Saturday, May 15, 2010

Saturday Morning

This is Aaron. I was given the assignment to update the blog this morning and I apologize for the late entry. Shannon's ICP (intracranial pressures) rose a little overnight. For a brief time they were 19-21. The goal is to keep them below 20. They turned up the pentabarbital (the coma-inducing drug) which helped a little. She is now as sedated as she can be based on her continuous EEG they have her hooked to. Last night they had turned off the versed drip (the first sedation medication she was on) because she shouldn't need it being on the pentabarbital, however this morning they restarted the versed back to see if it would help. Other measures they are taking to keep her ICPs down include driving her sodium levels up, her carbon dioxide level down, paralyzing her, draining off cerebral spinal fluid, keeping her blood count high enough, and keeping her oxygen levels maximized. All of these measures are to decrease brain swelling, decrease brain oxygen requirement, and increase oxygen delivery to the brain. Currently her all her numbers look good, however she is on maximum treatment. Gratefully we are coming up to the 72 hour mark. Sometime between now and tomorrow afternoon her brain swelling should peak and we will be out of the "danger zone." They are planning on turning the sedation off tomorrow morning to see how her ICPs will reponded. If it remains low, they will wake her up and we'll be able to exam her neurologic function. If it goes up off sedation, she buys another day or two in a coma while her swelling improves. They did another CT scan today. The swelling they see on the CT scan appears stable and there was so sign of additional bleeding. I was able to talk to one of the neurosurgery residents today who said they were pleased with the appearance of the CT scan, however they would be more encouraged if her pupils were responsive at this point. That could mean that she has some "diffuse axonal injury" which does not show up on a CT scan. DAI is a sheer injury to the axons in the brain. In order to assess for that, she'll need an MRI sometime in the future. There is no treatment per se for "DAI" but young healthy people usually recover well (some even completely) from it, albeit after months. All this to say, the waiting continues with little more we can do but pray and wait and wait and pray. Every patient recovers differently after an injury like this and no one can predict individual outcomes. That is the most frustrating part of all this. Shannon has many things in her favor including her health, her age, the fact that surgery was performed quickly, the fact that her ICPs have remained relatively under control, she doesn't have any other significant injuries, and she has be stable from a heart and lung standpoint. At this point it appears to me that her long-term prognosis will not be fully realized until after months of rehab and simply time.

This morning they also placed a feeding tube in her nose and are starting to give her nutrition now. They were also concerned that her sodium continues to slowly climb at the same time that her urine output has increase. Some tests were run and they feel that she has diabetes insipidus which is very common in traumatic brain injuries. DI is caused by an inability of the pituatary gland in the brain to make ADH (anti-diuretic hormone). The pituatary is usually dysfunctional from pressure or direct injury (likely Shannons case based on where her skull fractures are). The purpose of ADH is to concentrate the urine to prevent dehydration. In DI, the kidneys aren't able to retain water by concentrating the urine so the sodium levels go up and patients get dehydrated. The treatment is to give patients a medication called vasopressin which is synthetic ADH.

***Real-time update*** The neurosurgeon attending just left. He again said they were encouraged at the appearance of her CT scan but wished that her pupils were reacting. Again all we can do is wait. There are no plans for another CT scan unless her ICPs go up or she declines in some way. They still plan to turn off her sedation tomorrow. The DI is usually temporary and resolves weeks to months after the injury but sometimes it even resolves before they leave the ICU.

We continue to feel the love and support from so many family members and dear friends. Thank you all for the outpouring of compassion and service to my family. We continue to feel the love and tender mercies of our Heavenly Father and know that Shannon is in His Hands. As I end this blog, my mom asked me to ask you all to pray that Shannon's pupils will begin to react and that her ICPs will stay down (her most recent one was 15) and that things will go well tomorrow when they turn off her sedation. Thank you for your prayers on her behalf.

1 comment:

  1. Thanks Aaron for all the detailed explanations. It is really great to have you there with your knowledge, expertise, and wonderful spirit. We are praying for the specific things that you mentioned. Our love to all, Laurel & family