190th Day in the NICU

I called on him this morning. He had a rough night. Dropping his saturation down to the teens on occasion. I took the day off because we are supposed to be meeting with doctors all day today. Mom decided not to go to WIC or vote because of little man's condition.

We got to the hospital. They upped his nitic by 5 to a total of 10. His vent is still at 100% and he constantly desats. We ran into Dr Carter in the hall when we went down to grab a quick bite to eat. He does not think it is the lungs that are causing this. He thinks it is the heart. The echo they took on friday does not look better nor worse than the last time so he is stumped as well and they are going to get the team together to talk. He is going to ask Dr Prince what he thinks. We came back upstairs to find out they already rounded on him. Nothing much was changed. They are waiting for cardiology to come up here and decide whether the milronone would help him more than the digoxin. They orginially said they did not think it made a difference but they will come down and check him out.

The pain management team came in and looked him over and even agreed that this is more of a discomfort pain than a hurting pain so they have decided to make some changes. Please excuse the spelling:

Morphine drip was uppded to .08 from .02
Morphine as a PRN .7
Adavan drip .8 is being added.
Adacan as a PRN .7
Phenobarb as a PRN 2 1/2 mg
Methadone was pulled.

He is still getting the other drugs as well but nothing on them has changed. They also decided to stop feedings right now because the food is coming back up his OG tube and that it can cause more problems with forcing him to eat than from putting him TPN and lipids. He got a dose of Lasixs because he is looking like he is retaining water. He urine output has not been good but we were able to get a 94 gram urine diaper out of him right after the dose.

Repitory has to keep changing his vent over to PCV (Pressure control). It is where the machine is forcing him to do certiain pressures. It is harder on him than the other settings but he needs to keep his oxygen levels up.

We were told that he maybe on the verge of a point of no return with his heart (told by the nurse). His lungs are doing good but his heart is failing. It is common with kids in his condition. They are looking into what meds would help him. We are still waiting for the team to get together and talk to us about a Plan of Action for him.