Monday, July 19, 2010

July 19, 2010


Well Saturday started off good. My mom came to visit Laura and stayed awhile. Laura's sats were relatively stable throughout the day, in which she would only de-sat a little when she needed to be suctioned. Because of the major lung problem, Laura gets a build up of secretions in her airway that requires her to be suctioned and get a breathing treatment every four hours or so. Whats usually a nice easy routine to suction a sedated person by passing a suction catheter down the breathing tube in any other person, is a challenge in Laura. The process of suctioning Laura involves pouring lidocaine down her breathing tube to numb her airway because if not her heart rate will drop drastically as she vagals out (another medical lesson for another day). Then because she has a lot of pulmonary vascular resistance, Laura's blood pressure skyrockets as her sats drop and her heart rate drops. The room fills will alarms as all of her numbers go up/down. I've been through this routine waaaaaaayyyyy too many times, and it is only the beginning. If all of the beeping doesn't make your head spin, try throwing in the beeping from the vent machine as it warns the respiratory therapist that the vent is disconnected, every two minutes. And if that's not enough, add in the beeping from the pumps (IV machines) letting the nurses know the infusion is complete. All beeps, each a different pitch, a different pattern, a different warning. And, just when you think you've head it all, a new one throws you out of line. Its been less than a week of sitting by Laura's bedside to hear an alarm go off and know exactly which alarm is going off and why it is going off, without having to look up from my puzzle book.

Saturday Night[mare]

As the night went on, Laura's sats continued to drop little by little and instead of suctioning her every 4 hours or so, the nurse and respiratory therapist would suction Laura ever 2 hour and still her sats wouldn't get much better. Usually, I would leave Laura's bedside around 10 pm if I was going home for the night and around 11 pm if I was sleeping at the hospital. This particular night, midnight rolled around, and I found myself still by her side because of her fair condition she was in. To me, Laura looked more on the bluish side. I didn't feel comfortable leaving her. That "motherly" instinct was kicking in, telling me to stay. The nurse and RT (respiratory therapist decided to suction her, yet again. I took my spot at the foot of her bed and watched her sats and held my breath as her heart rate went down and back up again, like it always does. And down with the tube, they went again, as I held my breath and watched her hear rate go down and then right back up again. One more time they decided to try and get more secretions up. And one more time they went down with the tube. Again I held my breath and watch as her normally 150's heart rate went down: 130's...the vent machine alarm started to beep...then 110...104...the monitor alarm sounded...98...70's...60's....50's. This time it wasn't coming back up. I felt my heart race and my body go numb. In an infant like Laura, if a heart rate is below 60, CPR is performed. The "extreme" alarm on the monitor went off as the doctor and another nurse came into the room. "Start compressions" the doctor called out. The code button was pressed as the loud, distinctive beeps were sounded throughout the CICU. That noise that makes the hairs on your back stand up, the noise of a child (as painful as it sounds), dying. Within seconds, the room filled with all of the nurses on the floor. I backed up into the corner, tears filling up my eyes, a few slipping down my cheek, I watched as they did a round of CPR. The doctor yelled out for epinephrine and then sodium bicarb and then atropine to the nurses standing at the code cart that was wheeled to the room. Ice was placed on her head to prevent brain damage. Nurses ran back and forth delivering the meds to the doctor. Another nurse stood around documenting times and drugs that were pushed and other events. A nurse came over to me and asked if I wanted to sit and or if I wanted to leave the room. I couldn't talk and I couldn't take my eyes off of her. I was so afraid of losing her. After a round of CPR and a round of drugs, Laura's heart rate returned to normal. A chest x-ray was perform and showed that Laura had a small pneumonthorax (the same thing she had on day one) and it was relieved by a pleural decompression. Her blood gases that were taken before she coded and after she coded were relatively the same, so no harm was done. Since Saturday night, Laura's sats have been very good and her vent settings have been decreased due to her good vitals. That Saturday, I stayed by Laura's side till 2 am when I was struggling to keep my eyes open. It was so tough to leave her that night after I almost lost her. One thing is for sure...Laura is definitely a fighter!

Sunday and Monday

Sunday Laura remained on the high settings on the vent, just to give her a chance to recover and rest up after what had happen that night before. Her sats and other respiratory related numbers actually increased since the day before. No changes were made throughout the day and Laura had an excellent day with a just a few de-sats due to a need to be suctioned. Today, Laura did great as well. all of her sats and numbers were even better today so they turned down the vent settings a little, along with the nitrous oxide. Laura was put on a "vec holiday" to test how her neurologic functions were doing. A "vec holiday" (vec standing for vecuronium, paralyzes the muscles, so that Laura would be complete relaxed while the vent does its job) is when the vecuronium is stopped to make sure the patients neurological system is still functioning the way it should and that they are no seizures that are masked by the vecuronium. Once the patient proves that neuro is intact, he/she will be placed back on the vecuronium. Last time Laura had a holiday, it took her two days to come off of the vecuronium and prove that here neuro was intact. So not expecting to see anything today, I was working on my puzzle book, when I glanced up to see Laura, I noticed she was batting her eyes at me. Slowly her little eyes would open up about half way and then slowly begin to close again. The nurse witnessed the same thing while changing Laura's diaper. The doctor said that was excellent and Laura was placed back on the vecuronium. Due to the slow infusion rate, the vecuronium didn't totally come into effect until a few hours after it was placed back on. So for the few hours, I got to admire and cherish every moment Laura spent trying to open her eyes. Something so simple as eye opening, many people take for granted, and for me, excitement and happiness bloom inside of me as I cherished every second of her eyes being just partly open.

The rest of Laura's day went well, as she remained stable and good sats. Laura had a head ultrasound today to rule out any possible brain bleeds, especially after going through Saturday and being premature. The ultrasound came back normal. Tomorrow, the plan is to take Laura down to the OR to perform a chest biopsy. Very nervous about that. Just the risk of moving Laura out of her bed space and into the hospital outside if the CICU poses a threat for her being as sick and small as she is, never mind the procedure of making a small incision into the chest to grab a piece of lung tissue. But being as strong as she is, I Know she'll do fine. Hoping for some answers as to why her lungs are so sick!

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