Monday, November 28, 2011

Caelan's Monday

ok... where to start.  Monday was better than Sunday. Thank goodness.  Not sure I could handle another Sunday.

First priority today was keeping Caelan stable.  His two arrests yesterday are obviously a huge concern and remain a major focus.  It is common practice after an arrest to cool the body down.  By cooling the entire body down it slows the metabolic rate and conserves energy and betters the outcome post arrest.  Or something like that.

In addition this morning Caelan began to spontaneously drop his saturation levels.  Not something we want him to start doing.  Several times his sats dropped suddenly and they had to bag him to bring them back up.  It's suspected that this is because he is so sedated he isn't coughing up any of his secretions and as a result they pool and obstruct his airway.  They're able to suction these out and it seems to solve the problem but definitely something we need to watch closely.

There was also another new concern that developed late in the day yesterday and worsened overnight.  Caelan's right leg (the one with the arterial and venus central lines in it) was having extremely poor circulation.  That's probably an understatement too.  It was really bad.  They couldn't feel a pulse in his foot and had to use a doplar to hear it ever so faintly.  The were thinking that they'd have to remove the arterial line and called back in the cardiac surgeon for his opinion.  I have to admit that he really wasn't impressed with the idea of them taking out the line that took him two hours to get the day before - in the most good natured of ways.  He was concerned though that the leg wasn't being insulated from the cooling pad Caelan was on.  There was no reason to cool the legs post arrest.  He recommended that the legs be insulated and that the right leg be wrapped in warming blankets.  This would increase the blood flow to both legs and hopefully help.  I'm happy to say that it worked and his right leg and foot look remarkably better... Unfortunately for Dr. M, they still took out the art line later this afternoon.

There's always a risk for blood clots when there are central lines.  Ultrasounds were ordered on Caelan's groin to check.  At the same time an ultrasound was ordered for his abdomen/kidney as a precaution to just make sure everything looked alright there too.  What they found was a blood clot  in a vein carrying blood from his kidney. Actually I don't think they saw a clot specifically, more just a slowing down in the flow of the blood which is typical of a clot.

The blood people (don't remember the name for this team of doctors) were called in.  They explained that the two ways people most commonly get clots are from either central lines or as a result of cardiac arrest.  They understand the necessity for Caelan to have that central line but they'd like to see it gone as soon as possible.  They've started Caelan on the blood thinner heparin.  They chose that blood thinner because if for any reason he needed to go back to the OR they can stop it at anytime and within two hours it would be out of his system.  Four hours after starting him on the heparin they'll do a blood test to determine if the dose is too high, too low or perfect and adjust it accordingly.  It's because of this that they got rid of the art line.

I questioned today why cardiology hadn't been consulted when he'd had two cardiac arrests.  I understand that they're confident that it was because of a lack of oxygen, however he still had to cardiac arrests and they're not 100% sure.  They agreed.  Cardiology came and did an ultrasound on his heart but I haven't heard the results yet.

Speaking of results, cultures have been taken from just about everywhere and we're waiting to see what if anything grows.  Caelan's being treated with some wide ranging antibiotics but we'd like to be able to narrow that down a little and target something specific.  The Infectious Disease Team has also been consulted and are now involved in this aspect of Caelan's treatment.

Endocrinology has also been consulted because sometimes repeated steroid use can cause some type of immune deficiency - so that instead of getting a little cold Caelan would always get the biggest, worst cold ever, the most extreme.  Not sure I completely understand, but they've been consulted too.

Our ENT team came by several times today.  At this point while he's vented they're quite hands off and will wait until things settle down a bit.  It's expected that Caelan will have a bronchoscopy later in the week to check those cords.  Dr. V feels that the airway really is big enough and we really can't laser any more away. However at the same time he understands that we can't continue all winter like this if every sniffle is going to send Caelan to the hospital.  I hate to say it but there was mention of possibly re-traching to get him through the cold season.

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