Too Much, Too Fast

You know when you get sick and you take medication and think maybe you're not so sick after all?  And then it wears off and you realize, yeah, you really are?  Yeah, I think that's what's happening here.  Except instead of being able to take a decongestant (which would cause really bad things for him) we increased his ventilator support.  And he looked pretty darn good!

So the next step was to decrease the support back to his home settings, since he was soooo stable (and he really was!).  Right off, we started seeing a slightly higher heart rate, and then a little more on top of that.  Then more secretions, higher oxygen needs, and so on.  Can you see where this is going? 

We thought too far ahead.  About 4:00 p.m., they decreased his vent settings (still on the hospital vent) and wrote orders to try his home vent at 8:00 p.m.  Yeah, but at 8:00 p.m. he was on a lot more oxygen, heart rate climing into the 150's (low 110's would have been normal) and he was running a fever again.  Oh, and don't forget all the junk we were pulling out of him.  He was pretty miserable. 

I think it was about 10:00 p.m. that we gave up and increased his PEEP again.  And again at 4:00 a.m., so now it's at 13, which won't mean much to many people, but it's a lot of support.  However, that support is what is keeping his lungs wide open so he can move the oxygen through.  So think of it as your really classy drugs for that lousy cold that otherwise would have you moaning in bed.

And he kinda likes it.  Right now, he's asleep, and his heart rate is 99.  He's not working hard at all.  And earlier this morning, he was blowing raspberries.  Let me tell you, the vent didn't know what to make of that one.  We just laughed.

So now we're watching and waiting.  When the team rounded this morning, the consensus was that we had pushed too hard too soon.  He does have a cold, rhinovirus.  And it's going to have to run it's course, darn it.  But at least we can keep him comfortable while it does. 

I've got thoughts running around in circles inside my brain right now, trying to sort themselves out.  Thoughts on the different roles we take on, the different hats we all wear.  I'm hoping that by tomorrow they make a little more sense.  You've been warned...

“I’m here. I love you. 

I don’t care if you need to stay up crying all night long,

I will stay with you. 

There’s nothing you can ever do to lose my love. 

I will protect you until you die,

and after your death I will still protect you.”
― Elizabeth Gilbert