6:00 a.m.Five pokes and two IV teams later we have another scalp IV. It's the second in his head for this stay with three in his feet in between. It takes almost until the 7:00 a.m. shift change to get it in. I've lost count of the total number of pokes he's had, but I know we've tried multiple times for feet and hands and once in the scalp that didn't pan out.
7:00 a.m.Shift change. We've had the same nurse at night the past few nights but now she's off for a few days. R has been awesome with him and I've really enjoyed getting to know her. She said Aaron had a really good night. They played, he laughed. She gave him a bath around 4:00 a.m. and then he fell asleep -- right about the time the IV decided to quit. He had started getting uncomfortable earlier, around midnight, so rather than wait for the fever, he got Tylenol and Motrin to head it off.
Aaron was finally asleep as I left to get my shower during the shift change. Poor baby is such a hard stick. But he did keep his sats up during the whole sad experience. That's a good sign.
8:00 a.m.I came back in and Aaron is trying to sleep through his morning assessment. He just got all his morning meds and is starting home bolus feeds again. His last one was last Tuesday afternoon just before we called the ambulance. He was NPO (literally "nothing by mouth" but in his case it's g-tube) from Tuesday through Friday morning. He's been on continuous, 24 hour slow feeds since then. His fluid output has been quite low, even with Lasix.
The respiratory therapist (RT) comes in to check him, listen, and do therapy. He sounds a little wheezy so he gave him six puffs of albuterol and started CPT (Chest Physio Therapy) with a pneumatic percussor. Just before he arrived, Aaron desatted to the mid 80's. I checked his cuff, inflated it to 2 cc of air and listened prior to suctioning. Also, I cheated and gave him some O2 suction (a burst of oxygen) on the vent. I'm really not supposed to touch the vent. The RT walked in as I was finishing listening so I didn't suction but turned it over to him. Aaron loves CPT. He acts like he's enjoying a spa treatment.
8:30 a.m. RoundsEveryone went over all of Aaron's meds, treatments, feeds, and studies. Repeat labs came back positive for rhinovirus again (surprise!). Also he's holding onto a lot of fluids so we're scheduling Lasix. If his fevers continue, they'll get ENT involved to check his ears and sooner rather than later. He'll stay on nitric oxide until he's using less than 50% FiO2 (oxygen that's bled into the ventilator -- just measured in percentages instead of liters like on our home vent -- about 5+ liters). Then weaning off the nitric is a two day process.
9:00 a.m.Aaron's sleeping peacefully and I'm reading through people's comments on Facebook and the blog about him. It is so comforting and strengthening to know so many are praying for us. He's having a little trouble keeping those sats up right now and his heart rate is climbing a bit. Wonder if a fever is coming on.
10:00 a.m.Sats are starting to dip but no fever yet. It may be in part that he's not breathing as deeply when asleep. And he is OUT! Increase FiO2 from 65 % to 70%.
11:00 a.m.Sats are still 88-90% -- still sleeping. Rainbow Kids team just stopped by to see if we needed anything. They'll pray for him, too. It was a nice visit. It's also time for another feeding. He seems to like having a full tummy. I wonder why. We're also going to hold off on Tylenol and Motrin unless he spikes a high fever because we're trying to see if he's really trying to fight off some bacteria. His trach aspirate (think throat culture, like a strep test, but in the trach) is starting to grow out some bugs. But we won't know what they are or how much for a few days. And we know he's been colonized with a few different ones for quite a while. We're all thinking that his current lower sats are because he's sleeping deeply and not breathing as deep.
11:40 a.m. a Code on the unitAaron still sleeps, but tones have sounded in the unit. They're different in here than in the rest of the hospital. It's a gentle ding-ding tone in here. But when they sound, everyone stops. It's the code alarm. Someone's coding, lungs stopped, heart stopped, or dangerously close to stopping. And I've learned that medical personnel geneally don't run. Paramedics, doctors, nurses -- they move quickly and with a purpose, but they don't run. Except for when those tones sound. Then they run. Everyone's down at the other end of the unit now. I pray the child will be okay. See, when they're expecting, planning for a child to pass no tones sound. No code is called. A butterfly is placed on the door.
The PICU is not a quiet unit. It's busy, crowded. There's a lot of talking, laughing, joking. But it gets really quiet in the aftermath of a code. Almost as if everyone not actively involved is holding their breath, praying.