Some changes transpired through the night around 3:00am. Seth’s pupils became larger from 5-6mm to 8mm. Still reactive. Since he had a head injury they still check his pupils every hour. Intensivist was called, and he came and assessed Seth. Still having tremors in arms and legs and extremities more stiff, right more than the left side. Order received to get a stat CT scan of his head to cautiously rule out a head bleed. Will get a portable EEG done for a minimum of 2 hrs to check for seizures.
Nurses also noted that he’s been awake a lot the last few hours. Dr said he’s concerned about him not getting sleep. Seth could potentially be delirious and his sleep cycle way off. Valium was given to help Seth relax. He did close his eyes and snore for a little bit, but didn’t last long.
Team took Seth down for another CT scan. It was read right away and intensivist came back and said there was no concern on the CT. Not seeing any seizures either. Wanted Neuro Dr to come evaluate. Heparin is safe to continue. Neuro Dr came in. Did a thorough exam. Concerned that Seth has very spastic muscles, positive clonus (hyperactive nervous system) and is twitching. Good that brain stem is working, he responds to noxious (irritating) stimuli, and pupils are reactive. No clear answer clinically what is going on, and a “very strange case.”
Neuro Dr and intensivist recommending that they get his BP more under control . Will start a Nipride drip again on top of other BP meds. Neuro Dr will consult with oncoming dayshift providers. May consider some sedation to help his body to rest more. This could all be related to his brain injury, but reassuring that imaging is stable. Neuro to decide about sedation today because they also don’t want to mask his neuro symptoms. Needing him to rest more than he is, and seems overstimulated by everything.
Blood gases look good this morning. Sweep turned down to 1 on his ECMO. So lungs are looking better, and pulling good tidal volumes. Can be a slow process to wean. Anticipating an MRI once he’s off ECMO.
-Aunt Kerry
If you haven’t seen late last night’s update, please read.Dear Lord, Calm the storms within his cells and tissues. Amen
-Darcy
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