It's already Day 13. Tomorrow will mark two weeks since she was admitted into the ICU. Sigh.. It's taking a long time, but I suppose that's only to be expected. We had already dodged 3 close calls, and even though she has developed an infection, she's still stable and I guess that's good news. I just hope she wakes soon. It's really not good to stay sedated and immobile for so long.
Just curious, 1) How does she gets her supply of nutrients for energy? 2) Does anyone give her some sort of massage? All the best to her, time flies, didn't realize its 2 weeks already
Here's more positive news. Let's continue to pray for jenny! "Today jenny's condition is much better today. Her icp is in the 13 to 17 region and her temperature is down. They did a ct this morning. They original clot is small but there's still considerable cerebral oedema. They just reduced her sedation a little."
1. They feed her a liquid diet via a tube. 2. They have an automated machine that inflates and deflates rubber sleeves on her lower limbs to prevent DVT from developing.
On my second visit today, her intracranial pressure went up a bit (18-19 mmHg) after they reduced her sedation. However, they must think she's improving because they ordered a further reduction in her sedation. If her ICP goes up though, they will turn up the sedation again. The good news is that her fever is down... so her infection is under control. And her pupils are still reactive to light. About the CT and clots, it looks like there was some "miscommunication". The surgeon told me they removed some of the new clot, but in truth, they removed some of the OLD clot during the recent craniectomy operation. No wonder there was such a marked reduction in the size of the old clot! I don't know why the surgeon told me otherwise. Fear of litigation? Wasn't even in the room (someone else did it)??? Whatever it is... I'm just glad the CT scans showed no visible infarct of the brain, and the brain looks "healthier". Of course, the cerebral oedema (swelling) is still there. It's going to take a while to subside. Oh well, let's just count our blessings!
Great to hear that ICP only increased a little How come her brain could swell suddenly? Should this be an issue to be concerned off as it could happen again in the future? (touch wood!)
Day 15 Got the dreaded call this morning, urgently asking for consent to do a CT PA (pulmonary angiogram). They were worried she developed pulmonary embolism - basically blood clots from the legs going up and getting stuck in the blood vessels of the lungs. A bad thing to get. Luckily, the CT PA came back negative for the blood clots. They also did a doppler test on her legs' blood vessels and found nothing either. Guess we dodged the bullet this time! They planned to fit in an IVC (inferior vena cava) filter to prevent pulmonary embolism from occuring... a "just in case" measure since they think she's at risk. However, the radio-intensivist, Dr. Lau did another scan of her tonight and found nothing to warrant inserting the IVC filter. He took the opportunity to do an angiogram this time, and according to him, the AVM isn't actually as big as surgeons made it out to be. Very likely the clot itself obscured the actual AVM, making it bigger than it really is. Her intracranial pressure was generally very high today, but since the CT appeared good, the EVD tube was probably giving wrong results. As such, they intend to remove the tube either tonight or tomorrow morning. It's worthless now, and will only serve as a source of infection. Speaking of infection, she responded well to the meropenem antibiotic and her ventriculitis (infection of the brain ventricles) has cleared up. Still, it was not all good news. They discovered this morning that she has an acinetobacter infection in her lungs. That's a bad bug to catch, although her lungs are still in good shape and the meropenem they are pumping into her is just the stuff to fight it off.
The brain swells up as a result of the pressure (trauma) exerted by the presence of a pool of blood within the confines of the cranium. Blood itself is also an irritant.
