Motorcycle accident and patient comatose

[userabcd]

Yesterday afternoon my wife received a call that a distant relative (14 years old) had a motorcycle accident in Udon T. He was riding a motorcycle with no helmet, no license (yes all not legal) to a local store and was making a turn across the road to the store when a car coming from behind had hit him. Photos show the youngster lying in the road with this guy looking at him unconscious in middle of the road.

 

Bystanders called an ambulance and he was taken to a private hospital in Udon for an Xray (this is what the parents say) The doctor there diagnosed that he had blood on the brain and stated that an operation had to be performed but they apparently said they could not treat him as they did not have enough material and transferred him to a government hospital which they stated had the facilities and material to treat him? 

 

The doctors at the govt hospital, looked at the Xray and said there was no bleeding on the brain. The patient was placed in a ward where there are many other comatose patients and was put on a bed and given oxygen where he is still like that, nothing further done to him. From what my wife tells me he was very slightly responsive to family talking and touching him yesterday but today this is diminished.

 

My question is if there is any medical advice anyone could provide for such type of patient and injury which the doctors should be motivated to perform which could be relayed to the family.

Edited March 17, 2019 by userabcd

[OneMoreFarang]

If you have the money then talk to some medical specialist maybe in a nearby private hospital.

 

I think it's very unlikely that the doctors in a public hospital will listen to some internet advice.

If you want to motivate try money or some connection to some local influential person. Sorry, that's hard but realistic.

 

[Sheryl]

CT scan should be done if it has not already been.

 

Is it possible the "Xray" was actually a CT? That would be more usual. It is not possible to determine if there is a blood clot present from an Xray.

 

What level of government hodpital is this? He needs to be at a regional level one and under the care of a neurosurgeon.

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

 

[userabcd]

29 minutes ago, Sheryl said:

CT scan should be done if it has not already been.

 

Is it possible the "Xray" was actually a CT? That would be more usual. It is not possible to determine if there is a blood clot present from an Xray.

 

What level of government hodpital is this? He needs to be at a regional level one and under the care of a neurosurgeon.

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

 

Dear Sheryl,

 

Thanks for the reply.

 

I said to my wife that it is probably a CT scan that was performed for this condition. They paid 9000 Baht for this Xray so it probably was a CT Scan.

 

The govt hospital is the main one in Udon Thani city which I am told patients from all the area go to so it maybe the regional level one hospital to which you refer.

 

The family will check if the young guy is receiving treatment under supervision of a neurosurgeon but I'm hearing them say it's the weekend and they were told the doctor will only be available on Monday?

[jackdd]

17 minutes ago, userabcd said:

They paid 9000 Baht for this Xray so it probably was a CT Scan.

They didn't pay this themself, this was either paid through the compulsary insurance of the bike or through the 30 THB scheme.

 

30 minutes ago, userabcd said:

The family will check if the young guy is receiving treatment under supervision of a neurosurgeon but I'm hearing them say it's the weekend and they were told the doctor will only be available on Monday? 

According to my GF, who worked at another government hospital in Udon Thani, the hospitals have doctors on standby, and even if the doctor is not on standby they would try to get him in if it is really required. If they would be unable to get such a doctor they would transfer the patient to a hospital which does.

So in your case most likely the doctor who diagnosed the patient didn't see a need to consult with a neurosurgeon immediately

[uhuh]

Neurosurgery at Udon Thani provincial hospital is quite good. 

The X-ray must have been a CT (if it cost 9000). Most private hospitals in Udon would not be in position to treat a child with suspected intracranial bleeding in a CT scan (treatment is not necessarily an operation,  but a neurosurgeon should be consulted). The private ones who could handle this are Bangkok Hospital and Aek Udon (probably better).

Dr Somsith is an experienced neurosurgeon, working in the provincial hospital. If needed he works at Aek Udon. It is certainly easier (and more expensive) to access him through Aek Udon.

There are other neurosurgeons, too. 

 

If the consciousness of the patient deteriorates that is not a good sign. 

It must be reported to the nurses, and a doctor (not necessarily a neurosurgeon) should examine the patient to confirm it.

If confirmed they may want to repeat the CT scan to check if an operation has become necessary. 

 

I doubt much will be done during sunday night but relatives should be there tomorrow early morning.

Edited March 17, 2019 by uhuh

[carlyai]

Many years ago a young family member had a symilar motorbike accident and was placed in a bed, given blood tranfusions and leg plastered.

The short story is, when I got to see him and look at the x-ray, he had both the tibia and fibia broken, not reset and just put in plaster, bleeding away.

I arranged with (Convent hospital Bangkok), to send down an ambulance (at midnight) to pick him up. He was operated on, leg pinned and he lived.

 

So the question is, how much trouble do you want to go to to get this person to competent medical help?

Maybe the hospital is doing all it can.

You have to go and assess the situation for yourself and make your decision.

 

Sorry, I didn't see all the other posts. I only saw your initial post that I responded to.

 

 

 

 

[KidoBkK]

Government Hospital in Udon Thani is a major facility. I would recommend you to discuss with the MD dorecly whether there is any incracerebral hemorrhage or any indication for surgery. Should you still doubt in MD opinion, you may seek consultation and taking CT Brain result to other doctor. Moreover, you should asses the patient consciousness if he is getting better there is signs of improving. If he has drownsiness or panda mark in eyes, that might be other issues to discuss with neurosurgeon. Transfer to Bangkok is taking more risk during transfer and incecessary cost unless the patient covered by travel insurance or health insurance. If you, please contact your insurance.

[Sheryl]

14 hours ago, userabcd said:

Dear Sheryl,

 

Thanks for the reply.

 

I said to my wife that it is probably a CT scan that was performed for this condition. They paid 9000 Baht for this Xray so it probably was a CT Scan.

 

The govt hospital is the main one in Udon Thani city which I am told patients from all the area go to so it maybe the regional level one hospital to which you refer.

 

The family will check if the young guy is receiving treatment under supervision of a neurosurgeon but I'm hearing them say it's the weekend and they were told the doctor will only be available on Monday?

 

At that price yes, it was a CT.

 

Udon Thani Hospital is a regional level facility so appropriate.

 

There are doctors round the clock but the senior consultant likely not till Monday.

 

I frankly have more confidence in Udon Thani Hospital's interpretation of a Ct than that of private hospital. On theo ther hand it is nto credible that he remains this obtunded (unresponsive) with no cranial bleeding. It could be that the bleeding is diffuse with no localized clot that can be removed.

 

They will be giving him intravenous steroids to reduce the swelling in the brain. He may also be on a ventilator which likewise helps reduce brain swelling (the "oxygen" may be an endotracheal tube attached to a mechanical ventilator).

 

I would expect that, unless there is obvious clinical improvement, CT will be repeated today,

 

 

[userabcd]

2 hours ago, Sheryl said:

 

At that price yes, it was a CT.

 

Udon Thani Hospital is a regional level facility so appropriate.

 

There are doctors round the clock but the senior consultant likely not till Monday.

 

I frankly have more confidence in Udon Thani Hospital's interpretation of a Ct than that of private hospital. On theo ther hand it is nto credible that he remains this obtunded (unresponsive) with no cranial bleeding. It could be that the bleeding is diffuse with no localized clot that can be removed.

 

They will be giving him intravenous steroids to reduce the swelling in the brain. He may also be on a ventilator which likewise helps reduce brain swelling (the "oxygen" may be an endotracheal tube attached to a mechanical ventilator).

 

I would expect that, unless there is obvious clinical improvement, CT will be repeated today,

 

 

Dear Sheryl,

Thank you, it seems the treatment you describe is exactly what the young boy has received.

 

This morning the young lad crossed and was moving his legs. A recent update is he tried to sit up in bed and seems to be responding by nodding his head when his mother calls his name.

 

Other members of the family are at the moment also consulting privately with the neurosurgeon, Dr Somsith, so we think he is generally receiving good care.

 

Thank you also to everyone else who have commented positively on this situation.

 

[losworld]

Queen Sirikat in Khon Kaen is a good hospital.

[colinneil]

19 hours ago, OneMoreFarang said:

If you have the money then talk to some medical specialist maybe in a nearby private hospital.

 

I think it's very unlikely that the doctors in a public hospital will listen to some internet advice.

If you want to motivate try money or some connection to some local influential person. Sorry, that's hard but realistic.

 

1

Why are you saying take him to a private hospital?

He is in the regional government hospital, where he will get the best treatment available in the area.

All this about private being better than government is nonsense.

The regional government hospitals here are as good as you will get, very competent doctors/ surgeons, i am living proof of that.

[Sheryl]

From the sounds of it he is receiving appropriate care and responding well to it.

 

Upcountry locations especially, large government hospitals are best. And when it comes to motor vehicle accidents/trauma that would be true in Bangkok as well.

 

 

 

 

 

[NCC1701A]

1 minute ago, Sheryl said:

From the sounds of it he is receiving appropriate care and responding well to it. 

 

thank you Sheryl for all you do on TV.

[uhuh]

4 hours ago, Sheryl said:

 

Upcountry locations especially, large government hospitals are best. And when it comes to motor vehicle accidents/trauma that would be true in Bangkok as well.

 

Yes, few upcountry locations have private hospitals that are as good or better than the government hospitals.  Udon is one of them. The one place where private hospitals are really much better is Pattaya.

 

In Bangkok, victims of vehicle accidents are often brought to the Police hospital. There are many better hospitals than this,  public and private

[HighPriority]

5 hours ago, NCC1701A said:

thank you Sheryl for all you do on TV.

Yep, I’m new to this place, but every medical thread I’ve come across and there’s Sheryl giving straightforward, honest logical advice, she gives me faith in forums.

[Jeffrey346]

16 hours ago, losworld said:

Queen Sirikat in Khon Kaen is a good hospital.

Queen Sirkat is a Cardiac Hospital. I think you are referring to Srinagarind Hospital at KKU.

[hobobo]

18 hours ago, colinneil said:

Why are you saying take him to a private hospital?

He is in the regional government hospital, where he will get the best treatment available in the area.

All this about private being better than government is nonsense.

The regional government hospitals here are as good as you will get, very competent doctors/ surgeons, i am living proof of that.

Exactly, Colin. I am amazed at how many people think that in Thailand bigger bills mean better care.

[Formaleins]

On 3/17/2019 at 7:41 PM, Sheryl said:

CT scan should be done if it has not already been.

 

Is it possible the "Xray" was actually a CT? That would be more usual. It is not possible to determine if there is a blood clot present from an Xray.

 

What level of government hodpital is this? He needs to be at a regional level one and under the care of a neurosurgeon.

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

 

You would be surprised at just how high up the scale of government hospitals you need to go to get a CT Scan! I had a car accident and smashed my head in a bit, my local government hospital did an X ray then stitched it (no anesthetic) and that was it.

In later years I had some problems with my Pancreas and had to go to my regional hospital, they were the first level that were able to do a CAT scan, however, all of the results had to be e mailed to a specialist in Rayong to diagnose as no one was able to do this at that level.

I agree with what you say, CT scan, but I doubt it will have been done and X ray is much more likely (300 Baht Vs 13,000)

[uhuh]

12 minutes ago, Formaleins said:

You would be surprised at just how high up the scale of government hospitals you need to go to get a CT Scan! I had a car accident and smashed my head in a bit, my local government hospital did an X ray then stitched it (no anesthetic) and that was it.

In later years I had some problems with my Pancreas and had to go to my regional hospital, they were the first level that were able to do a CAT scan, however, all of the results had to be e mailed to a specialist in Rayong to diagnose as no one was able to do this at that level.

I agree with what you say, CT scan, but I doubt it will have been done and X ray is much more likely (300 Baht Vs 13,000)

CT is usually not available in the level below provincial hospital.

A provincial hospital has a CT.

CT is not routinely done for every head injury in Thailand. 

 

I don't know what you mean by "my regional hospital". In Thailand, regional hospital means a higher level than provincial hospital.  For your pancreas, you seem to have been in a place below the level of provincial hospital. Rayong has a provincial hospital with CT and radiologist.

 

 

[sawadee1947]

If you have the money you can get a second opinion or/and having an MRI.

[me4175]

On 3/17/2019 at 9:05 PM, jackdd said:

They didn't pay this themself, this was either paid through the compulsary insurance of the bike or through the 30 THB scheme.

Compulsory insurance pays nothing up front, they will only pay within 7 days after receiving the claim.

30 Baht scheme may not apply in case of private hospitals. There is a regulation that emergency patients have to be treated at any hospital, private or state, for the first 72 hours but I'm not sure if a CT would necessarily be covered under emergency treatment.

[Sheryl]

19 minutes ago, me4175 said:

Compulsory insurance pays nothing up front, they will only pay within 7 days after receiving the claim.

30 Baht scheme may not apply in case of private hospitals. There is a regulation that emergency patients have to be treated at any hospital, private or state, for the first 72 hours but I'm not sure if a CT would necessarily be covered under emergency treatment.

 

It should be, but enforcement of this requirement is extremely weak.

 

in fact i haven't heard yet of a case where a private hospital did not charge despite it.

[puukao]

We are talking about a young kid's life.  I would live in the hospital, give money to whoever you think might help.  have 10,000 baht on you and figure out a few people to give 1000 baht to.  sounds crazy?  maybe, but it's a kid's life.  yes, the squeaky wheel gets oil.  do whatever you need to do....i would be going crazy.  there is a chance nobody will take your money, but they will know you are serious.  again, this is super serious so i would really be at that hospital 24/7 for at least a few days.

[Sheryl]

1 hour ago, puukao said:

We are talking about a young kid's life.  I would live in the hospital, give money to whoever you think might help.  have 10,000 baht on you and figure out a few people to give 1000 baht to.  sounds crazy?  maybe, but it's a kid's life.  yes, the squeaky wheel gets oil.  do whatever you need to do....i would be going crazy.  there is a chance nobody will take your money, but they will know you are serious.  again, this is super serious so i would really be at that hospital 24/7 for at least a few days.

And I am sure his immediate family have been there 24/7.

 

But not waiving money around. Neither necessary nor appropriate in a government hospital. Will not result in better care and could cause offense.

 

 

[userabcd]

16 hours ago, Sheryl said:

And I am sure his immediate family have been there 24/7.

 

But not waiving money around. Neither necessary nor appropriate in a government hospital. Will not result in better care and could cause offense.

 

 

Thanks again Sheryl.

 

I raised this topic because of vague explanations coming from the patients family about the child's medical treatment and they were thinking the kid was not receiving appropriate care.

 

The treatment for such condition was explained by Sheryl and other forum members, and it seems the patient has received such care and when relayed to the family seemed to put them at ease. A suggestion of a neurosurgeon and a Dr Somsit was consulted and he is looking after the patient. 

 

The child is now awake, can talk briefly with his family and move although is hurting. He remains in a semi private ICU ward being monitored and looked after by hospital medical staff. 

 

Direct and indirect family are in attendance/visiting daily and there was never any necessity to motivate the medical staff with money.

Edited March 21, 2019 by userabcd