Day Three, Tuesday - Part Three

November 23, 2010:Kassi continues to be hopeful she will be released from the hospital tomorrow.  If the doctors allow, the plan is to take her to IHC to see Brandon.  We hope to take her there in the motor home.  It should give her a more comfortable ride and also provide a place to call home for the next several weeks. IMC has electrical hook-ups for RVs and several have taken advantage of it.  It would be nice to have something close and private.  It won't take much to beat sleeping in a chair in the waiting room.

Brandon continues with his little accomplishments.  The doctor this evening expressed his concerns and optimism at Brandon's condition.  He feels Brandon is further along than should be expected and he is progressing at a fairly steep rate for his head injury.  We were also visited by the trauma PA who was also a member of the flight team who cared for Brandon in flight.  He was also optimistic at Brandon's prognosis.  He feels Brandon's fever is most likely a result from aspiration.  While it raises concern for pneumonia, it beats several of the alternatives.  His white count is up slightly and the initial blood cultures are negative.

His movements would appear to be either extremely coincidental or they are getting more and more purposeful.  They are getting more consistent in action and association.  This evening he had one of what appears to be a triggering event and he kept trying to get out of bed as any of us would. He has had this same event three times today and his actions were exactly the same each time.  They have been trying all day to limit his anesthesia.  Tonight's care giver steeply increased his Propofol with one of these events rather than give a small bolus and keep the maintenance dose the same.  It is interesting that last night she ended up raising his dose to 60, while others are consistently able to keep it around 20-30. 

It gives you a deeper appreciation for the difference of those who do their jobs at an exceptional level and those who are exceptional at delivering excellent patient care. The trauma PA keeps reminding her the goal is to decrease and wean, not continue to increase dosages.

Brandon continues to over breathe the respirator.  He does a great job with the lower dosages of anesthesia and even over breathes at the higher dosages.    If he continues to improve at his current rate and they will continue to focus on reducing the anesthesia, I am hopeful for an intended extubation by the weekend.