27 yrs old male who got electrocuted

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PATIENT HISTORY: Pt is a 27 yrs old male, who after doing an ITI course was looking for a job.

Pt was completely fit and fine as claimed by his family members till 2019.

In 2019, he had once c/o left upp quadrant abd pain. When the pain intensified he was taken to a local hospital where he remained admitted for 2 days. After discharge no such incident.

5-6 months ago, one late night at around 10 pm, his friend dropped him some 800mts away from home near a lamppost after heavy drinking with his friends. 5 mins later while passing from that same area, his friend saw the pt is hugging the lamppost tightly. He was not replying when he called the pt. So, when he tried to touch the pt, he too got an electric shock. Realizing pt had been electrocuted he called his other friends and they took him to the hospital. His friend had reported while taking pt to the hospital he was unconscious. Upon reaching the hospital CPR was given and kept in ventilation. After 18 hours, the pt's eyelids were showing slight movement. Dr said he is in a vegetative state and referred him to another hospital.

Their tracheostomy was done and he stayed in that hospital for 45 days. By that time, he was able to move his fingers slightly. Dr. said nothing more can be done and he got discharged.

He was admitted to another hospital, where he is staying to date. 

In the past 4-5 months till date, slowly he is able to blink his eyes, make eye contact, grip someone's finger, open his mouth, can also lift his hands a little bit. He is trying to speak and lift his head. For the past 2-3 months, he is able to sip water when fed via spoon. Still being fed via Ryles tube.

Pt appears malnourished.

ADDICTION: Pt started drinking locally made alcohol (mostly with friends outside, quantity unknown) at 16-17 yrs of age. Since his mom won't give him money to drink, his friends use to give him money.

Used to chew tobacco (quantity unknown) since the age of 16-17 yrs.

Smoked cigarettes (no. unknown) occasionally with friends.

Psychosocial component:

Pt as a child was very fun-loving. Used to roam around with friends and play around. 

When in class 6, lost his father who was a heavy drinker and a daily wage laborer. His father's drinking habit would often lead to quarrels with his mom.

After their father's death (a few years after retirement), their mom became the sole earner (contract laborer). As per the elder son she never made them feel like they were short of money. Pt's brother reported though they were small, their father's death didn't have much on any of them.

Pt's brother thinks Mom used to like and pamper her younger son(pt) more than him. 

In class 10-11, pt's elder brother went away to study elsewhere. Since then, there were only small interactions between the two brothers. Pt started mixing with friends some of whom were heavy drinkers. He often started coming home late at night after heavy drinking  (friends reported he used to get drunk easily). Because of this, his mom used to scold him and used to tell him to look for a job, which often resulted in small quarrels. He not being a very good student couldn't land himself a job. His mom made him give some job interviews (e.g police) and even made him get some with her contacts, but he won't go, because he was not interested.

His friends reported he while drinking would often repent about not being able to get a job and support his family. He considered himself to be a family burden, which would often lead to more drinking. They claimed he was in depression. 

His family does not know how he got electrocuted but also suspects him of trying to commit suicide by touching a live wire, apart from it being accidental. 

FAMILY HISTORY: Father - a heavy drinker, died because ?renal failure. DM, HTN 

Mother - denied any h/o DM or HTN. c/o of mild pain in both knees while climbing stairs for the past 3-4 yrs. 

Elder brother - claims to be fit and fine

CHIEF COMPLAINT AND Pt REQ.: Pt is in a vegetative state for the past 8-9 months.

The family wants to know when can the tracheostomy tube be removed and seeks further advice.

REPORTS: 

PROVISIONAL DIAGNOSIS: Hypoxic ischemic Encephalopathy