If you want the nitty gritty, I'll try to detail it but you've been warned. I'm reminded of when I first started this journey and I would need two dictionaries to try to decipher what things meant: a medical dictionary for the terms and a regular dictionary for the terms used in the medical dictionary for whatever it was I was trying to understand. I don't think it will be that detailed, but at this point, I don't have it within me to try to put it in non-medical, at least I don't think I do.
This morning, Aaron's blood pressures were very "soft," they were low, really too low. In response, his heart was having a hard time pumping it, especially to his extremities. His lactate (yeah, measures lactic acid, the same thing that makes the muscles sore when you exercise) was building, indicating that there wasn't a good gas exchange in the cells. He was retaining CO2, which also made his body more acidic and his pH started slipping. Our bodies really like a narrow window: 7.33-7.39 from the veins. He was 7.26. Cell death begins about 6.9-ish. Like I said, a narrow window.
He was also fevering, his belly was huge again, and he was on 100% FiO2 through the vent and maxed out on his iNO. Even with all this, just moving him caused him to drop his sats and his blood pressures significantly. Diaper changes, shifting in bed, all those became dangerous even though he was already on versed for sedation, which helped, but didn't completely snow him.
Fortunately, he did have an IV that we could draw from so we didn't have to add the stress of being poked. The good news? His heart numbers actually came back better than we've seen for a few years. They're still high, but not as high as they have been and nowhere near as high as I was afraid of. The further showed that it's the storming that's driving the bus. If we can get the rest under control, his PH should fall in line.
We managed to get an arterial line in his right wrist to monitor his blood pressures better and put him on norepipenepherine (norepi) to stabilize them. He's on Precedex for deeper sedation, and lasix because he's now retaining fluids.
As of 2 pm, his lactate was smack in the middle of normal, his pH was much closer to normal, and his CO2 was decreasing towards his normal range. His blood pressures were better and his heart rate and respiratory rate were close to typical for him. He's doing better.
Because he's resting, he's now much more stable. So much more that we've already been able to decrease his norepi and precedex a bit and reduce his Fi02 to 80%. We still have several pretty intense rescue meds at bedside in case things go bad again, but I'm hopeful they won't.
They'll pull labs again this evening, and we'll hope the numbers are even better. We are making baby steps, itty bitty tiny baby steps, but the seem to be moving in the right direction.
The staff here have been incredible, trying to see all the options and I'm very much part of the discussion and the team. But I also have to credit the many prayers and good thoughts and vibes that have been sent from both near and far. This morning as things were so critical, I asked for prayers and they came pouring in. I was given strength and clarity that are beyond my ability, along with a sense of calm. What should have taken me to my knees (and did in prayer) did not. I was able to focus and be part of the solution, holding his hand and brushing back his hair, speaking to him as they worked to put in his line.
Thank you to everyone who holds us close and calls down heaven's blessings for Aaron and for us.
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