Late yesterday evening, one of the Intensivists came in and said that his RT arm ultrasound did actually show more than a superficial clot. They consulted the Neuro team again, who agreed that it’d be safe to start blood thinners. Heparin drip started. Sent baseline coagulation labs just prior. They will closely watch his coagulation labs every 6 hrs to see if he’s tolerating the Heparin (and that blood has the right amount of clotting factors, and doesn’t get too thin).Intensivists rounded again at 5am Looking at the P- Venous pressure on his ECMO machine that shows that this is slowing down. Likely that Seth is just volume depleted again. He received 500mg of Albumin through the night total, but drs want to give him 500mg more to replace the fluid he’s lost. He’s put out over 2L of urine tonight, and is in the negative for fluids lost in the last 6-7 days. Did a bedside ultrasound to check his cannula and everything looked good there. Drs are happy that he’s on Heparin now to help the machine run better.
No adjustments made to “sweeps” on ECMO machine (how much CO2 is being pulled off his lungs). Still has been at 3 since about 11:15pm last night. They can tell if he’s tolerating the wean by his blood gas results (looking at PH and CO2 levels). Will continue to check those every 6 hrs.
Seth will get his morning chest xray soon to see how his lungs are doing. BP has been good 148/68, temp 37.1, SPO2 97%. Maybe got one extra dose of BP meds through the night, besides his usual. Tidal volumes this morning 290-328. Nurse mentioned they might check him for Diabetes Insipidus again, looking specifically at his response to the antidiuretic hormone because of his high urine outputs again. Dr rounded from internal medicine. Happy with tidal volumes. No orders received. Nurse told him that after two therapeutic results on coagulation tests, will get a CT scan. The one this morning @ 6am was sub therapeutic (not within range yet), so Heparin drip was increased, (and doesn’t count towards getting two therapeutic labs). Earliest CT would be done is on nightshift tonight. Nurse said that the last two nights, his BP has been more manageable. Brain stem reflex is still good. Meaning he reacts when someone gets near his eyes (closes them), gags with the suction catheter, and coughs when they suction his trach. Pupils still reactive, more equal tonight than last night. Will give him a calcium supplement today for a low calcium level (that he’s had before). Other electrolytes not back yet.
-Aunt Kerry
Lord, thank you for the doctors and nurses that are doing everything they can for Seth. Please give him strength to keep fighting. All is well with our souls, but we implore you to make his physical body well on earth too.-Darcy
PS, Picture for cuteness 🙂
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