The NCCU fellow and attending perform a bedside TTE. Fortunately, her global LV systolic function has mostly recovered, though there's still some mild inferolateral wall hypokinesis. We proceed carefully with BP augmentation, starting norepinephrine gtt for a target MAP > 85. This doesn't seem to produce any exam change, so we bump up that goal MAP to > 100. Now, the patient is more briskly awakening to voice and localizing to pain in both extremities. As a result, neuroIR has decided to defer intervention for now.
BP augmentation continues for another several days, after which it is slowly weaned, without any repercussions to her clinical exam. She later undergoes PEG tube placement.
By ICU day 18, her EVD has been able to be weaned and is removed. As she's been stable, cardiology is re-consulted. They recommend a repeat TTE, which shows a stable mildly reduced LVEF, along with inferolateral wall akinesis. They recommend initiating goal-directed medical therapy, with outpatient follow-up to determine whether a full coronary ischemic evaluation should be pursued.
Due to a persistently poor neurologic exam with inability to participate in therapies, she is discharged to LTAC on ICU day 28.
One month after discharge, she's able to tolerate a PO diet (though requires tube feeds to fully meet her nutritional needs) and gets her tracheostomy decannulated. At five months after discharge, she's finally made it home. Her mRS score is 3.
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