Settling in to NY Presbyterian Hospital PICU

As per the original plan, William was transferred to NY Presbyterian Hospital's PICU because of his critical status post-operatively.  Presbyterian is literally across the street from Sloan....and its a massive hospital....like two full city blocks long.  It has 2,272 beds (as compared to Upstate Hospital's 409 staffed beds), with 20 peds in the PICU.  The most severe of the most severe kids in NYC are brought to Presbyterian's PICU.

I knew the ambulance trip across the street was going to be brief....but I was not expecting they would take William out the front door of Sloan (the one we always use), put him in the ambulance, turn the lights on, make a big U-turn on York Avenue and pull into the ambulance bay at Presbyterian.

Simple as that...

Apparently William didn't care for all the gosling during the ambulance ride.  Fortunately, I was placed in the front seat of the ambulance so I couldn't see all that was happening in the back.  William ended up getting 3 rounds of sedation and pain meds during the brief ride...

William was kept on systemic fentanyl (2mck/kg)  for pain management and ativan for sedation, each every 3 hours. 

When we first arrived in the PICU, the transport team continued to work to stabilize William, under the direction of Dr. Steven Pon. At times, there were six people surrounding his bed....it was intense.  His nurse seemed rather flustered.  At one point, she broke out in nervous hives.  Once things settled down many hours later, she shared that she is a traveling nurse and just started at Presbyterian earlier that week.

Right away, William had difficulty maintaining good blood pressure – he was running too low (around low 60’s over mid 50’s).  Heart rate was often high (due to low BP)...in the 180-190’s.  As his numbers continued to worsen (reaching low 60's over 20-30's), he was started on dopamine around midnight.

Dopamine stabilized his BP and HR better, but before too long, it seemed as though his arterial line (in left wrist) was shot. They were hoping extra fluids would revive it, since after multiple boli of fluids, it would show some response on the monitors. They even tried pushing bicarbonate to stop arterial spasming, but all efforts could not save the original art-line.  They started scoping out an artery for a new A-line (which was needed to keep an accurate & continuous BP measurement), but all preliminary scouring was not looking good due to William's increasing puffiness...


William's thoracotomy incision went from the middle of his abdomen to the middle of his back, in a horseshoe-like shape.  Because of his sensitivity to adhesives and dressings, Dr. LaQuaglia internally sutured him and used a surgical glue on the outside.

full-dependency on the ventilator

As the wee hours of that first night went on, William continued to have problems with low CVP's (central venous pressure - the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system).  William was ranging between 3 and a high of 8.  They would push extra fluids and he'd react positively, but could never get over 8...docs wanted him around 12, or at least 10 as minimum.

 

That night, William required lots of chest suctioning through the trachea - yuck. He had two sets of chest x-rays to monitor any fluid build-up. His left lung had a chest tube – but there was concern of fluid accumulation on the right side. 

 

As I attempted to sleep with one eye open that first night in the PICU, the complexity and fragility of William's status quickly became obvious...