Very Juicy

Wren was doing very well this morning at my first visit. His 9Am stats were:

Dopamine: 6 mcg/kg/hr
Morphine: 8 mcg/kg/hr
Vent setting: 0 repiration limit (ie only alarming and giving puffs)

Heartrate: 144 BPM
Arterial temp: 36.8 (normal)
Toes: 34.9 C
Breathing: 36 BPM
Saturation: 99% (this is how much oxygen his blood is carrying)
Pressures: - arterial: 76/37
- extremity: 62/40

I was there during rounds when the surgeon and the cardiac team joined the ICU doctors in discussing his case.

They described him as doing well, his perfusion (?) improved dramatically overnight and they agreed he is ready to go off the ventilator and onto C-pap. They are trying to drop his dopamine down adn reduce the morphine slowly. They reviewed the echo findings which showed that the valve is the same and performance of the Left Ventrical is "moderate". Overall the echo evaluation was positive and "things look good".

After rounds the nurse tried to drop the dopamine to 5 but his BPs dropped to the alarm limit so she popped it back up to six and would try again later.

The emerging issue this morning was his oedema. The nurse and intensivist describe him as "pretty juicy" and wonder whether they should hold off extubating until it reduces a bit. The swelling developed overnight and when I came in I was shocked to see him very swollen. His little eyes can't open even though he is more aware and responsive. His belly is shiny and taut. They check the fontanelle regularly for signs of swelling and its still okay but the neonatologist started him on diuretics to help him get rid of some of the fluid bolus that helped his BP yesterday. Apparently the diuretic MAY cause his blood pressure to slump a little.

He is also being given steriods to improve vascular function. Apparently cardiac babies commonly fail to mount a steriod response under low BP conditions while healthy infants will. Wren had a steriod level of 8 while normal is in the 50s. So, they are giving him some instead.

Now, some chatty stuff. The new nurse is very cool. She has just returned from Pakistan where she volunteered as a cardiac nurse, training local nurses in the management of post surgical patients. She went with theInternational Children's Heart Foundation and is going through christmas-culture shock. I don't want to talk too much in case I distract her from her work in testing lines and administering and changing the many things that ping and peep at intervals throughout the day. Anyway, she's very nice and reassuringly excellent at what she does.

Meanwhile, on my walk to the ICU this morning (passing kids with no hair and babies trailing IV lines on guerneys) I walked behind two ladies discussing Christmas shopping:

A: "I have my heart set on this one toilet-seat cover. I phoned Bellevue square but they're out. They say they have one in Issaquah and down at Southcenter so I think I'll go after work."
B: "You're a woman on a mission!"
A: "Oh, its just so pretty and it goes well with the set."
A: "Okay, see you with the chief resident at 11"

So, which is the alternative reality? This one, or the one in which we spend hours to find the right thing. I guess they are both valid but it gives me pause. I hope I bring more insight to my life through this whole process.