8/9/2006 Wednesday 17 Days Post Accident

            You had a restful and uneventful night. They took you off your ventilator support and you are breathing on your own without any problems.

            You are still pretty sleepy this morning as you are still on some sedation, however, the nurse says they are going to take you off the sedation sometime today.

            You still have a fever – 101 but you are comfortable and not sweating like you do when you have fevers.  Hopefully when you do come out of the sedation you will do it calmly.

            When I came in today I gave you a kiss on you cheek and told you I loved you.  You then put your lips together to give me a kiss too.  What a joy that was for me.

            This afternoon the nurse heard a heart murmur, so the Trauma team ordered an ECHO of your heart – this is a test to look at the blood flow through your heart and to look at each valve/chamber of your heart.  Then you will be getting an EKG – which is a tracing of the beating of your heat looking at each chamber.

            The ECHO of your heart showed you have a bicuspid (two) valve where there should be a tricuspid (three) valve which is evidently something you were born with.  You also have a pericardial effusion (fluid around the heart).  It also showed a “thickening” in the aortic wall which could possibly be a clot so the Trauma team has consulted Cardio/Thoracic surgery.  Dr. Byrne (Dept. Chair) will be coming to see you.  I’ll let you know what he finds.

            Dr. Byrne gave us two scenarios of what this could be without seeing the CT angiogram (which has not been done yet):

• 1.      This finding, the thickening on the aortic wall, is a fluke and the management would be a medical management.
• 2.      The thickening is a clot in the aorta which means there is a tear in the aorta which would require surgical intervention (open heart surgery) requiring you to be placed on a heart/lung machine.  This type of surgery also can cause some swelling of the brain so they would also do a CT of the brain to assess the possible risks to the brain.

Dr. Byrne’s “gut feeling” is this is a fluke finding as most aortic injuries present themselves with in hours to days after an accident.  We pray Dr. Byrne’s “gut feeling” is correct.

8/9/2006 Day’s End Report

            The CT angiogram did not show any tear or leak of the aorta and no clot.  The other CT’s you have had in review did not show any tears or leak of the aorta.  Your pericardial effusion has increased over the last couple of weeks so they are going to watch and monitor you for any signs of a pericardial tamponade (too much fluid in the pericardial sac around the heart) that would hinder the adequate pumping of the heart.  If that were to happen they would need to place a catheter into the pericardial sac to drain the fluid around the heart or the fluid could just dissipate. 

            We will pray for healing of the heart and for the fluid to decrease.  We love you!