September 12 Update 1

I apologize for this update being so late in the day. We needed to consider a decision about what to do next for Kirk. We have the results of his CT which was done with contrast. That shows that the blockage in the vein leading from his brain out of the right side is enlarging. Because spinal fluid enters the blood stream from the brain, the reduced exit flow is likely what is causing his ICP. So the choice we had to make was to try drugs to break up the clot or wait.

Risks of trying to break up the clot include bleeding elsewhere in the brain. This is a high risk on Kirk because we can't do a neurological exam on him which means we would not know until he had a bleed in his brain until it was very large. The only way to check for bleeds on him is using a CT every 24 hours. On someone not as deeply sedated, regular neurological exams can be performed to detect the effects of other bleeds. Another risk is his ICP monitor in his head. It is inserted through his scalp and skull into a ventricle in his brain. It alone can cause a significant issue on a strong anti-coagulant. One more risk, which exists anyway is that part of the clot can break off and migrate to somewhere else it isn't wanted like the lungs or elsewhere in the brain.

Risks of waiting include the continuing possibility of high ICP and the fact that the clot continues to increase in size down his neck. Also the vein on the right is usually the larger vein taking more flow than the left so the left is really being overworked.

So we have decided to wait at least 24 hours to see if we can get him off of the pentobarbital and controlled by other drugs. I don't know if that will be enough for us to do neurological exams. I also don't know about the ICP monitor. So we will talk about it again on rounds tomorrow and see where we are.

Otherwise Kirk is stable. His ICPs have been low today. He got another clean up and fresh sheets. We did another round of blood cultures just for monitoring because he still might have a fever even though he is only 91F. We are going to raise his temperature slowly while removing the pentobarbital. His femoral line is still good and he is able to get all the meds he needs right now easily.

Please pray for the doctors to have foresight and knowledge to guide me in making the next critical decision on Kirk's part.

Tonight is my night at the hospital. I hope it is quite for him and we can both rest quietly as close together as we can get for now.