Dear doctor,
37 year old male with history of bullet injury in the neck region, the inlet was in the shoulder region and the outlet was at the left side of the neck (posteriolateral area), no more damage to the skin tissue 7 months ago.
Clinically, he is completely quadriplegic suddenly immediately after the time of trauma with difficult breathing.
He was immediately referred to the hospital and was put on oxygen mask for 16 hour after which they did tracheostomy for him and he was put on ventilator.
The tidal volume was 450, pressure support was 8, peep was 5, he is fully conscious, oriented with complete quadriplegia.
Neurological examination revealed sensations at the level of C2and C3 by the result of neurological examination.
No motor or sensory effort in the both upper and lower limps.
No sphincter control of both urine and fecal control.
The investigations are done to him every three days.
Normal liver and renal functions, serum electrolytes are all normal; serum protein and albumin are within normal.
No bed sores because he is on synthetic special bed.
He is on regular good physiotherapy of the limps and the lungs.
Till now he has no complications.
Now, he is on ciprofloxacin 750 mg twice daily, multivitamins support and heparin 1 cc twice daily.
He is on nasogastric tube feeding in addition to simple oral intake.
His vital signs are 90 per minute for heart rate, blood pressure is 110/60, and temperature is 37.5 centigrade degree.
MRI was done to him recently but was not so clear (artifacts) in fact there is no specialist in reading such radiological views.
1- We need to do rehabilitation for him in your center.
2- the possibility of good rehabilitation and weaning from his ventilator.
Please if you can give me your advice to receive the patient for rehabilitation and your future transplantation in your center and giving me an idea about the roughly price and cost for his management.
I am waiting for your answer as soon as possible with my regards.
Dr. Mohamad salah
-16/3-2007
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