Wed 1-Apr-10 AM

Kind of status quo.  Simon still gets extremely hypertensive (systolic BP > 260) whenever he’s a little light and stimulated.  He still follows commands but no better than previous days.  The cervical collar was removed last night, which is good.  I spoke with Dr. Foster the ophthalmologist (who coinicidentally did my Lasik surgery some years ago!), and he said the left pupil may be dilated because the nerve is “weak” or because the pupil itself is damaged, but the eye itself is okay.  He would like to do a couple more tests, but they need to be done after Simon is off sedatives and fentanyl:  the “doll’s-eye movement” and a retinal exam.  He said that, even if they make a specific diagnosis on why the pupil is dilated, it’s unlikely there will be any treatment necessary, so there isn’t much urgency to make the diagnosis.

I was a bit tired and more emotional today, so I went walking with a friend, and had lunch with her and another friend, which was a nice break.

When I came back after lunch, the nurse told me they had tried to use “pressure support” for awhile – I guess this means setting the ventilator so that Simon triggers his own respiratory rate, and the ventilator delivers a minimal volume so he has to do more of the work.  Sounds like this is what they normally try before weaning someone off the ventilator.  Well, Simon didn’t handle it well; he got tachycardic (high heart rate), hypertensive, tachypneic (rapid respirations), and his sat (oxygen level) starting dropping.  So they put the ventilator back on its regular settings.

The pulmonologist Dr. Wallach came in and told me about it, and said they’d try again tomorrow.  When I asked her how long it might be before he could be weaned, she said sometimes a week.  Today he is at 72 hours post-trauma, so theoretically this is the peak of inflammation and swelling.  I guess we just keep our fingers crossed that he starts to improve over the next 3 or 4 days!

Ann