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Thread: My dad is in ICU with 3 spinal injuries!

  1. #41

    Update on SCVMC

    I met the SCVMC nurse this evening...had a meeting with her and my mom, the social worker from the hospital, and the discharge planner RN. Bottom line, the wound is too deep for SCVMC to take him yet. However, she definitely wants to work with me to get him to SCVMC ASAP--she explained that if they take him now, he will "use up" his rehab days and then he won't have enough days available later when he's ready for full rehab. Their policy is to avoid ALL pressure on pressure wounds, so he would not be allowed to sit or lie on his back at SCVMC...hence, only minimal rehab for probably a couple of months.

    She (SCVMC RN) wants him in a sub-acute unit that will focus on clearing up his pressure wound while maintaining his lung health (either wean him or not, she doesn't care). She reviewed the pictures of his sacral wound...the first one was taken 1 week after admission, and it was very dark or black in the center, probably 2" across, with red streaks going out from the wound. SCVMC RN says that this facility is usually extremely good about avoiding pressure wounds, and given the necrosis of the tissue, she believes that the wound probably started from the time my dad laid on his tool belt at the time of injury, and then on the backboard for a few hours. I could believe that, since the nurses were good about turning him at least every 2 hours during that first week, and and the HOB was always flat because of his unstable spine.

    Anyway, SCVMC RN gave us a recommendation of 2 subacute units (NOT Kindred) where she has visited and has seen good results from their skin teams..... So I'm planning a road trip tomorrow to visit the 2 facililties, unannounced, and see what sense I get from them. She has promised to remain in touch with me throughout the healing time, and is enthusiastic about helping me get my dad to SCVMC as soon as the wound heals.

    In the mean time, I was able to mention my concerns about skin care to the discharge planner and social worker, in front of the SCVMC RN. I was able to quote the guidelines I've been reading, state the requests that I've made that have been ignored, and then turn to SCVMC RN to ask her what their practice is....and each time, SCVMC RN affirmed that my request was their standard of practice. Bottom line, DC planner and social worker apologized for the problem and promised to take my concerns to the "trauma rounds" team meeting tomorrow morning, and get the problems corrected immediately. HURRAY!

    An ironic story from today (and proof that my dad is completely "with it" now: He was sitting up in a chair (ugh) with a brace covering his chest and abdomen, and I noticed that his resp rate was consistently 40 breaths per minute, with tidal volume of only about 350 cc (prior to spine surgery his tidal volume was over 800). I was trying to coach him to take slower deeper breaths, and I could tell he was trying, but he could only get up to about 450 cc. Finally, he mouthed "I can't." I asked him why, and he pointed to his chest/abdominal brace (I can't remember the technical term for that thing, and I thought the neurosurgeon said he didn't need it since all of his broken thoracic vertabrae were fused)......The ironic part was that the nurse this morning told me that he had to sit in the chair because his breathing is more important than his skin, but sitting in the chair was actually interfering with his breathing because they had put that silly (and I think probably unneccessary) brace on him..... And no one noticed the resp difficulty--my dad was the smart one who figured it out and communicated the problem! (and to think that "Dr. Death"--my new name for the head trauma surgeon--tried to get us to snuff him the first day!)

    OK, I could probably go on forever..... Thanks for all your fabulous ideas! If you don't mind, I'll keep posting updates, so you can help me keep him on the right track!

    DorAnne

  2. #42
    You said it DorAnne: HURRAY!
    I'm so glad everything is coming together for you and your dad. What a whirlwind. Way to work the RN in your favor, that's what it takes! Good job. All the best today, I hope your surprise inspection is favorable.

  3. #43
    Senior Member canuck's Avatar
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    Make sure the DC planner & the social worker follow through with their promises & action is taken. Its one thing to promise something in a meeting entirely something else to actually see things getting done. I trust you are taking notes at these meetings as to who said what & when. Yeah I'm cynical but I've spent a lot of time around hospitals & goverment, you need to document everything so you have proof when someobdy says "nobody told me that"

  4. #44
    Good for you! I hope you are feeling really empowered and good about being such a great advocate for your dad!

    Many people with tetraplegia can breathe more easily laying down, or even in trendelenberg than they can sitting. This is because in the seated position the diaphragm is in a position to be adversely affected by gravity, and when laying down it is in a gravity-neutral position. If they are sitting him to try to get him breathing better, that is a mistake. He doesn't have COPD. Also ask about what exercises they are doing for diaphragm strengthening when he is off the vent. He should be using a Pflex and/or abdominal weights for this.

    Is the area of the pressure ulcer completely bridged with foam or some other way of keeping all pressure off the area?

    Keep in touch and let us know about your road trip.

    (KLD)

  5. #45
    Senior Member Dave E's Avatar
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    Check out Craig Hospital in Denver. MRSA does not matter. Pressure sores don't matter. They are THE BEST! You also should never get kicked out durring rounds. This is your time to ask question to all of the team working with him. If they want you out, They are hiding something. They may ask you to leave durring shift change. But then you know all this being a nurse. Keep up thr fight!
    Dave E. C6-7 Incomp. Quad 9-06

    "NEVER LOSE SIGHT OF YOUR DREAMS!"
    "THERE IS NOTHING BETTER FOR THE INSIDE OF A MAN / WOMAN THAN THE OUTSIDE OF A HORSE"

  6. #46

    Update: My dad has graduated out of ICU!

    Hi everyone!

    I haven't posted an update for awhile, because I've been pretty busy trying to keep life going as well as spending time with my dad..... The good news is, he was transferred today to a rehab hospital, but as a "long term acute care" patient. The goal is to get his pressure wound healed and keep his lungs clear, and then transfer him to Santa Clara. We chose this facility because it is a rehab hospital in addition to long-term acute, so he will get all the rehab therapies during this time, even though he isn't technically a rehab patient--so he'll be able to get even more rehab than if he had gone directly to Santa Clara. AND the physiatrists here trained at Santa Clara....

    We left the neuro trauma ICU hospital at a good time. After our fury of communications last week, my dad was the topic of their trauma rounds and overall (except for one nurse) I was quite pleased with the care that he got for the remainder of his stay there. I began to realize that it was a culture clash between his critical care needs and his rehab needs, and after it was brought to their attention, I think the staff did a good job of balancing the 2, sometimes conflicting, types of needs.

    As we left, they all (including "Dr. Death") asked that we keep in touch and let them know how my dad does with rehab. Even though the doctors didn't agree with our decision, they really did put a lot of effort into caring for him. The social worker mentioned that, if my dad does well, it may just change some of the dire recommendations that they give to families...so I'm cheering for my dad's success, not only for him, but for all the future patients who are taken to that trauma facility.

    BTW, he's been off the vent since last friday, and we had some conversations today using a speaking valve (Passey Muir)..... He's talking in complete sentences, but I don't think he's completely oriented.... Hopefully that will come with time.

    Thanks for your ongoing supportive messages & ideas...... I'm sure that I'll have many more questions as we get into the rehab experience!

    DorAnne

  7. #47
    Hi everyone,

    You were all so wonderful during our time of distress last fall and winter.... I wanted to give you an update with wonderful news!!!!

    My dad was discharged home on March 13, 6 months to the day after his accident. Today he and my mom drove off for their first road trip since the accident--going for a week to visit some friends and attend a reunion at the church they attended in the 70's.

    After the month in ICU, he ended up going to a wonderful long-term acute facility with a fantastic rehab program for a month, acute rehab at a general hospital for a month (that was a waste of time) and then 3 months at a SNF with a rehab program that was far superior to the acute rehab unit. He spent another month working with home health rehab, and now he's going in for OT and PT twice a week at a rehab clinic.

    We were never able to get him into Santa Clara, but I remained in contact with the Santa Clara intake nurse, and she assures me that he is doing as well now as he would have if he'd gone to Santa Clara.

    He has no sensation and only trace movement below his knees, but he's regaining bowel and bladder control, and his decub is completely healed. He's able to stand (supported) for longer periods of time, and even spent a 1/2 hour splitting wood last night!

    I really want to thank everyone on this forum--you are truly life-savers! My dad is very grateful for his life, and you all gave us the courage to keep fighting on his behalf when it all seemed so pointless.

    Blessings to you!

    DorAnne

  8. #48
    Thanks so much for the update and the positive outcome. You should be proud of your dad! So often people ask questions and never come back and we are left wondering how the person is doing.

    (KLD)

  9. #49
    I didn't read this entire thread, so I don't really have the whole story, only the beginning and what you just posted today... So... that being said..

    Aren't you glad you didn't listen to that first dr and pull life support??? I have the utmost respect for physicians, but don't always believe everything they say..

    CONGRATS!! Sounds like dad is doing great!
    AB, Husband is c5-6 inc quad, 25 years post injury.

  10. #50
    Such great news!

    This thread made my blood boil and my heart soar at different times. Pat yourself on the back for being such a great advocate.

    Best wishes!
    Ugh, I've been kissed by a dog!
    Get some hot water, get some iodine ...
    -- Lucy VanPelt

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