivery. Advice needed. From: douglas krell (douglas.krell@nsionline.com) Fri Mar 21 20:01:59 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Netscape User: "CONFERENCE ON PRENATAL CARE AT HARVARD" Previous message: Gary Kleinman: "After catastrophic event in labor and delivery. Advice needed." Maybe in reply to: Gary Kleinman: "After catastrophic event in labor and delivery. Advice needed." Next in thread: Malcolm Griffiths: "Re: After catastrophic event in labor and delivery. Advice needed." Gary Kleinman wrote: . Please! Could anyone help me with any suggestions to help improve > long term neurologic outcome? Any way to tell if patient is responding to > voice or other subtle stimuli? Gary, So sorry to hear about this tragic case. I have absolutely no clues to give you except that I remember that Plum and Posner's book...Diagnosis of Stupor and Coma is a valuable resource. I am assuming that regardless of the underlying cause of her condition, her mental status is likely the result of some degree of hypoxia sustained during the convulsions and the resuscitation. Under the heading of cerebral hypoxia, Plum and Posner says: "The prognosis for for recvovery cannot be accurately judged immediately following removal from hypoxia. Some patients recover completely even though they fail to awaken fully for days after the exposure while others arouse promptly only to relapse and die a fortnight later. Generally speaking subjects who exhibit intact brainstem function when removed from hypoxia as manifested by normal pupillary light and ciliospinal reflexes, intact doll's eyes movements, and oculovestibular responses have a good outlook for recovery of consciousness and perhaps their total faculties. The absence of any of these normal functions is serious, and pupils that are persistantly fixed to light stimulation following hypoxia imply a hopeless outlook." Given the lack of any primary intracranial process and assuming that she was mechanically ventilated properly and had good systemic circulation, as evidenced by her apparently normal renal function, she should have every chance to recover. Meanwhile good supportive care and physical therapy are of equal importance. Good luck to both you and your patient. Doug -- @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ Douglas J. Krell MD FACOG Galisteo OB/GYN Associates PC Santa Fe, New Mexico "Consistency is the last refuge of the unimaginative" - Oscar Wilde @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ Next message: Netscape User: "CONFERENCE ON PRENATAL CARE AT HARVARD" Previous message: Gary Kleinman: "After catastrophic event in labor and delivery. Advice needed." Maybe in reply to: Gary Kleinman: "After catastrophic event in labor and delivery. Advice needed." Next in thread: Malcolm Griffiths: "Re: After catastrophic event in labor and delivery. Advice needed."

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