Sat 3-Apr-10

I realized yesterday that there is no description of Simon’s injuries on it, so for those who don’t already know, they are:

1. Traumatic brain injury (closed head injury)
2. Fractures of left orbit (eye socket) and cheek
3. Fractured left clavicle (collarbone)
4. Fractured ribs x 4
5. Fractured 7th thoracic vertebra
6. Fractured pelvis (pubic bone?)

Despite that list, he actually looks quite good – even his left eye and cheek are almost normal-looking, with only a very slight black eye.  And, it appears that no surgeries or other interventions are needed for any of the fractures - just time to heal.  However, all of the fractures are going to be painful when he is allowed to awaken more!!

Simon is doing well this morning – still sedated, still on ventilator, but his blood pressure is much more normal with the treatments he’s getting now.  Yesterday afternoon they had the ventilator on “assist” mode, so that Simon was setting his own respiratory rate and doing most of the work of breathing, and the ventilator was only supporting him a little bit.  He managed to keep this up for about 2 hours without getting too fatigued or having his oxygen level drop.  He also seemed to produce more secretions from his airway during this period, as his own exhalations seem to bring up a lot more of them (and the nurses suction his trachea on a regular basis).  Hopefully that will help clear things out!  Obviously they are watching the secretions carefully, looking for any signs of pneumonia, but his daily chest x-rays continue to look good.

The doctors just came through and they are planning to go ahead and do a tracheostomy (and a feeding tube), today (if they can get all the right people together).  It sounds like a week of oral endotracheal intubation is usually the limit (to avoid too much trauma to the larynx and mouth, etc.), and everyone agreed that weaning off the ventilator would be safer and faster with a tracheostomy.  Apparently there is a reluctance to do tracheostomies early on in head injury patients, but several people seemed to think they shouldn’t be so reluctant.  Anyway, I’m all for it, if it will speed things up!!


Also - good news - his left pupil is coming down in size, and starting to regain its PLR . . . it had been measuring something like 4.90 and 4.88 before and after light (ie, almost NO change), but today it's more like 4.5 and 4.0 before and after.  They seemed happy with that improvement.  (They have this cool "pupillometer" that automatically records those dimensions and gives them a 3rd number, indicating not only the % change in size, but how rapidly it changed.)

Ann