Day 2: Midmorning March 15, 2012

Okay.... so much for our quiet day.... Has been a busy morning.  Here is the update.

Scott was heavily sedated throughout the night, so it was a peaceful night for him.  His fever did return, but nothing concerning.  They are watching it.  Currently it is right on target, so he came down on his own without Tylenol.

First look at him this morning was  a pleasant surprise.  His facial swelling, especially his right eye swelling, decreased substantially overnight.  We were expecting it to increase over these first couple of days, but it is a nice surprise to see it decreasing so quickly.

We were able to speak with the neurosurgeon again this am.  He is REALLY wanting him to wake up. So are we!  Our concern about the possibility of diffuse axonal injury rises the longer he takes to wake up.  The surgeon showed us the original and followup CT scans.  The original CT scan showed the blood clot in the right temporal area of his brain. It measured about 1 inch in diameter. It was outside of the brain covering itself, but was compressing the temporal lobe of the brain.  The temporal lobe affects memory and emotions. The artery (can't remember the name, sorry!) right under the orbital fracture was also severed and actively bleeding, so it is good that they did surgery immediately before further damage was done.  An additional concern immediately, was that the displacement of the temporal lobe was beginning to apply pressure on the brainstem, which has majorly serious consequences, so they wanted to prevent any damage to the brainstem.  Followup CT scans do show the blood clot gone, the temporal lobe of the brain beginning to refill the space it once did, and pressure on the brainstem absent now.  Swelling in the brain has remained low following the surgery.

The neurosurgeon did attempt to wake him this am.  They took him off the sedation for about 15 minutes.  He began moving on his own,....kinda' fidgeting, appearing like he was in pain and was moving his arms and legs in response to that pain.  He was grabbing at his chest with his left hand, able to move his hand normally, no abnormal neurological tone, ....the movements appeared to be purposeful, like he was trying to remove the source of discomfort/tubes.  The apparent purposeful movement is a good sign.  They also said that he was responding to commands at the scene, which is a good sign.  But... we haven't been able to get the "awake response" that we are hoping for.  He did move in response to commands this am, but "Not convincingly", according to his neurosurgeon.  It was difficult to assess if he was still "squirming" or if he was actually moving in response to the command.  They will try again after his surgery.  We are becoming anxious to see him awaken.  He is currently having an MRI.  2 reasons.... I'll explain the cervical reason below, but they will also look for the diffuse axonal injury while he is there.  We were able to see 2 small areas on bleeding on opposing areas of his brain, which is indicative of a contra cou injury (when the brain smashes against one side of the skull, then rebounds and smashes against the other side of this skull, causing bruising and potential damage to the brain.)  The evidence of contra cou can imply that there may have been some shearing forces, as well, so... it is a real possibility that he may have diffuse axonal injury.  The neurosurgeon was visibly dissappointed that he did not wake up this am.   So... we will be anxious to see the results of the MRI.  We are grateful the cervical spine urgency required the MRI, less wondering, more knowledge.  Knowledge helps us to know what we are dealing with.  There is no treatment or surgery or medication to treat diffuse axonal injury, so it will not change his treatment plan, we will just know.  We will have more realistic expectations.

So... onto the cervical (neck) reason.... The facial surgeons informed the "Intensivist" (an MD that specializes in ICU) that they are now planning to wire his jaw shut on Friday or Saturday.  So.... another surgery then delays taking the ventilator out.  But also.... they won't be able to do the jaw surgery with the intubation tube in the way, so they will need to move the intubation tube to his nose.  For the jaw surgery and the movements/positions for the surgery and change of intubation sites, they need to take his cervical collar off and need to know that his neck is safe to do so.  The xrays are negative, no neck fractures, but they aren't able to assess ligamentous injuries because he is not conscious.  So... the MRI will give them the answers they need.  We are grateful for the MRI..did I say that?

The arm surgery is planned for 3 pm today.

Also... so many of you have expressed a desire to do something to help at a time where there is not much that can be done yet.  We are not able to accept flowers, etc. in ICU.  Ashley's sister stated today that she is working on setting up a Recovery fund at America First Credit Union in Scott's name.  ... we don't know the extent of the expenses they will experience yet.... the rehab/recovery we presume will be extensive.  This fund might present an option for those of you who are struggling by not being able to do something to help.

This has been a long post...sorry... I will update you on the MRI results as we get them...

We love you all!
Patti

I am so grateful for his physical, mental, emotional, and spiritual strength more than ever!  He will need every ounce of it through this recovery process.