Day 1 Summary and Evening transfer plan:

It is 5pm and Dr Andy Shin has taken over as attending. Our night nurse again will be Jin.

The plan is to continue to administer meds PRN (as needed) rather than returning to the fentanyl drip. Our day nurse, Amy, has been very concerned with the way the LAPs spike when he wakes up and moves or cries. She would prefer to go longer stretches without administering morphine or versed. All day he has been waking up and sleeping in short stretches rather than resting. She explained to Dr Shin "he spikes to 32 when he wakes up and he's not thrashing about or crying."

Dr Shin is more tolerant of this high LAPs. He explained to the fellow and nurse that this lower pressure is a big change from Wren pre-op. He can tolerate some higher pressures that would cause pulmonary edema in someone not used to it.

They are working to balance sedation against pressures when he is agitated. The orders are in for morphine, Ativan, tylenol and benadryl to be use as needed (PRN). He has orders for Tordol (like a prescription strength bene

Dr Shin would like to keep him calm but to space out the Ativan to avoid him being too medicated. He explained to the fellow that Wren is used to a higher baseline - 20-30 is OK. We want to keep him out of the 30's if we can but that 17 is excellent for him.





Here is the offending monitor showing the LAP measurement (left atrial pressures) on the bottom.

PS. The boy in the background (of the one photo of Wren) is amazing. He was the surgery after Wren and was brought in from post op about 8pm. He was born with ToF and was in for a pulmonary valve replacement. The evening after surgery he was sitting up and eating jello while sticking a syringe through his hear. He is a teenager with an ipod and a large ear piercing he likes to frighten the nurses with.

The first case (before Wren) was also a valve replacement in a girl who looks about 11. She is also up and very vocal and may leave CVICU tomorrow if they find a bed. The recovery can be so quick, its amazing.