Night 10-
Heart rate and BP spiked a few times tonight. HR in the 130’s, and BP systolic would go up to 150-160’s (up to 190’s 1x). They would like it less than 150 systolic. They think it is related to pain because after giving him extra doses of Dilaudid, his numbers would come down. Started giving oxycodone again as needed for the same reason (help with pain). He has a very large catheter in his Rt neck for the ECMO, a broken clavicle, and 2 chest tubes. So lots of reasons for discomfort. They also gave him a few doses of Labetolol to help lower his BP when it gets up higher. They say this can be common when coming off the Pentobarb, or “coma” med.
Will also see it when he starts getting weaned off the Versed.
Another thing that they watched and treated was his high urine output. He was putting urine out “by the gallons” the nurse said, or over 4 liters in 4 hrs. They think it is related to his high sodium levels and all the “third spacing” he has had. Now that his sodium levels are decreasing, his body is starting to finally release all that extra fluid he’s been storing.
Sodium levels tonight have been 158, 161, and 167. Going the wrong direction despite him not getting anymore sodium anywhere. These levels are being checked every 4 hrs.
To treat his excessive urine output, they gave him two doses of albumin for volume replacement. What this does is help restore blood volumes. The ECMO machine was showing “chugging, and lost flows.” So they needed to speed up the flows on the ECMO machine by giving his body more volume for it to work effectively. The Albumin did slow his urine output down. It was more the rate at what he was diuresing that was the concern. Ultimately they want him to get rid of the extra fluid in his body, just not so quickly!
A doctor rounded around 11pm and and checked the chest tube drain. She said it still had an air leak. Made aware of extra Dilaudid doses given tonight, and excessive urine. Going up on feedings tonight to 30ml/hr. Will repeat his chest xray in the morning again.
Per nurse, will most likely start weaning Versed (sedation) tomorrow. Is still a very high dose. His continuous Dilaudid dose is a more normal amount. He could potentially start showing seizures coming off Versed because it can mask any seizures while he is so sedated. They will start weaning during the day when more doctors are around in case of this. He is still on Kepra for seizure prevention, but they can give him other meds if needed.
They still are drawing multiple labs on him through his arterial line every 4-6 hrs. His potassium level was a little low (3.7) at 1am, so they have given him a few potassium supplements. Normal is 3.5-5. Repeat was 4.1 (yeah!)
Temperature went up to 37.5 at 0300 (99.5F). Has put out 5L of fluid by this time as well. He has not been on a diuretic for a few days.
He has not needed any blood, but I learned that they always have blood on hold for him. The order expires after 3 days, so they renew that at midnight on the third day.
Blood sugar this morning was 83. A little lower than what they want, so they are going up on his feedings to 40ml/hr. Blood gas showed improvement. His PH is 7.39 (good), CO2 is 55 (improved) but Bicarb still elevated. The nurse said it could be because his lungs are still acidotic, and because of all the urine he’s had out.
The nurses here have been great and tell them when they are doing something. I liked how one of them
tonight in her sweet voice would say “I’m going to do this, my friend,” “you are safe Seth,” “you’re okay friend,” etc. [P.S. Hannah here–the nurse a couple of days ago told Seth “Hi Seth, it’s your nurse Nalamie. It’s 2pm on April 10. You are safe. Your big sister Hannah is here with you. She loves you very much.” And I loved that! Hoped he did too <3]
Fun fact, a code ”stork” here means someone is delivering a baby outside the L&D unit. In this case, it was in the front lobby tonight!
Overall, Seth is still very stable. It’s such a balancing act with everything in the ICU. They’ll fix one thing, which then will lead to needing to fix another thing, and another. I’m amazed at how much autonomy the nurses have, and all their resources readily available. He is down to 2 nurses now whose sole care is Seth (instead of a third neuro nurse).
To act on the high sodium levels, they are back to doing 1 cup of free water flushes every hour. Next check is 0800. His total urine output tonight was 5.9 liters (a lot!). They would expect to have to replace his electrolytes with all the urine he is spilling. Blood sugar at 0600 is 84 (Good) They want this >60. Kidney and liver function still looks good.
6:42am Nursing is going to bring up getting a CT scan sometime due to his bolt coming out and his Pentobarb being stopped. Just not an easy thing with ECMO to get to CT. Chest xray this morning showed improved lung expansion on the Rt side! So more than likely that hole is closing up.
Prayers for today:
1) Lower sodium levels
2) Improved Rt lung on xray
3) Urine output within a normal range
4) Normalized vital signs
5) Decreased pain for Seth
6) No seizures when he starts getting weaned off of Versed
-Aunt Kerry
Crosswalk Kids made some cute drawings for his room a couple of days ago. These are some of Aunt Kerry’s favorites.
Leave a Reply