The current view of my world today
Day 2 and Day 3 have been a little turbulent.
The big news from rounds during Day 2 was that they are going to keep him sedated and paralyzed for the entire week until they do the first trach change. He just moves and thrashes too much when he starts to come off sedation and the trach needs to heal. I understand, but I don’t like him being on a vent that long.
Too many things can start to happen when your that medicated and on a vent.
Yesterday morning we moved to a different room in the PICU. Things seemed to take a turn after we moved. He began to have episodes where his peak pressures go up to the 30’s and he starts to de-sat. Once he’s suctioned his pressures drop a little and his sat’s come back up. You can literally feel the secretions when you feel his chest. 🙁
To help with secretions he was ordered breathing treatments with Albuterol and IPV every four hours, and he has really responded well to the breathing treatments.
Throughout the day, after all his episodes of de-sating his was maintaining a sat of 94. But, after his first IPV he went up to 96, after his second he was holding strong at 98, and then it was 99 all through the late night and early morning. So, we hit a small victory there!
To add to the list two nurses kept trying to get a second IV last night; they were unsuccessful. Later they ended up calling another nurse who was able to get one in. And then they couldn’t get his feeding tube in without kinking it. Neither of these alleviated my stress last night. I just wanted them to let him rest. Neither one was a necessity last night.
The less exciting news from Day 2 was that they put some gauze over his eyes to help keep them closed. He gets gooped up every two hours to keep any exposed part from drying out. He is so drugged up he’s sticking out his tongue and not closing his eyes.
Before that happened I went out to grab a bite to eat, while I was out I stopped by Academy sports and bought a pair of running shoes since I didn’t bring any with me. There is a gorgeous 13 mile trail right outside of the hospital and I figured if he’s going to be sedated I can get out and get some exercise and fresh air.
As I watched him respond to the IPV treatments I was feeling a lot better. He is still real junky and coarse, but his sats were good and a lot was being suctioned out. They drew a venous blood gas at 4:00am and it looked great.
The nurse this morning came in and took out the kinked feeding tube and put a new one in. And the plan was to start getting some nutrition in him to help him heal and to make sure he doesn’t whither away. He’s a small boy, there isn’t much meat on his little bones.
BUT, of course something had to go wrong.
During rounds they decided to get a sputum sample because he is SO junky. I am still amazed that I can put my hand on his chest and feel how coarse he is. I don’t even need a stethoscope – you can’t do that with adults! The doctor also played with his vent settings and changed his I-time which brought his peak pressures down.
Anyway. The two nurses came in to get the sputum sample.
I have to pause right there for a moment because this is crazy to me! Where I work if a sample needs to be taken RT does it. If there is an x-ray on vented patient, RT is there to make sure the airway is protected. If the patient isn’t syncing with vent RT can make changes. I know every unit, ward, hospital has their own protocols, but the RT’s have been the ones who have improved his care every time they come in the room (I could also be slightly biased toward RT as well 😉 ). Problem is, they only come for scheduled treatments or when nurses call. They don’t really have much autonomy over their patients.
Anywhoo- back to the sputum sample. Two nurses were getting a sputum sample and one was bagging and dropping saline while the other sterile suctioned. As they were bagging and suctioning a HUGE mucus plug Jameson decided to de-sat.
I mean, he DE-SATED. From 88 to 4 in a split second. As they are bagging him I am totally feeling helpless. I’m thinking his pulse-ox is off, it’s not reading right. But, no, he was turning blue. Every person rushed to the room, the Attending, the Nurse Practitioner, two RN’s, his RT. ME. The doc turned his vent O2 up and gave him more PEEP and he came back up. It happened in a matter of seconds and he was back to 100.
And, I’m thinking, why didn’t anyone else crank that up? If they did I missed it. I am so thankful to work where I can touch the vent if I need to help a patient. My hands would feel so tied working anywhere else watching this.
While he was being bagged you could also hear air coming back out of his trach, so the cuff was filled up with more water (it’s a water sealed cuff).
Since that episode and those changes, his PEEP and cuff, he hasn’t desated once. And his FiO2 has been weaned back down.
Sooo, due to all that they haven’t got his feeds started yet.
The less exciting news from Day 3 is that he had a PICC line put in.
They drew blood to run a CBC and sent his sputum cultures off.
Still waiting on the CBC but the gram stain for sputum cultures showed gram positive cocci pairs, and gram negative bacilli. So, he has something brewing. They started in on broad antibiotics for now, and will narrow it done when they know which bug he has.
As a parent/family member this sucks to watch. But, honestly, nothing that has happened hasn’t happened with a patient I’ve had. So, I am prepared for this to get a little worse before it gets better over the next few days.
So, my boy is making these people work.
They can sedate and paralyze him all they want, but he is gonna get you somehow, lol.
Medical staff, let me introduce you to Jameson. He will light a fire under you.