Day 2 post-op

Well, today has been an eventful day. And usually in the PICU eventful doesn't mean good. Having said that however, Burke is doing a lot better today than yesterday. Today the nurses have been trying to ween him off of the many medications that he is on. One in particular is the paralytic. As he comes off this he tries so hard to roll over and pull his breathing tube out. I must say I can’t blame him. Having a large breathing tube down your throat, a feeding tube down your nose, 3 drainage tubes coming out of your chest, along with everything else he is hooked up to - lets just say it can’t be pleasant. As they take him off the paralytic they replace it with another sedative to help keep him sleepy and calm in hopes that he doesn’t fully wake up. Well today while we were just sitting around waiting for him to wake up, all of a sudden he woke up and was really agitated. He started moving all around grabbing his tubes and simply trying to get away from all this stuff. While he was moving around his sats declined to 45 which is WAY too low. They increased his oxygen and increased his dose of the sedative to help him stabilize. Slowly he began to calm down and went back to sleep. When this first episode happened this morning, his heart rate (HR) went sky high – almost 200 beats per minute. A heart cannot sustain a rapid pace like this for very long before it begins to give up. The nurses hooked him up to a pace maker in hopes of taking control of his heart beat then slowly bringing it down to a lower pace. This worked until about 180 bpm but then his heart climbed right back up. At one point one of the nurses turned to the nurse practitioner to say “what’s plan G.” Unfortunately the last resort plan of stopping his heart with medications then starting it up again was quickly approaching. As you can imagine we were all pretty worried about this option. Despite this high heart rate Burke seemed to be comfortable so rather than do something dramatic like stopping his heart they decided to switch his sedative medication thinking this high heart rate might be a side effect of the one he was on. Sure enough as they switched the medication his heart rate slowly began to decline throughout the day. It fell to about 165 bpm and stayed their most of the today. At times it would dip down to 135 but then go back up to 165. Hopefully with more time that medication will wear off and his heart rate will stay down at the 135 level.

All the events of today have shown us that there is certainly an art to health care. The nurses are constantly adjusting medications to keep him comfortable and sedated but also trying to let him come closer to waking up so he can, for example, begin to breath on his own and be extabated.

Tonight the nurse ended up putting him temporarily back on the paralytic because he was waking up and squirming around too much. As I am sitting here writing this the paralytic should have worn off by now and he should be resting comfortable with the pain killers and sedative. His oxygen saturations right now are 77 which is great and they are decreasing how much oxygen % they are giving him. He is down to 45% on the machine. His blood pressure is good and his heart rate is still high (165ish). His heart has a normal beat whereas earlier today it was somewhat irregular. His blood gas (which is the blood count) is 49 which is great. So his body is doing what it needs to in order to heal and recover from this major surgery. Heidi our PICU nurse (she has been here the past two nights and is on tonight also) said, "he is doing much better than he was yesterday." She also mentioned that she is coming down on the Nitric acid which helps keep his Pulmonary artery relaxed and open. Burke is certainly in great hands and we are so grateful for all the nurses, nurse practitioners, doctors, and surgeons who all care for and worrying about Burke. Thank you for all your prayers, they truly help.