Day 2

1445: Physician at the bedside. The client is sedated, receiving mechanical ventilation via the #8 endotracheal tube. Current ventilator settings: assist control; rate 12/minute; tidal volume 450 mL; FiO 2 100%; positive end-expiratory pressure (PEEP) 5 cm H2O. Intraventricular catheter present and zeroed and calibrated. No purposeful movement, and pupils were 3 mm equally round and sluggish to light. No abnormal posturing. + gag reflex; + corneal reflex. Lung sounds clear bilaterally, and the chest rises and falls synchronously with the ventilator. Peripheral pulses 2+ and S1 and S2 heart tones. Normoactive bowel sounds in all quadrants, no abdominal distention. Skin warm and dry. Indwelling urinary catheter patent and draining clear, concentrated urine. The client is currently positioned in a semi-Fowler position.

Day 2

1515: The client was admitted yesterday evening following a 30 feet fall while on a ladder. Was notified by nursing about multiple episodes of increased intracranial pressure of 22-28 mm Hg and some seizure activity. Currently, ICP is 11 mm Hg. Computed tomography scan of the head showed a large subdural hematoma in the frontal lobe. The client remains sedated and receiving mechanical ventilation via an endotracheal tube. No purposeful movement when sedation was paused.

Day 2

1530:

• 0.45% saline infusion at 80 mL/hr
• Increase PEEP to 15 cm H20
• enoxaparin 40 mg subcutaneously, daily
• levetiracetam 500 mg intravenous piggy-back (IVPB) every twelve hours
• Intermittent pneumatic compression devices to the lower extremities
• Repeated computed tomography (CT) scan in 24 hours