Plan for the Day

Connie's bleeding slowed down, but his crit continued to drop some, indicating that the bleeding was still going on, just that the chest tube had clotted. He has been given a total of 4 units since coming up to the ICU and has orders for more today. His numbers all look great except for his crit, but the x-ray was very telling this morning. His left side looks terrible so they ordered a left chest tube to be put in and he will be having a fogerty (sp?) procedure done to try to unclot the mediastinal chest tube. The surgical resident feels like this will be the help he needs to get moving in the right direction. Once he relieves some of his pressure on the left side, his bp should come back down (it's been slowly creeping up all night). They are keeping his minimal pressure support (dopa at 6) until he's proven himself after the procedure. Sedation-wise, he's stayed relatively stable overnight. He's had PRN's of morphine and ativan and had to have a little versed during x-ray and weighing and rounds due to being messed with so much. He started arching his back and looked like he was crying. Of course you can't hear anything when he's intubated. It only lasted 10 or 15 seconds and then he was restful again after the versed. He seems to like the dex. I'm so glad we found something he does well with instead of a constant battle to keep him settled. At least with him settled, we can focus on the bleeding and drainage. He's been given so much fluid that his feet especially are starting to balloon so they will start Lasix today Q6.

So, if he can get his pressure down a bit after they insert that left chest tube and unclog the middle one, they may try some sprints off the vent and eventually extubate later today. It really depends on what happens with this bleeding.

One new bit of information I learned during rounds was that during his TEE yesterday (the echo they do in the OR after the operation) they noted that he has LV function is "severely depressed". What?! Why did I not know that before. The resident on this morning explained that they think it is just an issue due to all the "monkeying around in there" yesterday and thinks that if they were to do one even now they would see that improved. He said Connie is not acting like a kid with a severely depressed LV and he's showing them he's fine through his numbers and the minimal amount of support he's on. That's somewhat reassuring, but I don't think I'll really feel better until I hear words like we did on Monday telling me that his LV function had been preserved and looked great.

Prayer focus for today needs to continue to ask God to help with this fluid issue, mainly blood loss, and that his LV will kick back in and recover fully from this operation. Also, please ask God to give me patience as I'm in such a rush to extubate him so that he can start waking up and show us that he's okay.

We've had great nurses and are so thankful for all their help. They really do a great job taking care of the sickest kids in the world. There are 21 PCTU patients right now and only 15 beds. They have kids in PICU and NICU and all over the place b/c they just don't have room for all the cardiac kids in one place. Tawnya, it was Kelli V. and yesterday was her last day. She's moving to Cali to go to NP school and be with her boyfriend, the CT surgeon. There's been some turnover here, but most everyone remembers us and that has been comforting.