Friday, September 2, 2011

Bumble Bees Shouldn't Be Able To Fly, Technically

There he was in the ICU. Pressures good. Heart beating away. On a ventilator. An open belly. And a heart of gold. His drug screen was negative. Not a drop of alcohol in his system. New lab results coming back that I was extremely happy with--considering. So we scanned him. Had we just done a big time surgery to find out he had a devastating head injury?

A list of his injuries:
1. Intraparenchymal cerebral hemorrhages (multiple and terrible looking)
2. Large scalp laceration
3. Left clavicle fracture
4. Bilateral pulmonary contusions
5. Left hemothorax
6. Left diaphragm injury
7. Shattered spleen
8. Grade IV liver laceration
9. Left retroperitoneal hematoma
10. Left acetabulum fracture
11. Left pubic ramus fracture
12. Left sacral ala fracture
13. L1-L4 left transverse process fractures of spine
14. C2 fracture of neck
15. Large amount of pneumomediastinum

Then I spoke to his granddad. Sweetest man ever and obviously aching over his prized grandson. And grandma, the smallest, cutest, and soft spoken woman doing her best to maintain a hopeful smile. And Dad, the most fit middle aged man I've seen, doing his best to act as the backbone for the group when deep down he could use just a moment to have his own breakdown. And Mom, energetic, outgoing, and totally in love with her son. Then the girlfriend, they've been dating for 3 years and this was going to be the biggest growth spurt they could ever take as a couple--you could see she was up for the challenge. And girlfriend's mom who obviously cared for him like her own son. I remember telling Dad, "I just want to meet one mean person in the family. Then I know he'll walk out of here in a week." No such luck.

The next day, his pneumomediastinum appeared to be increasing. So an emergent bedside tracheostomy was placed with significant improvement. Neurosurgery and orthopedics came by. A "bolt" to monitor intracranial pressure was placed. He was started on medications to keep his blood pressure down and to keep fluid off his brain.

A couple days later, he returned to the OR. The sponges were removed and everything appeared ok. No more bleeding. So his belly was closed and he was again sent back to the ICU.

Over the next few days, he remained status quo. Multiple EEGs were done to examine brain function with no devastating (but really not hopeful either) results.

We started tube feeds and the next day we was noted to have what looked like gastric contents coming out from around his trach. More concern for a possible esophageal injury arose. The following day, we took him to the operating again. With a scope, we confirmed that no esophageal injury. We opened his belly again and placed a gastrostomy tube. We placed an IVC filter for prophylaxis, in hopes of avoiding any kind of clot traveling to his lungs. And we closed his belly again.

Over the next few days, he didn't tolerate tube feeds too well. So he stayed on TPN and we watched as his liver function tests and his pancreatic enzymes trended down as his pancreatitis improved. He remained on antibiotics for pneumonia. But otherwise, he wasn't deteriorating but things weren't moving rapidly either.

Then his bolt was removed! No more prongs sticking out of the head making us anxious with roller coaster like numbers. After that, things really started changing. He was overbreathing the vent. He was moving his arms more. Each day, something more happened. His eyes were open wider. He had purposeful movement. He was tracking with his eyes. And on occasion, many of us swear he was following commands. On a number of neurostimulants, he was coming around. Just as I felt he would. With love and age on his side, he was going to get out of here.

To Be Continued...

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