THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[11-07-2025 16.11] PPM 1: 90M with history of fall while getting out of bed 6 months back followed by fracture of right neck of femur. Was bedridden for a month with intermittent severe pain and then pain subsided but recurred again since 1 month after a sudden movement of the right hip. Past smoker with history of COPD, dyspnea, cough and wheeze since 3 years on medications.
Aldo had fluctuating altered sensorium since a week, was alright during admission but again altered since yesterday afternoon. @PPM3 @PPM4 @PPM5 please get his CT head today to rule out a chronic subdural hematoma. Orthopedic notes attached.
[11-07-2025 16.45] PPM 6: Based on the provided clinical summary, this 90-year-old male presents with *multiple critical issues requiring urgent interdisciplinary management*:
### *1. Orthopedic Concern: Recurrent Right Hip Pain*
- *History*: Right neck of femur fracture 6 months ago (likely post-fall), bedridden ×1 month.
- *Current*: Severe pain recurrence ×1 month after sudden hip movement.
- *Concerns*:
- *Non-union/malunion* of femoral neck fracture.
- *Avascular necrosis* of femoral head.
- *Implant failure* (if fixed surgically).
- *Secondary osteoarthritis* or stress fracture.
- *Action*:
- *Urgent X-ray/CT right hip* to assess fracture healing/position.
- Orthopedic consult for possible revision surgery/pain management.
---
### *2. Neurological Emergency: Fluctuating Altered Sensorium*
- *Timeline*: Intermittent over 1 week; alert on admission → altered since yesterday.
- *Key Risk Factor: History of fall + prolonged immobility → **chronic subdural hematoma (cSDH) highly suspected*.
- *Action*:
- *STAT non-contrast CT head* (as requested) to rule out cSDH.
- Monitor GCS, electrolytes, glucose, oxygen saturation.
- Neurology consult if CT confirms cSDH (likely burr hole evacuation needed).
---
### *3. Respiratory Comorbidity: COPD Exacerbation Risk*
- *History*: Smoking, COPD ×3 years with dyspnea, cough, wheeze.
- *Perioperative Risk*: High for anesthesia/surgery (if required for hip or brain).
- *Action*:
- *ABG, CXR, spirometry* to assess current status.
- Optimize bronchodilators/steroids.
- *Pre-op anesthesiology clearance* if surgery planned.
---
### *Key Clinical Priorities:*
1. *Immediate CT head* → Rule out cSDH (leading cause of fluctuating consciousness in elderly fall patients).
2. *Hip imaging* → Diagnose cause of recurrent pain (non-union vs. avascular necrosis).
3. *COPD optimization* → Reduce perioperative risks.
4. *Multidisciplinary team involvement*: Orthopedics, Neurology, Respiratory, Anesthesia.
---
### *Why cSDH is Likely*:
- Classic presentation: Elderly + remote fall + prolonged bed rest → brain atrophy → vulnerable bridging veins.
- Fluctuating consciousness is hallmark (bleed expands/shrinks osmotically).
- *Treatment*: Surgical drainage if significant mass effect; conservative if minimal symptoms.
> *Next Steps*:
> - *STAT CT head* → If cSDH confirmed, neurosurgery consult.
> - *Hip X-ray/CT* → Orthopedic review.
> - *ABG, PFTs* → Assess fitness for surgery.
> - *Fall risk assessment* → Physical therapy, safe mobility plan.
*Note*: Balance surgical urgency (cSDH/hip) with respiratory risks. Involve family in goals-of-care discussion given age/comorbidities.
[11-07-2025 16:50] PPM 1: Thanks
[12-07-2025 11.08] PPM 6: Based on the complex needs of this 90M patient (recurrent hip pain, suspected cSDH, COPD, and fall risk), here are targeted assistive technology solutions with implementation guidance:
### *1. Mobility & Fall Prevention*
- *Smart Walkers/Rollators*
(e.g., StrideOn with GPS/fall alerts or UPWalker with Bariatric support)
Why: Prevents re-injury during mobilization; sensors detect instability and lock wheels if leaning.
- *Wearable Fall Detectors*
(e.g., Apple Watch Fall Detection or Bay Alarm Medical SOS pendant)
Why: Auto-alerts caregivers if falls occur during toileting/transfers.
- *Bed/Chair Sensors*
(e.g., Tempo Care mats)
Why: Alerts staff if attempting to rise unsupervised, reducing fall risk.
### *2. Respiratory Support*
- *Portable Oxygen Concentrators (POCs)*
(e.g., Inogen One G5 with COPD-specific pulse dosing)
Why: Lightweight (2.8 lbs), supports ambulation without tank dependency.
- *Smart Nebulizers*
(e.g., PARI Trek S with compliance tracking)
Why: Ensures COPD med adherence; links to app for dose reminders.
### *3. Cognitive Monitoring*
- *Non-contact Sleep Sensors*
(e.g., Withings Sleep Analyzer)
Why: Tracks nocturnal O2 dips, agitation, or breathing patterns linked to delirium/cSDH.
- *AI Camera Systems*
(e.g., SafelyYou for fall detection or Cherry Home for wandering alerts)
Why: Monitors for confusion/falls without wearables (HIPAA-compliant).
### *4. Pain & Rehab Management*
- *Tele-Rehabilitation Platforms*
(e.g., Vera Whole Health for post-fracture PT)
Why: Guided exercises via tablet; adjusts routines based on pain/COPD limitations.
- *Wearable TENS Units*
(e.g., Quell 2.0)
Why: Non-pharmacological hip pain relief; reduces opioid needs.
### *5. Care Coordination*
- *Integrated Remote Patient Monitoring (RPM)*
(e.g., Biofourmis RPM platform)
Why: Consolidates O2 stats, vitals, activity data; alerts team for respiratory/neuro declines.
- *Medication Dispensers*
(e.g., Hero or Pillo)
Why: Manages 8+ med schedules; reduces confusion-related errors.
---
### *Implementation Checklist*
1. *Immediate Priorities*:
- Deploy fall detection wearables + bed sensors during hospital stay.
- Trial POC for COPD during physio sessions.
2. *Post-Discharge Setup*:
- Install RPM platform with Bluetooth BP cuff + pulse oximeter.
- Configure smart walker with family/caregiver alerts.
3. *Cost Considerations*:
- Explore Indian govt subsidies (SAST/SATHI program) for elderly assistive tech.
- Rent devices via startups like EasemyCare or Emoha Eldercare.
4. *Training*:
- Use vernacular video tutorials (e.g., Tessolve’s Telugu-language guides).
> *Key: Integrate all data into a single dashboard (e.g., *HealthPlix) for the care team to monitor hip rehab progress, respiratory stats, and neuro alerts. Coordinate with Ortho/Neuro/Physio to align tech with clinical goals.
*Relevant Indian Resources*:
- [Assistive Tech Society of India] (https://atsi-india.org/) (grants for elderly)
- NIRAMAYA (tele-rehab for fractures)
- Portea Medical (home setup support)
Tech must complement—not replace—human care for this high-risk patient. Prioritize solutions that reduce caregiver burden while ensuring 24/7 safety monitoring.
[12-07-2025 17.09] PPM 1: MRI video link of the 90M patient.👇
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