Phitchanan Chaidi, Registered Nurse Level 4

Nurse Pitchanan Jaidee conducted patient rounds and observed that the scalp flap appeared too deep; the patient was experiencing shivering and breathing out of sync with the ventilator. Although the follow-up CT scan showed improvement with no additional hemorrhage, the patient was lethargic and febrile. Consequently, Dr. Thakorn—who was covering for Dr. Rerkchai—was informed, and a follow-up EEG was requested to rule out subclinical seizures. However, the EEG result showed no seizure activity. A brain CT scan was subsequently performed, revealing newly developed Sinking Skin Flap syndrome. The neurosurgeon was notified immediately, and an urgent operation was scheduled for right front parietotemporal bone flap replacement and repair of the dural defect. Dr. Rerkchai commended the early detection, which ensured appropriate treatment and led to clinical improvement—specifically, the patient regained consciousness and opened their eyes. Had the surgery been delayed, it could have resulted in brainstem herniation.