On the first day of Ms X admission to ICU post Craniectomy surgery, she was

sedated and intubated. Her GCS at the point of admission was 3/15. After the
sedation was discontinued, she was still having poor GCS status that was 7/10
(E1 V1 M5). Ms X did made some improvement in her condition during her stay
however the rate was typically slow and not impressing. She was unable to obey any
commands despite some spontaneous movement were seen. Her nutritional needs
were met by administering enteral feeds through Ryles tube. Her specially tailored
milk fed was to be administered every 3 hours as ordered by the dietician. It was
then decided by the anaesthetist, in view of the poor recovery rate and GCS, a
tracheostomy is needed for airway protection. No family members were present to
make any decisions nor contactable throughout her stay in the ICU. The procedure
was performed for her after the consent form was signed by 2 anaesthetists. She
was subsequently transferred out to the neurosurgery ward to continue with her
recuperation. Her case was then referred to the social welfare department to assist
in her discharge process to the nursing home.