Saturday, May 15, 2010

More Medical Stuff...

For those who are interested in even more medical stuff...I've discovered some additional information about her injuries after talking to the doctors and reviewing her chart. The bleeding in her head included blood outside the dura (the thick covering around her brain), under the dura, and around her brain but she didn't have any bleeding or bruising in the brain itself. In surgery it appeared that most of the epidural bleeding (above the dura) was coming from a tear in her sagital sinus, which is part of the venous drainage of the brain. Usually epidural bleeding is from an artery. During surgery they did not open the dura to remove the subdural blood. They removed the front part of her skull in anticipation for the swelling that we've seen the past 3 days. They will replace the skull in several weeks. She also appears to have a traumatic carotid-cavernous sinus fistula. The carotid artery runs up through the skull base. At the skull base the cavernous sinus is the venous drainage of brain. On her initial CT scan it looked like there was a connection (fistula) between these two vessels. Right now there is nothing to do about it and she'll likely not need intervention for it but it will need to be re-evaluated by another CT or angiography when she gets better. Her skull fractures were pretty significant. They extended from the top of her head down both sides and into her skull base going through the left external ear canal and both carotid canals (where the carotid arteries transverse the skull base).

She does have a fracture of her left 2nd rib but no underlying lung injury. She has several thoracic spine fractures. The left transverse processes of T2, T5-6 are fractured and she has compression fractures of T3-6. The good news is there is no spinal cord involvement and she will likely not need surgery. She may need a brace for comfort/support. They are allowing her to sit up to 30 degrees and once Shannon can stand up, they will check some additional xrays to make sure the fractures are stable.

Thankfully that's it. Her management would be much more complex and difficult if she had lung or intraabdominal injuries. Also she doesn't have any orthopedic injuries. She doesn't have cervical (neck) spine fractures but they will keep her in a hard cervical collar until they can rule out ligamentous injury. She is on minimal ventilator support except that the ventilator is breathing for her since she is paralyzed. She is on a little levophed (blood pressure medication) to keep her BP high enough while the sedation tends to drop it.

I can't think of anything else to include. Hopefully that is interesting and/or helpful for some of you.

1 comment:

  1. I'm a debater at West, and I just wanted to thank you for doing this blog, and to let you know my family and I are also praying for Shannon. I live in Salt Lake, so please let me know what I can do to help.
    alas [dot] pooor [dot] yorick [at] gmail [dot] com