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I am from Saint-Petersburg, Russia. My brother Levon (34) worked day and night as a taxi driver to support his family of three (wife and little son). Sept 21st he was doing his routine night-shift trip with a female passenger when his car was severely hit from behind while waiting for the green light at a crossroad. The two cars pushed forward to the crossroad for about 100 feet (30 meters). The taxi passenger and the driver of the other car got off with medium severity injuries, while Levon was delivered to a hospital in critical condition with severe brain trauma. He was trapanized and put into intensive care ward. At the first week of his stay there the most optimistic survival prognosis was 15%. But later (in mid October) the situation started to slightly improve and now, after more than 3 weeks of coma he got back to "partial consience" state. The reanimation crew said that their work had been well-done, and now we needed to start seeking a professional reabillitation center for him as soon as possible, because the first 2-3 after-coma months are the most critical and vital for such patients. We cannot lose a day to bring Levon back to more-or-less normal condition. But all reabilitation centers are very very costly for us. The minimum day-cost is over 300$. He critically needs a 60-90 days course. Our family-friends circle could have urgently collected about 10 000$ by now, but amount is not enough. That is why i beg all people of good will to please help us. Below is official medical anamnesis dated Oct 11:
Research Institute of Emergency Medicine.
11.10.2013
Patient: Nerkararyan Levon
Age: 34
Date of arrival: Sept. 21st 2013
Diagnosis: road-accident trauma. Complex injury of head, chest and limbs. Closed cerebral trauma. Heavy brain injury resulting in subdural haematoma in the right frontal-sincipital-temporal part. Subarachnoid haemorrhage. Contusion center of the pons cerebelli area. Closed chest trauma. Fractured ribs 3,5,9 on the left. Lungs injuries. Postcontusional left-sided pneumonia in resolving stage. Closed fracture of surgical neck of the left shoulder. Condition after September 21st decompressive trepanation and removal of the subdural haematoma in the right frontal-sincipital-temporal part.
Anamnesis: The patient was taken to the hospital September 21st at 9-11 AM after road accident. General condition on arrival was critical. Skin and visible rheum were pale. Vesicular murmur. Equable pulse - 110 p/m. Soft unbloated stomach. Consciousness was at contusion 1 level, pupils D=S, eye-reaction to light retained, face-symmetry retained. No visible cuts or palsies. No pathological symptoms. Meningeal signs were in the form of rigidity of the occipital muscles.
Sept. 21st computerized tomography of the brain, cervical spine, dorsal spinal cord, chest organs, lumbodorsal part: signs of two-sided cover haematoma in frontoparietal temporal area up to 92 ml (mostly on the right), horizontal dislocation for 6,2 mm. Fractured ribs, two-sided low-lobe pneumonia. No data regarding pathology of cervical spine or lumbodorsal area.
September 21st due to critical condition an emergency decompressive trepanation in the right in frontoparietal temporal part was performed to remove the subdural haematoma. After the operation the patient was placed at the surgical reanimation ward up to Sept 27th. Since Sept. 27th up to the present he has been at the septic reanimation ward.
During his stay at the hospital the following procedures have been performed:
- Pelvis X-ray of Sept. 21st – no bone-traumatic changes
- Left shoulder-joint X-ray of Sept. 21st – fracture of the surgical neck of the left humerus (shoulder bone)
- Sept. 26th computerized tomography of the brain – subdural haematoma of the right frontal-sincipital part (12 ml). Cover (?) subdural haematomas of the infrontoparietal temporal part on the left and alongside the brain falx. Contusion center in the pons cerebelli area of 7 mm size. Subarachnoid haemmorrhage. Ischemia in the occipital region. Midline structuresare not shifted.
- Chest X-ray of Oct. 5th – signs of infiltration in the basal section of the left lung. Increased pulmonary vascularity in the juxtahilar zone. The roots are expanded. No gas in pleural space was detected. No dynamics comparing to X-ray performed on Oct. 2nd.
Blood test of Oct 11th: Hb 93g/l; Er 3.0 x 10/12; Leu 18,2 x 10/9; Urea 12.0 mmol/l; Crea 65 mcmol/l; Glu 8.4 mmol/l; K + 4.5 mmol/l; Na+ 150 mmol/l; TP 72g/l; Bil 11.0 mcmol/l
For Oct. 11th
Generally: the patient’s condition is severe, stable. Hemodinamically stable. Arterial pressure – 130/80. Pulse rate – 100 per minute. Autonomous breathing through tracheostomy tube. Auscultatory – performed in all sections. Somatically – no negative trend. The stomach is soft, painless. Peristalsis is soundable.
Neurologically: The patient is in state of stupor II. Can react to simple voice commands. Pupils D=S, photoreaction is retained. The eyeballs are fixated at the center. The face is symmetric. The tongue is behind the tooth-line. Reaction to pain is retained. Tendon reflexes D<S. Limb strength: upper-right – 4 points, upper-left – impossible to rate due to the limb immobilization. Leg strength – up to 3 points. Babinski’s symptom on both sides. Slightly positive meningeal signs.
Post operational wound healed by first intention with no signs of inflammation. The sutures removed. Decubital sores in the area of sacrum and heels. Diuresis 2800 ml per day.
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