Two steps forward, one step back, one step forward, two steps back, brings us back to nowhere. NOWHERE!
You know it’s going to be a bad day when the Fellow runs into your room at 7am, flips all the lights on, exclaiming “Is he extubated?”, “Is he extubated?”
As I shoot up out of the little pull-out cot that I
sleep, toss & turn, lie awake on, trying to make sense of what’s going on, the nurses are saying, “No, No, he’s fine.”
What the fric- N- frac is going on?
Evidently, on the babe’s morning x-ray, they couldn’t see the end of the breathing tube. So the Fellow assumed it had been pulled out and that David wasn’t intubated anymore.
But he appeared to be breathing just fine (Well, you know what I mean, the vent was breathing for him just fine.).
The Fellow , the RT and the Chaperone went around and around, and finally the Fellow suggested that they sedate him with the propofol until they could sort out the x-ray. His sutures holding the breathing tube in place were going to be replaced today anyway, he just didn’t want to take any chances that the breathing tube was in the wrong place. Okay. Grand idea. Administer propofol and
His blood pressure drops to 40/20 and now they have to push albumin (3X) to bring his pressures back up.
It’s not even 7:20am and I just know our day is going to be a pisser.
So, they announce during rounds that the lab is reporting another smear with yeast on it. They have now reported 3 or 4 specimens over the past week and a half, that are positive for yeast. They just hadn’t figured out the ‘species’ yet. They had already switched around his anti-fungal meds when they reported the first positive. So really, no biggie in terms of meds, he has already being treated for it.
Except they really wanted to double check to make sure the meds he was on were the best meds for the whatever the fungus was. So they needed to contact the lab and get a handle on what was growing.
In the meantime, they ordered a full body CTscan, to be rule out any visible evidence of a yeast infection. That’s right, apparently just like mold on bread, fungus can grow on your internal organs.
Yeah, I couldn’t eat breakfast after that lovely announcement. *gross*.
Today was the day the Shriner’s doctors were supposed to come and check out the babe. They tried to schedule the CTscan and then the dressing change to accommodate the doctor AND so they could use the propofol for the the CTscan then go right into the dressing change without messing up the sedation.
That didn’t work out so well, so Shriner’s is scheduled to come Wednesday.
The x-ray was repeated and the breathing tube needed to be moved a couple of centimeters, so after rounds the Fellows (ICU & Surgery) came in to replace his sutures and adjust the tube. But the ICU Fellow starts rambling on about fungus and lipids and we won’t be able to use the propofol anymore, but we’ll use it right now and WHAT?!?!
One step forward, two steps back, two steps forward, one step back, brings us back to nowhere. NOWHERE!
Malassezia Furfur is not our friend. It is a nasty little fungus that likes to feast on lipids. I know you’re just itching to find out what lipids are. Lipids are a fat used to round out his IV nutrition. So they stopped the lipids AND apparently the propofol has a lipid base, so they had to stop the propofol, as well.
So our sedation nightmare continues.
The dressing change was awful – the med they substituted for the propofol didn’t even begin to touch him, in fact, I think it made him more agitated. So they had to go back to the propofol to get through, Wednesday they will have another plan.
His skin continues to improve. Round of applause, please…. Wednesday they will start giving him smaller doses of campath every few days. These aren’t ‘treatment’ doses. They are prophylactic in nature, to keep those fugly little T-cells gone.
So I was pretty sleepy @ midnight. I thought I would finish this up Wednesday morning -I was 3/4 of the way done, so easy breezy to finish up before rounds.
Oh, I had plenty of time alright. It’s now 4am Wednesday morning and the designated Chaperone has flipped on all the lights, calling for other Chaperones to come in and help her.
The arterial line that took those 6 plus hours to insert, is gone. Apparently while she was getting blood from it, the internal catheter slipped out of the artery. The Fellow tried to re-wire it, but with no luck.
It’s not even 4:30am and I just know our day is going to be another pisser.