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Are you a F1 fan ? Just curious..
Michael Schumacher in a critical condition
- Thread starter James
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Are you a F1 fan ? Just curious..
Orion
Banned
If you came into this thread then you are a f1 fan or just curious.
Wyvern
Khaleesi
I will say this only once, this thread is to keep the few f1 fans updated and that is it, please if you want to discuss other things or posting to get points do it else where.
As for the critical but stable condition - http://en.wikipedia.org/wiki/Medical_state Have a read here.
As for the critical but stable condition - http://en.wikipedia.org/wiki/Medical_state Have a read here.
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New member
Thanks for keeping this thread concise and informative, it's apt for the subject at hand.
Wyvern
Khaleesi
Just a note - Gary Hartstein who is the blogger whom I am reposting from is not just some random hack or once of doc who worked at an F1 race. He worked with Prof Sid Watkins and was an integral part of the F1 scene for many years, when he was fired unexpectedly end of 2012.
http://en.wikipedia.org/wiki/Gary_Hartstein
Wyvern
Khaleesi
That news is once again taken from the Daily Mail - that is why I posted the blog from Gary. There has been no such statement from his family or his doctors. So they are speculating to sell papers.
Wyvern
Khaleesi
Quick update, sorry I didnt have time over the weekend to post this.
Stopping the sedation!
January 31, 2014garyhartstein Aside
Let’s be unambiguous about this – the announcement that Michael’s care team is discontinuing his sedation is the news we’ve been waiting for. It’s the first big transition – from acute, life-threatening head injury to subacute recovery. Followed no doubt, let’s not forget, by a chronic rehabilitation phase. But this is wonderful news.
In terms of how this is done, well it’s actually pretty simple. The electronic pumps driving the continuous infusions of the sedative drugs are turned off. That’s it. But doing that means that the people taking care of Michael have a reasonable expectation that he will not exhibit untoward reactions to the “stress†of these medicines being turned off. The most undesirable of these would be elevations in . . . you guessed it . . . intracranial pressure, but to be honest, we’re now more than four weeks post-injury, and I’d rather think that we’re past that.
So what will happen now that this stuff is turned off?
1) It may or may not be true that, in general, French neurointensivists maintain sedation longer than their Anglo-Saxon colleagues. It doesn’t matter. The people taking care of Michael know what they’re doing.
2) while it’s possible that a long-acting drug may well have been used in the early, “suppressive†phase of Michael’s care, it’s quite likely that if so, it’s been replaced with one or more short-acting substances. These usually allow signs of emergence to appear within several hours of stopping the infusions.
3) What actually happens? Well in general, the first attempt to stop sedation usually gets interrupted by something. The patient gets agitated, the blood pressure goes up, the oxygen saturation goes down . . . something. So you turn the sedation back on, let the situation settle down, and then either try again or wait until tomorrow. It often takes a few tries before everything goes the way it should.
How should it go? Well ideally Michael will start to want to breathe, and allow weaning from ventilatory support. And just as important of course he will hopefully start to show meaningful interaction with his environment. Following simple commands, visual tracking, etc.
Now I’ve heard (from unconfirmed sources), unconfirmed reports (double “unconfirmed†should ring alarm bells of course) that Michael has indeed already done this.
I’d love any neurosurgeons to jump in and comment, but if this indeed is true, it is fairly astonishingly good (but indeed totally conceivable) news. So we need to cross our fingers and hope something like this DOES get confirmed in the future.
Tell you what – let’s not talk about any other alternatives right now, ok, so we keep it positive.
One last thing.
I’ve seen some very heartfelt comments here and there about articles, tv pieces, and blog speculation “hurting†Michael’s family. I wanted to just weigh in for a second.
I’ve been pretty harsh with the tabloid press, and deservedly so. But not because the Daily Mail’s moronity hurts Corinna, Gina Maria and Mick. ARE YOU KIDDING? Could they possibly hurt more? And if so, is it likely to be because of the suffering induced by a British rag? Of course not. I think it’s detestable coz it’s shit “journalismâ€. I kinda don’t think it’s on Corinna’s reading list, I don’t think their “journalism†could possibly add to their pain, and lastly, Michael’s care team have no doubt been TOTALLY up front with the family. Meaning they have a better idea than any of us of just what the . . . hell . . . is up.
If I thought for a second that anything I’ve written might hurt Michael or his family, I’d not have written it. To be honest, I’ve spoken to you as I’d speak to Michael’s family. I assume you know that, because I think it’s to THAT that you’ve reacted (to my infinite astonishment), more than to the information that I’ve transmitted.
Source
Stopping the sedation!
January 31, 2014garyhartstein Aside
Let’s be unambiguous about this – the announcement that Michael’s care team is discontinuing his sedation is the news we’ve been waiting for. It’s the first big transition – from acute, life-threatening head injury to subacute recovery. Followed no doubt, let’s not forget, by a chronic rehabilitation phase. But this is wonderful news.
In terms of how this is done, well it’s actually pretty simple. The electronic pumps driving the continuous infusions of the sedative drugs are turned off. That’s it. But doing that means that the people taking care of Michael have a reasonable expectation that he will not exhibit untoward reactions to the “stress†of these medicines being turned off. The most undesirable of these would be elevations in . . . you guessed it . . . intracranial pressure, but to be honest, we’re now more than four weeks post-injury, and I’d rather think that we’re past that.
So what will happen now that this stuff is turned off?
1) It may or may not be true that, in general, French neurointensivists maintain sedation longer than their Anglo-Saxon colleagues. It doesn’t matter. The people taking care of Michael know what they’re doing.
2) while it’s possible that a long-acting drug may well have been used in the early, “suppressive†phase of Michael’s care, it’s quite likely that if so, it’s been replaced with one or more short-acting substances. These usually allow signs of emergence to appear within several hours of stopping the infusions.
3) What actually happens? Well in general, the first attempt to stop sedation usually gets interrupted by something. The patient gets agitated, the blood pressure goes up, the oxygen saturation goes down . . . something. So you turn the sedation back on, let the situation settle down, and then either try again or wait until tomorrow. It often takes a few tries before everything goes the way it should.
How should it go? Well ideally Michael will start to want to breathe, and allow weaning from ventilatory support. And just as important of course he will hopefully start to show meaningful interaction with his environment. Following simple commands, visual tracking, etc.
Now I’ve heard (from unconfirmed sources), unconfirmed reports (double “unconfirmed†should ring alarm bells of course) that Michael has indeed already done this.
I’d love any neurosurgeons to jump in and comment, but if this indeed is true, it is fairly astonishingly good (but indeed totally conceivable) news. So we need to cross our fingers and hope something like this DOES get confirmed in the future.
Tell you what – let’s not talk about any other alternatives right now, ok, so we keep it positive.
One last thing.
I’ve seen some very heartfelt comments here and there about articles, tv pieces, and blog speculation “hurting†Michael’s family. I wanted to just weigh in for a second.
I’ve been pretty harsh with the tabloid press, and deservedly so. But not because the Daily Mail’s moronity hurts Corinna, Gina Maria and Mick. ARE YOU KIDDING? Could they possibly hurt more? And if so, is it likely to be because of the suffering induced by a British rag? Of course not. I think it’s detestable coz it’s shit “journalismâ€. I kinda don’t think it’s on Corinna’s reading list, I don’t think their “journalism†could possibly add to their pain, and lastly, Michael’s care team have no doubt been TOTALLY up front with the family. Meaning they have a better idea than any of us of just what the . . . hell . . . is up.
If I thought for a second that anything I’ve written might hurt Michael or his family, I’d not have written it. To be honest, I’ve spoken to you as I’d speak to Michael’s family. I assume you know that, because I think it’s to THAT that you’ve reacted (to my infinite astonishment), more than to the information that I’ve transmitted.
Source
Wyvern
Khaleesi
It seems that we have reason to start worrying, even though there has been no press release, Gary makes a good case for being worried about Schumi's situation:
It's just about two weeks since the team caring for Michael Schumacher stopped administering sedatives in order to allow him to emerge from the pharmacologic part of his depressed consciousness. Where are we now?
As usual, a few caveats. I am not receiving medical information from Grenoble. I am basing most of what I say on experience-related conjecture, as well as cautious interpretation of whatever is leaking from the hospital. This obviously means that it all needs to be taken with a rather large grain of salt!
I'm assuming, taking as axiomatic, that if there was significant good news we would be told. Despite the totally understandable need of Michael's family for privacy and "space", Michael is a public figure, admired and revered throughout the world. It's the public who largely made Michael the hero he is to so many. If my assumption is wrong, if there has been a decision to effectively embargo all news, then I think this is somewhat unjust, unfair, and maybe even a strategic error in terms of communications. What's more, it automatically means the only "information" we get is from leaks.
I've heard that the hospital staff is warned every day about protecting confidentiality. This is normal - but so is a passing comment made by a staff member to a friend or family member (prefaced of course by "you mustn't tell anyone" and relayed in turn to another, trusted person, but still preceded by "you mustn't tell anyone") that then gets relayed to a journalist, hungry for anything to write. This is usually a tabloid, as only they would publish such unconfirmed stuff. So in the current state of affairs, I'm somewhat inclined to accord Bild's latest output "there's rarely smoke without fire" status. For what it's worth.
First, as to the "gradual" reduction in the sedation.
In terms of the pharmacology of ICU sedation, we tend to use drugs that are eliminated quickly. This is to allow rapid adjustments in the level of sedation. Several drugs fit the bill; the actual choice depends on local practice, patient characteristics, and the objective of the sedation.
I've seen one article that implies that Michael was sedated using anaesthetic gases. It correctly points out that after prolonged administration these agents take considerable time to be eliminated. It is almost certain that these were NOT used. While some ICUs (as opposed of course to operating rooms) use anaesthetic gases, it is rare, requires special equipment, and has numerous drawbacks. And IF anaesthetic gases were turned off two weeks ago, well there's none left ANYWHERE in Michael's body, for over a week now. So much for "coaxing the last molecules" from his body, as I saw written somewhere!
As I've mentioned, it's quite possible (in fact highly likely) that a long-acting agent (a barbiturate) was used as a sedative during the period with what appears to have been dangerously high and resistant intracranial pressure. These agents would almost certainly NOT have been administered for more than 5-10 days at the beginning of Michael's care. They would simply have been stopped, not weaned, and another agent (or agents) with much shorter actions would be started. In a young fit patient with normal liver and kidney function (certainly the case with Michael), the barbiturates would have been cleared within three to five days - but remember, shorter acting agents were started when the barbiturate phase stopped. These agents have such a fast on/off that they have to be administered continuously (by carefully calibrated pumps). This phase of sedation would be based around either propofol or a cousin of valium (a benzodiazpine), usually with a low-dose infusion of a morphine relative.
When the time has come to stop the sedation, it is usually just . . . stopped. I mentioned this in my previous blog post. Any problems along the way are usually cause to re-start the sedation, and make another attempt at stopping later. It is very rare that the first attempt succeeds. That said, it is two weeks since we were told that the sedation was being stopped. I think it's a very fair assumption at this point that sedation has been stopped sufficiently long for there to be no residual pharmacologic effects.
Still with me? I never fail to amaze myself with just how wordy i am . . .
If my assumption is correct as to sedation, the next question I'd ask would be about ventilatory support. I hope Michael is breathing unassisted at this point, through the tracheostomy that has no doubt been placed two or so weeks ago. This qualifies as some of the good news I spoke about above. If Michael is indeed autonomous from a respiratory point of view, it's a milestone. And one about which I think you deserve to be told. Again, I assume that this has been accomplished. If on the other hand Michael cannot be weaned from the respirator, especially if this is because of lack of ventilatory drive, this is more than ominous. At this phase post injury and post sedation, this kind of strong evidence of severe brainstem dysfunction (especially if corroborated by other testing) would likely prompt discussion with the family about withdrawing support. I do not think that this is the situation. At least I truly hope not.
If ventilatory weaning has been successful, the next question one asks is what is Michael's level of reactivity with the environment. It's here that we need to think about the Bild report.
The motor response of a head injured patient is one of the most important prognostic indicators. People involved in caring for head injured patients use a standardised scoring system (called the Glasgow Coma Score, or GCS) in order to do this. The motor component of the GCS has six steps. These range from obeying simple commands (stick out your tongue, put your thumb up, etc) down to no reaction at all. In between, on the way "down" from obeying, one sees progressively less organisation in the response. Makes sense.
So IF what Bild says is true (and I looked on their site summarily, but didn't see where this was said), we need to figure out what they meant by "no reaction to external stimulus". If there is no response at all to painful stimulation, not even archaic stereotypical responses organised deep within ancient parts of the brain, then this is very bad news indeed. This would likely imply extensive damage to the brainstem, and at this stage post injury would, I think, be associated with a patient who was also dependent on the ventilator, as mentioned above. I would simply note, as one of those things I wish I had never heard, that when the neurosurgeon spoke about hematomas "left, right and centre", this is what I feared. The brainstem is one of those things in the centre…
If the motor response to external stimulation is one of the primitive stereotypical responses, this is bad news but leaves hope of some level of recovery. Numbers? Well, this level of response would indicate the persistence of a vegetative state, but roughly 50% of these patients emerge, usually with some level of residual dysfunction.
To be honest, based on Bild I don't think any other reactions (all of which are MORE organised than what I mentioned) would lead someone familiar with the care of these patients to say he's not reacting.
Upshot: not good. Starting to be really not good.
Lastly, I spent three days last week teaching on a trauma course with a bunch of motorsport medicine mates. One of them is a professional neurointensivist. He works in one of England's regional neurointensive care centres. They get 600 PATIENTS LIKE MICHAEL A YEAR. One regional centre. That means that we're all just 2 or so degrees of separation from someone affected by this. So I really hope that more than just provide "information" about Michael's condition, I hope my "head injury" blog entries sensitise us to this devastating society-wide plague.
Source
It's just about two weeks since the team caring for Michael Schumacher stopped administering sedatives in order to allow him to emerge from the pharmacologic part of his depressed consciousness. Where are we now?
As usual, a few caveats. I am not receiving medical information from Grenoble. I am basing most of what I say on experience-related conjecture, as well as cautious interpretation of whatever is leaking from the hospital. This obviously means that it all needs to be taken with a rather large grain of salt!
I'm assuming, taking as axiomatic, that if there was significant good news we would be told. Despite the totally understandable need of Michael's family for privacy and "space", Michael is a public figure, admired and revered throughout the world. It's the public who largely made Michael the hero he is to so many. If my assumption is wrong, if there has been a decision to effectively embargo all news, then I think this is somewhat unjust, unfair, and maybe even a strategic error in terms of communications. What's more, it automatically means the only "information" we get is from leaks.
I've heard that the hospital staff is warned every day about protecting confidentiality. This is normal - but so is a passing comment made by a staff member to a friend or family member (prefaced of course by "you mustn't tell anyone" and relayed in turn to another, trusted person, but still preceded by "you mustn't tell anyone") that then gets relayed to a journalist, hungry for anything to write. This is usually a tabloid, as only they would publish such unconfirmed stuff. So in the current state of affairs, I'm somewhat inclined to accord Bild's latest output "there's rarely smoke without fire" status. For what it's worth.
First, as to the "gradual" reduction in the sedation.
In terms of the pharmacology of ICU sedation, we tend to use drugs that are eliminated quickly. This is to allow rapid adjustments in the level of sedation. Several drugs fit the bill; the actual choice depends on local practice, patient characteristics, and the objective of the sedation.
I've seen one article that implies that Michael was sedated using anaesthetic gases. It correctly points out that after prolonged administration these agents take considerable time to be eliminated. It is almost certain that these were NOT used. While some ICUs (as opposed of course to operating rooms) use anaesthetic gases, it is rare, requires special equipment, and has numerous drawbacks. And IF anaesthetic gases were turned off two weeks ago, well there's none left ANYWHERE in Michael's body, for over a week now. So much for "coaxing the last molecules" from his body, as I saw written somewhere!
As I've mentioned, it's quite possible (in fact highly likely) that a long-acting agent (a barbiturate) was used as a sedative during the period with what appears to have been dangerously high and resistant intracranial pressure. These agents would almost certainly NOT have been administered for more than 5-10 days at the beginning of Michael's care. They would simply have been stopped, not weaned, and another agent (or agents) with much shorter actions would be started. In a young fit patient with normal liver and kidney function (certainly the case with Michael), the barbiturates would have been cleared within three to five days - but remember, shorter acting agents were started when the barbiturate phase stopped. These agents have such a fast on/off that they have to be administered continuously (by carefully calibrated pumps). This phase of sedation would be based around either propofol or a cousin of valium (a benzodiazpine), usually with a low-dose infusion of a morphine relative.
When the time has come to stop the sedation, it is usually just . . . stopped. I mentioned this in my previous blog post. Any problems along the way are usually cause to re-start the sedation, and make another attempt at stopping later. It is very rare that the first attempt succeeds. That said, it is two weeks since we were told that the sedation was being stopped. I think it's a very fair assumption at this point that sedation has been stopped sufficiently long for there to be no residual pharmacologic effects.
Still with me? I never fail to amaze myself with just how wordy i am . . .
If my assumption is correct as to sedation, the next question I'd ask would be about ventilatory support. I hope Michael is breathing unassisted at this point, through the tracheostomy that has no doubt been placed two or so weeks ago. This qualifies as some of the good news I spoke about above. If Michael is indeed autonomous from a respiratory point of view, it's a milestone. And one about which I think you deserve to be told. Again, I assume that this has been accomplished. If on the other hand Michael cannot be weaned from the respirator, especially if this is because of lack of ventilatory drive, this is more than ominous. At this phase post injury and post sedation, this kind of strong evidence of severe brainstem dysfunction (especially if corroborated by other testing) would likely prompt discussion with the family about withdrawing support. I do not think that this is the situation. At least I truly hope not.
If ventilatory weaning has been successful, the next question one asks is what is Michael's level of reactivity with the environment. It's here that we need to think about the Bild report.
The motor response of a head injured patient is one of the most important prognostic indicators. People involved in caring for head injured patients use a standardised scoring system (called the Glasgow Coma Score, or GCS) in order to do this. The motor component of the GCS has six steps. These range from obeying simple commands (stick out your tongue, put your thumb up, etc) down to no reaction at all. In between, on the way "down" from obeying, one sees progressively less organisation in the response. Makes sense.
So IF what Bild says is true (and I looked on their site summarily, but didn't see where this was said), we need to figure out what they meant by "no reaction to external stimulus". If there is no response at all to painful stimulation, not even archaic stereotypical responses organised deep within ancient parts of the brain, then this is very bad news indeed. This would likely imply extensive damage to the brainstem, and at this stage post injury would, I think, be associated with a patient who was also dependent on the ventilator, as mentioned above. I would simply note, as one of those things I wish I had never heard, that when the neurosurgeon spoke about hematomas "left, right and centre", this is what I feared. The brainstem is one of those things in the centre…
If the motor response to external stimulation is one of the primitive stereotypical responses, this is bad news but leaves hope of some level of recovery. Numbers? Well, this level of response would indicate the persistence of a vegetative state, but roughly 50% of these patients emerge, usually with some level of residual dysfunction.
To be honest, based on Bild I don't think any other reactions (all of which are MORE organised than what I mentioned) would lead someone familiar with the care of these patients to say he's not reacting.
Upshot: not good. Starting to be really not good.
Lastly, I spent three days last week teaching on a trauma course with a bunch of motorsport medicine mates. One of them is a professional neurointensivist. He works in one of England's regional neurointensive care centres. They get 600 PATIENTS LIKE MICHAEL A YEAR. One regional centre. That means that we're all just 2 or so degrees of separation from someone affected by this. So I really hope that more than just provide "information" about Michael's condition, I hope my "head injury" blog entries sensitise us to this devastating society-wide plague.
Source
Wyvern
Khaleesi
Yep, it's why I like this guy, he doesnt pull punches and speaks from experience.
He also doesnt fall for the crap that most of the papers are publishing. It is why read his blog and only his for updates.
Wyvern
Khaleesi
Schumacher’s situation remains unchanged 07 Mar 2014
Michael Schumacher’s management has released the first update in just over three weeks on the seven-time world champion. His condition remains unchanged as doctors continue the process of bringing him out of his medically-induced coma following his skiing accident in December.
“Michael is still in the wake up phase,†read Friday’s statement. “The situation has not changed. Any medical information published which is not confirmed by the team of doctors treating Michael or his management has to be considered as not valid.â€
Schumacher, 45, was placed in an induced coma in Grenoble's University Hospital in France after falling and hitting his head on a rock during a family ski trip. The German’s medical team began reducing his sedation at the end of January.
Source
It is not looking good at all for him unfortunately
Michael Schumacher’s management has released the first update in just over three weeks on the seven-time world champion. His condition remains unchanged as doctors continue the process of bringing him out of his medically-induced coma following his skiing accident in December.
“Michael is still in the wake up phase,†read Friday’s statement. “The situation has not changed. Any medical information published which is not confirmed by the team of doctors treating Michael or his management has to be considered as not valid.â€
Schumacher, 45, was placed in an induced coma in Grenoble's University Hospital in France after falling and hitting his head on a rock during a family ski trip. The German’s medical team began reducing his sedation at the end of January.
Source
It is not looking good at all for him unfortunately