Family Meeting

1) Had quit a lot of fluid buildup in lungs last night. They were able to remove most of the fluid thru the night.
2) No real change in the lung volume in lungs.
3) Pneumonia does not seem to be a problem
4) Could only stay off ventilator for 4 minutes today, not good
5) Opened his eyes when sedation reduced
6) Became very agitated and needed to be sedated again
7) Temperature 99.2
8) Blood Sugar 294
9) Blood pressure 117/49 Heart rate 84
10) Labored breathing
11) Tubes could be causing pain in back, etc
12) Trying to wean off sedation and go more to pain medication to see if he will wake up
13) Cardiology wants to run more tests once he stabilizes and is off the ventilator
14) Liver, kidneys function is good
15) Pain meds and sedation caused his blood pressure to fall but they were able to stabilize.
16) Blood pressure 80/31 @ 1:00
17) Blood pressure improved 123/66 @1:30
18) Breathing labored because they moved him and his eyes have been opened
19) He have blinking reflex when they wipe his pupils
20) Both pupils are the same which is a good sign
21) Eyes were open for 10-15 mins
22) Breathing on his own a little
23) Large brain damage ruled out
24) Mersa in control
25) Good prognosis full response to stimulation
26) Heat did not stop
27) EEG- no specific abnormality
28) Urine output good
29) Blood pressure need to be lowered
30) Large amount of brain damage not noticed
31) There will be some intermediate brain damage

Meeting with Dr Boes
32) Been on machine-Looked for cause no specific reason why it occurred
33) EEG - Brain wave test is abnormal - no evidence of seizures
34) Has abnormal brainwave pattern
35) Encephalopathy - see explanation below
36) Liver-kidney-thyroid ok
37) No evidence of blood or swelling in the brain
38) No tumor indication in the brain
39) Encephalopathy can improve but the longer you remain unconscious recovery is less likely for a full recovery.
40) Prognosis guarded not sure how much he will recover
41) Tomorrow we will see if there is some improvement. If not they will do a tracheotomy on Thursday to remove ventilator out of his mouth and add feeding tube to his stomach. This may make him less agitated and able to take him off the sedations and possibly try and wake him.
42) Antibiotic medicine is working good
43) It’s a wait and see situation and may be weeks instead of days.

What is Encephalopathy?Encephalopathy is a term for any diffuse disease of the brain that alters brain function or structure. Encephalopathy may be caused by infectious agent (bacteria, virus, or prion), metabolic or mitochondrial dysfunction, brain tumor or increased pressure in the skull, prolonged exposure to toxic elements (including solvents, drugs, radiation, paints, industrial chemicals, and certain metals), chronic progressive trauma, poor nutrition, or lack of oxygen or blood flow to the brain. The hallmark of encephalopathy is an altered mental state. Depending on the type and severity of encephalopathy, common neurological symptoms are progressive loss of memory and cognitive ability, subtle personality changes, inability to concentrate, lethargy, and progressive loss of consciousness. Other neurological symptoms may include myoclonus (involuntary twitching of a muscle or group of muscles), nystagmus (rapid, involuntary eye movement), tremor, muscle atrophy and weakness, dementia, seizures, and loss of ability to swallow or speak. Blood tests, spinal fluid examination, imaging studies, electroencephalograms, and similar diagnostic studies may be used to differentiate the various causes of encephalopathy.
Is there any treatment?Treatment is symptomatic and varies, according to the type and severity of the encephalopathy. Your physician can provide specific instructions for proper care and treatment. Anticonvulsants may be prescribed to reduce or halt any seizures. Changes to diet and nutritional supplements may help some patients. In severe cases, dialysis or organ replacement surgery may be needed.
What is the prognosis?Treating the underlying cause of the disorder may improve symptoms. However, the encephalopathy may cause permanent structural changes and irreversible damage to the brain. Some encephalopathies can be fatal