Monday, June 21, 2010

welch update

Some of my friends and family have asked about Welch and how he is doing below is an update from his girlfriend today. I requested to her to get a caringbridge page so maybe soon she will. PLEASE CONTINUE TO PRAY. As you can tell from this info below he is very critical:

I’ll start at the top.
Welch’s head injury: Last week, Welch’s nurses would do a neurologic assessment every hour. Welch was able to follow command (wiggle toes or thumbs up/down). He wasn’t able to talk at this time because he was intubated. Toward the end of last week, Welch’s doctors felt the need to put Welch in a deeper sedation because Welch was becoming less sensitive to the original, short-acting sedative (propofol) and was becoming more and more agitated. As a result, his blood’s oxygen saturation would drop some although he was supported by the vent 100%. The doctors also placed Welch on a neuromuscular blocking agent (aka. paralytic called Nimbex) to prevent Welch from fighting with the vent, having the hiccups, or exerting himself in anyway.
Welch’s lung injury: Welch had a huge contusion on his right lung from the initial impact, probably from the airbag. Also, Welch had a pulmonary embolism (blood clot in his lung) about a week and a half ago. The blood clot likely originated in his broken leg as a result of the initial leg trauma. The embolism, about the size of a man’s thumb, lodged in a pulmonary artery that supplied blood to his lower lobe of his left lung. Welch was placed on heparin to thin his blood so that no new clots form. As far as the existing clots go, his body will slowly dissolve them in time. I’ve referred to Welch having “episodes”. What happens during these episodes is Welch’s oxygen saturation (the amount of oxygen bound to hemoglobin in his blood) drops despite being supported by the ventilator 100%, his blood pressure [BP] tanks to 70s/30s, and he bradys down to a heart rate [HR] of ~30 bpm. At this point, the ventilator is not able to support Welch’s oxygen demands. Welch’s body (BP and HR) slow down as a result of the decrease in O2 supply. As you might imagine, this is a life threatening situation. When this situation presents itself, Welch’s team takes Welch off of the ventilator and manually bags him. They are forcefully pushing air into his lungs, more so than the vent. This approach has been successful thus far but not a guarantee (he still needs tons of prayers). What they think is occurring is one of two things or perhaps both. The first possibility involves the original blood clot in his lung is breaking down. As a result, the pieces that are breaking off are lodging in other viable parts of his lung, reducing the amount of substrate available for oxygen transfer from his lungs to his blood. Since his lungs are already in such bad shape, he can’t afford to sacrifice any viable lung space and therefore, his O2 sats drop. The second possibility is that small clots that were formed (likely in his broken leg) prior to the heparin are being dislodged and making their way to Welch’s lungs. Welch does have a IVC filter (inferior vena cava filter) that acts as a little basket to catch large clots that are traveling from his legs en route to the lungs. Smaller clots are still allowed to pass through the IVC filter or break off from the larger ones trapped by the filter. When these episodes started occurring, the doctors wrote orders preventing anyone from moving or turning Welch. Any little disturbance, can set a clot in motion. In the same regard, these episodes can happen without any physical disturbance or warning. We can’t predict when they will happen, for how long he is at risk for an episode, how large these clots will be or how difficult it will be to get his O2 sats back up. Since Welch can’t be transported, he isn’t able to have a CT scan, which might be able to provide a few answers. So, it is just a “wait and see” situation. Welch has also had a series of infections (blood, urine, respiratory) and was on several antibiotics. The infections seemed to clear up but currently, Welch’s white blood cell count (cells involved in the immune response) is elevated and continues to rise. The doctors aren’t exactly sure what is causing his immune response because they haven’t been successful in culturing any bacteria from samples from Welch. Welch’s kidneys are in acute renal failure and so he was placed on continuous renal replacement therapy. There is no clear prognosis of his kidney function at this point. Once again, we wait and see. Welch has a broken femur and is currently in traction. It will eventually be resolved with surgery once he is stable enough.

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