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My dad is in ICU with 3 spinal injuries!

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    #16
    Update on my dad with 3 spinal injuries

    Thanks to all of you, I had the courage to stand up to the pessimistic trauma surgeon, and insist that we wanted to prepare my dad for transfer to Santa Clara's rehab unit. They were actually pretty funny (if it wasn't so serious)..... They started out saying that he was not a rehab candidate and that his Rancho scores were too low, and that his pressure ulcer would never heal (from laying on a tool belt too long before he was found), and that no neurosurgeon would consent to do his spine stabilization surgery--but when we mentioned that we had already spoken with Santa Clara and that it sounded like he was fine for them, they suddenly realized that his Rancho scores were great, and that his pressure ulcer would be healing soon, and that, amazingly, they had a different neurosurgeon who would be willing to do the stabilization surgery. They also went into great detail about how fantastic Santa Clara is, and that they refer all their rehab candidates there..... ODD! This meeting happened on Wednesday.

    They put in Dad's trach on Thursday, and on Friday his stabilization surgery was done--from above T5 to below L1.....Huge surgery, but apparently very successful. As soon as the pressure wound is healed, he should be ready for transfer to Santa Clara.

    Questions now:

    1. Any suggestions to speed up the pressure wound healing? (it's on his sacral area)
    2. Anything that can be done to minimize pressure to that area when he's sitting up? He's on the special bed now that constantly changes the pressure points...Is there an equivalent item that can be used for the seat of a cardiac chair?
    3. Any suggestions on minimizing the possibility of surgical wound infection? That's what the neurosurgeon who did the surgery is the most worried about....

    Thanks so much for your support and ideas!

    DorAnne

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      #17
      DorAnne,
      Sorry no real answers to your questions. I just want you to know that you and your family are in my thoughts and prayers. I am so glad he is doing better.

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        #18
        As you say, if it wasn't so serious it would be hilarious...........

        ......... what a bunch of hypocrites!

        I hope he makes a quick (in SCI terms) recovery.

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          #19
          Wow. Like Timaru says.
          Good for you for being an effective advocate.
          As to the pressure sore, it's not so much a matter of minimizing the pressure on it, it's a matter of eliminating all pressure on it, all the time, until it is healed. That may present all sorts of difficulties, but really, I don't think there's a choice. SCI-nurse will likely have advice for you on that.
          - Richard

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            #20
            He should be on either a low air loss mattress or a Clinitron, not an overlay alterating pressure pad, which is pretty much worthless. If on a LAL mattress, he should be manually turned every two hours and NEVER allowed to lay on his back, and this includes having his head up. Unless absolutely necessary to have his head up for ventilator precautions, the head should be kept flat. He should not be sitting in a cardiac chair at all. Insist on getting a good quality reclining wheelchair, and that a custom back cushion be designed to keep all pressure off his sacrum when sitting (horse-shoe cut out of foam, never a donut).

            Nutrition is critical. This should include a high calorie high protein diet. He should also be on a multivitamin. Insist on a wound expert consultation for help with dressings. It can take a long time. Was the tool belt really under his sacrum?? Sacral pressure ulcers are most commonly caused in hospitals by not turning the patient or having them on the correct surface from the beginning, and from keeping the head of the bed elevated too high.

            (KLD)
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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              #21
              Correct me if I am wrong, but I don't think he has to wait until the pressure sore is healed to start rehab. From my experience it is best to get into rehab as soon as possible. My husband had a pressure sore on his coxsys, rehab continued, wound care nurse looked at it daily. Had we waited it would have been months. She told me it would take 2 years for the skin to return to "normal"

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                #22
                For God's sake don't listen to BeeBee! Fight the fight! Get a GOOD lawyer to make sure your insurance provider is getting you all you are entitled to. They will do everything they can do to make you think thry will do everything they can, when all they really care about is their$! And keep on prayin'! If my wife wouldn't have done just that I wouldn't be here today to enjoy every sunrise, my kids and grand kids, my wife, friends, and A GREAT LIFE! Bless you and your family
                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"

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                  #23
                  I think Kittim is right on rehab. I was still on a vent when my rehab started at Craig Hosp. in Denver. Check them out! They don't believe in can't!
                  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"

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                    #24
                    Help! Now they want to transfer my dad to a long-term medicare hospital

                    Based on a family conference last Wednesday, I thought we had a plan in place that this hospital would keep my dad until his decub was healed, and then he would be transferred to Santa Clara. Now, even though I was at the hospital for most of the day, the lead doctor (who we went against by insisting that my dad be kept alive) waited until I and the social worker were gone for the day before he approached my mom to tell her that my dad needs to be transferred to this other facility (Kindred--a long-term ventilator facility that is funded by medicare) by tomorrow. My mom put him off for a couple of days, but I'm very concerned that this might jeopardize our chances of getting him to Santa Clara. Do you know anything about this? Santa Clara has said that they want to take him while he's still on the vent, but they do not accept open wounds.

                    In addition, today I found out that they have him on a low air loss mattress but they keep putting his head up, and apparently this afternoon they had him sitting up out of bed, in a cardiac chair... SCI Nurse specifically said that he should NOT be on his butt until his decub heals. I asked the nurses about that, but they didn't agree at all....Do you have any professional guidelines or research literature that I could cite to get them to be more careful with his skin? They just seemed to indicate that what I was saying was my preference, but their experience was that the way they were treating him was fine....that's why I'd like some printed material to share with them about SCI Nurse's recommendations.

                    Thanks
                    DorAnne

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                      #25
                      I'm hoping that the nurse will chime in but I wanted to say -- Insist on your your father's rights! Don't let them bully you around!
                      Daniel

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                        #26
                        You will have to be VERY proactive in his care. State your wishes and his needs and be persistant. Unfortunately, not all ICU nurses are aware of SCI needs. Getting him up is great for his lungs and blood pressure, so I would think that was their plan, but not so good on his skin.

                        I asked the nurses about that, but they didn't agree at all....
                        When you know you're right, don't ask, TELL. But, be sure you're right. It's very easy to make mistakes early on and sometimes there are trade offs.
                        Also, you really shouldn't leave him in their care for long periods. I know you should be able to, but if doesn't have an advocate there, things can happen fast.

                        I've had dietary bring the wrong meals, leave meals across the room, alarms ignored, no turning for hours, wrong meds or meds left across the room, foley pulled out and left to drip, vomit left on the floor... And this was in a good, Trauma 1 facitily ICU. Nurses get busy or fail to read the full chart, etc.

                        I wish the best for your family. This is a really hard time and you have to be very physically proactive while dealing with major emotional trauma. Is he able to talk yet? When he gets a speaking valve, it will help a lot in his care and his mental status. What about nutrition? If he is unable to eat very well, you need to ask about a feeding tube. Skin damage takes a lot protein to heal and the spinal surgery needs calcium, and just a lot of calories to heal.

                        Take a look at the CARE forum. There are some Sticky threads with care guidelines and great information.
                        BeeBee

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                          #27
                          The wound care nurse at the hospital should be your friend in this. Print the clinical practice guidelines on Prevention and Management of Pressure Ulcers in People with SCI you can find on as a sticky on the Care forum.

                          Avoid going to Kindred at all costs. They are a chain, essentially a nursing home, and at least in my area notorious for their poor care. They know nothing about SCI, and less about wound care. He will only go downhill there. They take care of people with COPD and in comas on ventilators primarily. Call Santa Clara Valley back and ask to speak to someone with some authority.

                          Call the patient representative at the hospital where you are. Complain about his care (ie, the sitting and leaving him on his back sitting) all the way up to the hospital director. Don't be put off. You or someone from the family needs to be there 24/7 at this point. Refuse to move your father. Request a meeting with the head nurse and director of nurses, the medical director and hospital director. They gave him the pressure ulcer, and if your father is on Medicare, they know they will not get paid for days of care that are caused by this anymore. That is why they are trying to shove him out the door.

                          Insist that he not get out of bed. He has the right to refuse this (and anything else that is unsafe), so get him on board NOW. If they get him up or turn him onto his back in spite off his refusals, legally it is assault. You may have to see an attorney.

                          (KLD)
                          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                          Comment


                            #28
                            I am so sorry that you have to go through this, in this country, in this day and age. I can feel for you-we were given no advice at all during any of my treatment, etc.. Definitely make noise. Remeber that your father deserves the best care right now. Don't worry about hurting feelings. They will get over it. Good luck-sending positive thoughts your way.

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                              #29
                              Originally posted by SCI-Nurse
                              You or someone from the family needs to be there 24/7 at this point. Refuse to move your father. Request a meeting with the head nurse and director of nurses, the medical director and hospital director. They gave him the pressure ulcer, and if your father is on Medicare, they know they will not get paid for days of care that are caused by this anymore. That is why they are trying to shove him out the door.

                              Insist that he not get out of bed. He has the right to refuse this (and anything else that is unsafe), so get him on board NOW. If they get him up or turn him onto his back in spite off his refusals, legally it is assault. You may have to see an attorney.

                              (KLD)
                              DorAnne, I've been following your questions and keeping your family high on the prayer list. What KLD says above is just stunning to me, and makes me wonder if you happen to know anybody in the media. The hospital doesn't need bad press. If I were you I'd do exactly what KLD suggests, and I'd also make it clear that I'm documenting everything that happens. They will hate this, or at least some of them will. I know from personal experience, though, that it really matters to be seen as somebody who is taking notes and taking names.

                              I personally think it's borderline criminal to suggest that a family give up on someone so early after a neurological injury. These injuries by definition are not easy to categorize or predict, as many, many people here can tell you.

                              The most important thing is for someone to be there 24/7 -- and it sounds like your mom ought not be left alone to fend off the doctors.

                              Hang in there! We're pulling for you.

                              Comment


                                #30
                                DorAnne, I've been following your Dad's progress here too. SCI-Nurse KLD and Kate hit the nail and I wish you and your family all the best dealing with this hospital.
                                get busy living or get busy dying

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