Recovery: 3rd Surgery 2nd & 3rd Day

6.6.12

Wide awake! 6.7.12

And sleepy. 6.7.12

Well our little warrior is making teeny tiny bits of progress each day. Overall, his numbers look great. His oxygen saturation, heart rate, and arterial blood gas numbers look great but his pressures are still high and his function is still moderately to severely depressed.  


They plan to take out his Foley catheter tomorrow and his chest tube on Saturday. They want to leave his Foley in because of the diuretics he is on and because his Central and Arterial lines are in his groin. He was getting Lasix every six hours yesterday to help his swelling come down and pull out extra fluid. This made him put out almost 400 mL more than what he received, so it did what they hoped. So he is now back to getting it every eight hours because they do not want to dehydrate him too much. Despite two Pas, two nurses, and Dr. Wilmot manipulating his chest tube, it has put out next to nothing since 7:00PM Monday. Even though it really isn't draining any fluid, the doctors want to leave it in until they begin feeds. They have decided to do this to test if he has Chylothorax (leakage of lymphatic fluid of small intestine). If he does, then a milky substance will leak into his chest tube. This is a possibility because the area that the surgeon repaired is close to the small intestine and sometimes (not often) it gets nicked but we are hoping this is not the case because it could lead to more problems down the road. With that said, they intend to start feeds tomorrow. They are going to start on a slow continuous rate through his J-tube. Hopefully he is able to tolerate it. So he is still on TPN but at a rate of 12 mL/hr (instead of 10) and Lipids at 1.5 mL/hr.


He is slowly being weaned off the ventilator and as long as his heart can tolerate it and his lung gets better, he should be off it by Sunday... we'll see. His left upper lobe is partially collapsed and the doctors think it is because he has a mucus plug. Since it has not gotten better the last two days, he will be getting a medication, Pulmozyme, to break down secretions and allow air to flow better. But this morning the tape from his breathing tube was cutting into his mouth, causing it to bleed, so the respiratory therapist changed the position of the tube over to the right side. With this, Cael got upset and had some good coughs. Jennifer suctioned him and a huge, think, blood-tinged wad of mucus came up through the tube! It was disgusting. But hopefully that is what needed to come out to help his lungs. He will get another chest X-ray tomorrow so we'll see if it looks any better. But his rate is down to 16 breaths per minute and he is doing a good job of breathing over the vent. His oxygen level is at 26%, so really close to room air (21%). 


His EPInephrine (adrenaline) was turned off this morning at 9:53AM and he has tolerated it. He got an echocardiogram at 2:00PM and Dr. Wilmot said his function looked about the same; however, he viewed this as an improvement because Caelin's heart no longer has the assistance of EPI and his Nitroprusside (NiPRIDE- blood pressure medication) is lower than it was on Tuesday during his last echo. So it is a good sign that his function has not gotten worse with these adjustments. Although Cael is doing pretty well, Dr. Wilmot might increase his NiPRIDE again because his pressures are still high (systolics in the 80s and 90s) and he wants them in the 70s.


His Morphine drip went from 0.2 to 0.1 yesterday and he seemed to do okay with this. He also got put on a scheduled low dose of Versad to help keep him relaxed. He is still able to receive PRN/bolus doses (acronym for 'pro re nata' meaning "in the circumstances" in Latin) of Morphine, Fentanyl, and Versad if he needs them.


He has had a couple instances where he gets uncontrollably upset. This happened once last night for no known reason and twice this afternoon from suctioning his breathing tube. During these events his face turns the color of a blueberry, his heart rate spikes to the 190s, his pressures to the 130s/140s systolic, his oxygen saturations drop to the 60s, and he forces fluid out of his chest tube. Two of these three times he had to receive extra sedation because he was taking too long to recover on his own. When he gets this extra sedation, he looks stoned. I have yet had the heart to take a picture of him when he looks like this because he looks so goofy. Also, it's been rainy outside and more dark in his room to help keep him calm so it has been more difficult to get good pictures. Hopefully getting out his Foley, chest tube, and/or breathing tube within the next couple days will help his comfort level increase.


So little baby steps is what he is taking and that is exactly what he needs to do. We are so proud of Caelin for working so hard to make progress! He is hearing and responding to all your support!