After spending the last 6 nights overnight at the hospital, we convinced Darcy to spend the night at their air bnb. Got a few more questions answered. He has 4 nurses tonight. One to manage his patient care, one to manage his Ecmo machine, a neuro nurse to manage his phenobarbital (seizure med) and pupil exams, and one learning Ecmo. Normally he would have just 2 nurses. So lots of extra hands to better care for him! His nurses sat right outside his room all night, so that was comforting. They’ve really all been great answering my questions.
He’s on a continuous phenobarbital drip for possible seizures since 4/8. Not abnormal for a head injury. The neuro nurse came back in and said she couldn’t find this in his chart, so she’d ask the dr this morning. They are continuing to monitor his EEG brain waves and watch for seizures.
His CT scan done Wednesday night on his way to the new unit did not show a blood clot (so no pulmonary embolism).
He’ll be on contact and droplet precautions until sat probably, when his virus should be gone. They said the adeno virus is like a cold. We aren’t sure if he ever had that H flu after all? He continues to be on antibiotics and a steroid. No fevers. His Ecmo machine has a heater on it that helps to regulate his temperatures and ensures that the blood returning back to the heart is warmed.
His blood gases are improved, but they continue to draw labs from his arterial line every 6hrs to check his kidney and liver function, red blood cells, WBC’s, and blood gases. A continued concern is that his sodium level is high. Tonight it was 173 around 0100. Yesterday as high as 170. They switched him to a different type of IV fluid solution called D5W (dextrose 5%) instead of the free water flushes in his OG tube to see if this will help bring it down. Their goal is to keep his sodium level >150, but no more than 160.
They are turning him every 2 hrs, assessments every 4 hrs, pupils hourly. These have remained stable, meaning they are both reactive and within a certain range of each other. The best part of the night is when they gave him a bath around 215 while they played Seth’s favorite music from “Pitbull.”
Seth is still on plenty of sedation including Versed, but no longer the paralytic medication. Also Oxycodone & Dilaudid (pain and sedation). Pentobarb is being given to keep his ICP pressures down in his brain. He got his bolt taken out yesterday afternoon, so they are no longer monitoring them, so they can focus more on his lung recovery. The goal is to wean him off this after 24-48 hrs. Then they will slowly reduce his sedation meds, so that he is awake while on ECMO. They prefer patients to be awake on ECMO, which would be him opening his eyes and then going back to sleep.
The respiratory therapist said they took him off of Nitrous oxide tonight, which is good that he’s not needing it! This is a vasodilator that dilates the blood vessels in your heart and lungs to get more oxygen. They are more tolerant for lower oxygen levels. They’ve been around upper 80’s to low 90’s. May not exactly match up with levels on the ECMO machine. Seth is still on a ventilator, but the settings are low for muscle memory, so that his lungs don’t forget how to work. The ECMO machine is still doing all the work for his lungs. Seth’s heart is still strong and pumping blood like it should be on its own w/o support.
Kidney function remains good, and he’s putting out plenty of urine. He is still on a diuretic and a low dose of blood pressure medication. His liver enzymes are a little elevated, but they are focused more on his PT/INR levels to be within range (for blood clotting)
They started tube feedings tonight around midnight at a slow rate to make sure Seth’s gut stays healthy. Meds can slow his intestine motility, so they’ll start slow. Still having bowel movements, and they’ll expect more now that he’s on tube feedings.
His Ecmo machine is checked hourly to ensure that no clots develop in the tubing because they don’t have him on blood thinners anymore (that normally patients are on to prevent the tubes from getting clogged from extra coagulation). This is to help protect his brain from more bleeding.
He has been having daily chest X-rays, so had another this morning. Showed pneumothorax as before, but needs to get read from radiologist. Chest tube still on right side.
Things to pray for today:
1) Improved chest xray results
2) Lower Sodium levels
3) No clots in his ECMO circuit
4) Continued stable pupil checks and vital signs
5) Continued stable blood gases (Lactic acid 1.3 this am- good)
6) Rest for Seth and the remainder of his family
Update 7:15am
ICU drs just rounded. Right sided pneumothorax is worse, but they aren’t sure why bc his chest tube seems to be functioning. Overall, aeration is a little better. Ecmo settings good. Need to continue to treat his high sodium levels. They’ve gave him so much sodium from a neuro standpoint to help his brain. Need to ask the neuro team about seizures. His WBC count is still elevated, but it has been. He has 2-3 more days of antibiotics, and still on steroids. Will repeat the echocardiogram today to check his heart. Overall, a little better aeration of his lungs on the chest xray.
Update 7:20am
Neuro came in. Sodium is still 172 (they want it 150-160). Pupils still reactive, which is good and is all they expect right now. He is on so much Pentobarb that turns his brain off essentially. So they don’t expect any movt’s from him or neurological signs until a minimum of 72 hrs once it is turned completely off. It’ll need to be weaned slowly. The drs will decide what to do today. They have not seen any seizures since he has been here, but the Pentobarb can also mask any as well. It is a very strong drug.
– Aunt Kerry
We continue to ask for just family at the hospital. Thank you.
