Day 7: First post, March 20, 2012

Sorry no post last night.... What a whirlwind.  But the bottom line is that they are making every effort to transfer Scott today to an LTAC on Phoenix for aggressive ventilation weaning and consciousness raising.  We had a lot of logistics to rush and organize last night, so... this is my first opportunity.  I will be impressed if I am able to complete this before the next step of the process.

So... Big day yesterday ....   Look at all of the progress he made the day after all of the fasts and elevated prayer efforts!!!  He followed commands to move extremities consistently and convincingly with all attempts through the rest of the day.  So huge!  And... what a great way to boost our energy and spirits.  It was definitely getting wearing sitting and wishing and seeing no change on the consciousness aspect.   He finally cleared his bowels, which also was a big deal.  They removed the chest tube, sedation,  and IV pain meds.  He has been very very squirmy as a result.  We hate to see him in uncomfortable, but we are glad that his consciousness is raised.  They are giving him Percocet ground up and placed in his feeding tube, and they gave him some small injections of Morphine yesterday (yikes!) to manage the pain, so they wouldn't have to turn the sedation back on.  The effort worked.  They were finally able to get him off of the sedation so he could respond to commands.  Did I mention how excited we are by this progress?!?  We have been counseled that he will be up and down for awhile, likely not consistent, and there is still no telling for sure when he will actually open his eyes and wake up, but... it is still a positive sign and the first step that we have been waiting for.  ...Oh... nurse just re-assessed him.  Still very consistent and convincing with following commands: able to bring his hand to his nose, move all extremities, able to distinguish right and left without verbal cueing, et.  Still not able to open his eyes, follow her finger when his eyes are manually opened, or open his mouth/stick out his tongue.  It sure was good to actually see his eyes when she manually opened them.  He was not able to focus and there was definite spontaneous Nystagmus bilaterally, but it was nice to see his eyes!

Oh,... I have failed to mention that they have been giving him anti-seizure medication preventatively, since seizures are so common after head injuries.  We will also need to be aware of the potential throughout his rehab.  He has not shown any seizure activity to date, though, fortunately!

They now are saying that he does not have a respiratory infection.  They said that the swab was determined inconclusive by Q score, which basically just means they think they had a contaminated sample.  They think it may be due to aspiration artifact.  The WBC (white blood cell count) was only a little elevated, etc... so now they are dismissing it.  His temperature has remained normal since, so... it looks like his fever was neuro fever after all.  The brain is responsible for thermoregulatory control, so fevers are not uncommon with head injury.

They just now put the trach collar on today, which basically is a small oxygen mask placed over the opening in the trach tube through which is humidified oxygen.  No pressure.  He is breathing on his own and keeping his lungs inflated on his own. HIs measurements are staying normal (SpO2 99 on his own)!  His lungs are doing very well.  I mentioned that they took the chest tube out yesterday.  Yeah! Fewer tubes!

Jaw swelling still remains quite large.  I keep expecting that it will decrease as quickly as the rest of his swelling sites have, but.. I guess they all progress at their own rates.  Something we haven't thought about until yesterday was his teeth.  As much force as he took on his face, and with a broken jaw, we wonder what condition his teeth are in.  The nurses aren't able to give us much info on that because there is so much swelling in the area, it's hard to tell.  So... it might be interesting to see what they look like when the swelling goes down.

My wonderful sister-in-law is nurse extraordinaire, which is a nice resource.  She recommended that we begin talking to Scott telling him what was going on, where he is at, why his left hand has a mitt on it, why he has tubes, it's okay to go to the bathroom, etc.  She said that often times unconscious patients feel that they are captives and that the nurses are "the enemy" and... wonder why their family is there, but still "allowing" these captors to torture them.  She felt that some of his restlessness may be due to this feeling.  So we have begun doing this when he gets extra restless, and it has made a difference.  He calms down each and every time.  So.. Thanks, Robin!  We noticed the nurses doing it, but we didn't know why and what kind of talk we should have with him.  We had just been talking about the weather, etc.  Knowledge is power!

Last night, Ashley found a 40 page educational brochure on the Barrows website.  We will link it later.  It also had many recommended reading options that we will pursue.  So... I guess I'm going to be dusting off my neuro PT hat and using it again.  That hat has been in the closet since PT school 30 years ago. Yikes!  This will be a good test for my aging brain.

If he is still here today, PT will try to sit him up, which as a non-neuro PT seems crazy to me that they would attempt to sit an unconscious patient, but... sounds like there are current studies showing the benefit of sitting unconscious patients and stimulating trunk reflexes.  I can also tell you that Ashley and I were getting a little "beep" crazy.  There are so many "attachments" (tubes, IVs, monitors, etc.) to Scott and they all have alarms.  They are quite sensitive, which is both good and bad.  The beeping wasn't completely constant, but it sure seemed like it.

Also, he is doing well enough to travel by land ambulance now, so that is how he will travel to Phoenix.  So... we will see if we go to Phoenix today or tomorrow.  Rounds are over about now, so we expect people to start filing in and progressing toward that direction.

We love you all!
Patti