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Thread: New sci C5-C6, pls help with questions

  1. #1

    New sci C5-C6, pls help with questions

    My brother had a diving accident in shallow water in Kuwait on the 7th May (C5-C6), he was in ICU in Kuwait for 2.5 weeks, operation was done 5 days after the trauma. We have transported him to Kazakhstan (he is from Kazakhstan) last week and he is still in ICU, on ventilator. They are still trying to stabilise him, he is on adrenalin - having low BP. He re-acquired pneumonia again, his right lung was collapsing in kuwait. Doctors here says he is in extremely critical condition. He seems to feel his legs at the moment and couple of days ago i noticed movement of his left leg, he says he can do it himself sometimes, other times he feels it as a reflex. His arms a moving a little, but no hands movement, although he feels touch in his palms. I had so many questions and learnt a lot from this site. Thank you all for being here and helping each other.

    I have a question about bed pressure/ulcers matresses, one of his doctors recommended we get one. Can you please advise what is the best one to get. Im based in the UK, so can order one either in the UK or States. He doesnt have any bed ulcers yet as far as i know. Also pls let me know what are the best bed ulcers cream and whether we can use them before having bed ulcers. Also, what are the good hand and feet splits we should get (there are so many of them - im lost). Thanks so much.

  2. #2
    Welcome to our site. We are sorry that you had to find us, but glad that you did.

    Creams and topical applications to the skin will do nothing to prevent the development of pressure ulcers (the correct term for "bed sores"). They are caused by pressure deep under the skin, not from the surface of the skin. A pressure reducing mattress will help, but most critically, both for his lungs and his skin, is that he be religiously turned at least every 2 hours, and that his skin be inspected with each turn. Are there family members with him who can assure that this happens? Nutrition is also critical, especially enough protein. Is he on tube feedings?

    I am surprised that the hospital would require you to purchase a pressure reducing mattress rather than provide one. Does his health insurance not cover this? They are very expensive. I can recommend a low air loss mattress (LAL) as the best if his skin is still intact. They should be used with no sheets or linens underneath him, ideally, especially not any waterproof bed pads, as air flow across the skin is an important way that they function.

    In the USA you can often find these mattresses used on eBay. They are expensive, ranging from $5000-8000 (USA) new, and of course require a compatible power source (they must be hooked up to electricity at all times). The Invacare MicroAir 3500 is a dependable product, as is the Joerns/Triline TxCair Plus.

    Please come back and ask more questions. We can help.

    (KLD)

  3. #3
    Hi Adema, I am sorry this has happened to your brother. Please keep us posted on how he is.

  4. #4
    Thanks so much for replies. Spoke to his insurance company in Ireland, they said will cover mattress costs if prescribed by the doctor, will speak to doctor tomorrow to get a presciption for this. Kazakhstan is a developing country, not much available there, i even couldnt buy feet splints there! Looked at Invacare MicroAir 3500 is and the Joerns/Triline TxCair Plus - both are not power compatible for Kazakhtan (read Europe sockets). Can you please suggest Europe made mattresses similar to the ones you mentioned so they are power compatible?

    On nutrition - can you please reccommend what to get him - what type of protein and other nutritional support? He is on feeding tube. In Kuwait he was on nutrition but in Kazakhstan they make us cook for him (beef/chicken soups with rice), and then grind it in blender/mixer so this can go through the tube. I was shocked. Not sure whether this is a good approach. Please advise what i can get for him to get him on a right nutrition. Many thanks!

  5. #5
    Spoke to KCI just now, they are offering LAL Thera Care Visio mattress for GBP 5,800, they are saying this is the best in the UK, and also not many US products available in the UK and EU. Have you heard about this LAL Thera Care Visio mattress? Does it worth what it costs? Also, i noticed alternating pressure are cheaper than LAL, what are the advantages of LAL? do they make a big difference to alternating pressure ones? Thanks

  6. #6
    Sorry, typo, it is spelt TheraKair Visio

  7. #7
    The KCI product looks like it would be comparable. I am unable to tell with the very limited information on the KCI webpage though.

    Ideally, his tube feeding should be with a high protein formula that is designed for someone who is totally dependent upon tube feeding and that has the appropriate protein, fat, and vitamin/mineral content. Additional fiber is often also needed. Common solutions used in the USA are Jevity, Ultracal, Osmolite, and Ensure. Most of these come in special higher protein formulations, or those for people with diabetes or renal failure. At this point in his injury, he should be getting roughly 2500-3000 calories daily; more if he is running a fever. We always consult with a registered dietitian about selection of the tube feeding formula, the rate, and also lab tests that should be done regularly to determine if his protein levels are sufficient.

    Here are some guidelines in selecting a formula:
    Standard enteral feeding products provide about 15% protein, 55% carbohydrate, and 30% fat calories. The protein content can range from 6% to 25% of the total calories. The lower protein formulas are intended for renal insufficiency and the higher protein formulas for burns and trauma. Formulas with more than 300 mOsm/L osmolality may cause diarrhea.
    Source

    Continuous feeding with a slow continuous drip is best initially (rather than bolus feeding), and care must be taken to avoid giving it too fast. We usually start at 50 cc./hour and work up from there. Feeding too fast can cause vomiting and aspiration...very dangerous. It is common for people with his level of injury to have extremely slow stomach (gastric) emptying. Residual amounts in the stomach should be checked every 4 hours, and should be fewer cc. than the hourly rate. A small bore feeding tube (such as a Dobhoff) is preferred over a Salem sump type tube, and if long term feeding is required (more than 3-4 weeks), a gastrostomy or jejunostomy is preferred. This can usually be done percutaneously (PEG tube). Long term use of a nasal gastric tube puts him at risk of dangerous sinus infections, is uncomfortable, and looks awful.

    (KLD)

  8. #8
    Thanks for reply and advice. As an update, my brother is still in ICU, he has got a non-sugar diabeties (not sure if it is a right terminology), meaning he produces more that 7 litres of urine per day. Not sure why this is the case, doctors dont explain. Any ideas why? They have done a scan of the head - no abnormality there. He also unfortunately acquired another infection - Pseudomonas aeruginosa (blue pus bacillus), so on increased doses of antibiotics. It doesnt get easier unfortunately.

  9. #9
    I assume the pseudomonas infection is in his lungs, correct? Is he being maintained on proper VAP (ventilator associated pneumonia) precautions? This includes taking nothing by mouth, keeping the head of the bed elevated to 30 degrees at all times, and oral care with an antiseptic such as chlorahexidine and brushing every 4 hours.

    When you refer to "non-sugar diabetes" I assume you are talking about diabetes insipidus. This is a problem that is not due to SCI, but can occur often in brain injury. It can also be associated with hypercalcemia (high blood calcium levels) which can occur following SCI, esp. in adolescent or young adult males. It is usually a temporary condition, but can be very dangerous if not properly managed.

    DI is a disorder of the hypothalamus area of the brain (right next to the pituitary gland) where it is not excreting enough anti-diuretic hormone. This is also the area of the brain that controls thirst. While increasing his fluid intake to keep up with the urine output would appear to be the correct way to go, that is NOT how it should be treated.

    The best treatment is the use of DDAVP (vasopressin) which is a drug that is usually given with a special nasal inhaler. It is also available in a pill form now days. Other drugs sometimes used include chlorpropamide, carbamazepine, and clofibrate. Dosage and fluid intake should be adjusted based on the sodium and osmolaity level of the blood which may need to be checked several times daily.

    Here is some more information on DI:

    http://www.nlm.nih.gov/medlineplus/e...cle/000377.htm

    (KLD)

  10. #10
    Thanks so much for useful information. Docs gave him medication to help with diabetes insipidus, he seems better now, less urine, they say about 2 litres today. He started having bowel issues though, they had to use tube through his nose i think to clean up his stomach as food is not being digested (he is not on tube feeding anymore, they started giving him harder type of meal to chew etc), and doctors say that the reason he is having bowel issues is that his stomach is paralysed and thus he cant digest. I asked whether this is a temporary problem but no clear answers. Do you know if this will stabilise and improve over time? He didnt eat for the last 2 days, he feels sick and very weak. Doctors say that we should not bring anything to eat till tomorrow lunch time. Mum say he lost lots of weight.

    As for his pneumonia, his temp seems ok - 36.7 - 37.2 C, not sure how they are treating him but will tell my mum to brush his teath and ensure he is elevated in bed by 30 degress.

    He is off the ventilator for the last couple of day or so i think. Doctors say may be best to transfer him out of ICU to normal ward but they havent decided yet. He started swallowing and coughing, but coughing is very weak at the mom. He says he can feel his legs and arms, he know positioning of his legs. I truly hope this is positive sign but also afraid to hope for too much.

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