William had the smoothest night yet in the PICU. He seemed overall comfortable, with only a few wakings. They tried turning the vent back to 10 breaths per minute but William's entitles (carbon dioxide) went up, indicating he was not tolerating the decrease in ventilator help. It was then resumed at 12 breaths per minute and 35% oxygen.
8:30am brought morning rounds and our first experience with a new attending, Dr. Peter Savard. We later nicknamed him "The Bald Eagle" (any idea what he looked like?)
Dr. Savard interrupted the resident as she was reviewing William's history when she said "Day five post-op..." He said, "Excuse me? And why are we still intubated? We need to get this moving....stop all sedative and systemic fentanyl, only use the epidural. We need to get him awake and get this show going. Enough already."
For days, we had been told that William would show readiness for extubation at his own pace. They would notice breathing attempts on the vent and he would begin to tolerate longer periods with reduced support. Dr. Savard's perspective was much more radical....and certainly anxiety-provoking for all of us. My mouth was literally left hanging open with this new approach...the bald eagle swept away just as quickly as he had swept in barking this orders.
By 9am, the ativan and IV fentanyl were stopped, except the fentanyl epidural….and William was very happy to sleep! Go figure!!!
In this photo, you can see the bruising in his left groin area from the arterial-line disaster. He had many bandaids too, covering other a-line attempts. So sad.
His little wrist in a restraint...
William's heart rate remained elevated four full days later, averaging around 147 bpm at this point. His body remained under a tremendous amount of stress, from fluid overload, medication effects and general traumatic shock.
11:00pm that night, we all joked that once again, William had dictated his course of treatment. After being taken off the sedatives and systemic pain meds over 14 hours previously, he decided to catch up on the sleep he’d had been lacking from the past 6 months. I was certainly quite the change from what we are used to with our sleepless William. Yup, William had remained asleep nearly the entire day, rather comfortably, I may add.
The four of us have been bedside waiting for him to wake up and show his displeasure with the tubes and arm restraints! We had a feeling he would be a little pissed when he finally woke. Because the hospital is staffed less over night, the team made arrangements to give William a short-acting sedative (propofol) at 1am to keep him sleeping through the night. In the morning, the medication would be stopped and we would move forward with extubation.
8:30am brought morning rounds and our first experience with a new attending, Dr. Peter Savard. We later nicknamed him "The Bald Eagle" (any idea what he looked like?)
Dr. Savard interrupted the resident as she was reviewing William's history when she said "Day five post-op..." He said, "Excuse me? And why are we still intubated? We need to get this moving....stop all sedative and systemic fentanyl, only use the epidural. We need to get him awake and get this show going. Enough already."
For days, we had been told that William would show readiness for extubation at his own pace. They would notice breathing attempts on the vent and he would begin to tolerate longer periods with reduced support. Dr. Savard's perspective was much more radical....and certainly anxiety-provoking for all of us. My mouth was literally left hanging open with this new approach...the bald eagle swept away just as quickly as he had swept in barking this orders.
By 9am, the ativan and IV fentanyl were stopped, except the fentanyl epidural….and William was very happy to sleep! Go figure!!!
In this photo, you can see the bruising in his left groin area from the arterial-line disaster. He had many bandaids too, covering other a-line attempts. So sad.
His little wrist in a restraint...
William's heart rate remained elevated four full days later, averaging around 147 bpm at this point. His body remained under a tremendous amount of stress, from fluid overload, medication effects and general traumatic shock.
11:00pm that night, we all joked that once again, William had dictated his course of treatment. After being taken off the sedatives and systemic pain meds over 14 hours previously, he decided to catch up on the sleep he’d had been lacking from the past 6 months. I was certainly quite the change from what we are used to with our sleepless William. Yup, William had remained asleep nearly the entire day, rather comfortably, I may add.
The four of us have been bedside waiting for him to wake up and show his displeasure with the tubes and arm restraints! We had a feeling he would be a little pissed when he finally woke. Because the hospital is staffed less over night, the team made arrangements to give William a short-acting sedative (propofol) at 1am to keep him sleeping through the night. In the morning, the medication would be stopped and we would move forward with extubation.
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