Posturing and VS changes

[kimmie518]

I'm confused and need some advice about a patient of mine today. So if anyone could give me some insight that would be fantastic! FYI- I'm a new grad off of 3 days off of PICU orientation with little neuro experience.

The patient- Shaken baby. Multiple brain bleeds. Possible Infarct. NA- 160s (during my shift confirmed in DI). Half of day pupils were 5 (left) and 4 (right) and NR. Half of day 3 bilat. + clonus activity. + nystagmus. Pt intubated but no sedation.

Mostly throughout the day, whenever he has been resting, he has been posturing (more decorticate). VSS and I agree with that. Now periodically during the day, he would have these "episodes". His BUE and right legs would jerk un-rhythmically, eyes would dart, desat to 60-70's and HR would dip to the 90's (he would sit 110-120s). I had to bag him cause he turned blue once, sats in 30's, HR 70's. + fighting the vent. After these "episodes" he would chill out and his clonus would go away for a little bit.

An EEG was done overnight, and according to Neuro, this was not seizure activity. According to our PICU team, he was not having seizures. This is all related to his posturing. He's on phenbarb and his levels were wnl.

So my question is, have you ever seen this kind of "episodic posturing" that is intermittently present and is accompanied by VS changes? I've never heard of posturing itself (not herniation) having a change in VS.

I kept bringing it up to our team and they're sticking with the fact that it's related to him posturing. Neuro's going to repeat an EEG tomorrow though....

Thank you for any insight/advice!

[ccc2066]

Look up the true definition for Agonal breathing. Sounds like that's what was happening.