Rocky Road

We knew going into this that it was going to be an emotional roller coaster, but really we had no idea. Yesterday went from super low to pretty high. And today has been highs and lows each hour. Apparently Elli knew that we left last night because soon after we did, her gases started looking worse, the changed some vent settings and gave her some PRN morphine and versed, trying to keep her calm so that she was able to let the HFOV (high frequency oscillating vent) help blow off the CO2.

I called early this morning around 5 and she was doing okay, not great, but they were tweaking her settings a little hoping that it would help. Brian and I got to the NICU late this morning considering we didn't leave until around 2:30 last night and then had to have our nightly chat when we got back to RMH, so incidentally we slept in until almost 10:00 (luckily I hadn't pumped for 4 hours, so our alarm clock was a wet T-shirt if you know what I mean). Anyways when we got here, Elli wasn't doing the greatest. Her HFOV had been turned up, and so had her O2 flow it had been at 40% when we left last night and they had it turned up to 59%. Her blood gases were looking worse and worse, and I was freaking out. Dot our nurse for yesterday and today said that it all started going a little down hill since they came in and did an ultrasound of Elli's abdomen. They were looking at the liver to see if any of the swelling had gone down and looking for any possible active bleeds. The ultrasound isn't 100% back yet, but it doesn't appear that she has any active bleeds, because her Hemoglobin and Hematacrit have been excellent and her blood pressure is also holding stable without any extra blood or boluses (thank goodness, her little head is so edemetous just to rest your hand on it for even a few minutes, your fingers leave an indention).

Anyways, back to the ultrasound, when the ultrasound tech was doing it, she was pressing on Elli's abdomen making her very mad, also soon after she left Dot noticed a very large amount of blood in Elli's chest tube and on her bed (equivalent to almost 50 mL's). At this time Elli started destating (her blood oxygen level started to drop) and was down in the low 80's, so Dot turned her O2 up to 80% which helped a little, but only brought it up to the upper 80's low 90's. This is odd because typically Elli has not had a problem with oxygenation, it is with ventilation (CO2 removal). So of course she once again had the doctors scratching their heads. They did a chest x-ray to make sure that the pressure on her stomach from the ultrasound hadn't disrupted anything and to make sure that her lung wasn't collapsing or anything. The x-ray looked pretty good, Dr. A actually said that it looked a little better than last night, but the questionable area in the Right upper lobe is still there. They are thinking probably pneumonia or a small amount of collapsed area. Either way like I said last night the HFOV helps with both and she already has antibiotics on board that would cover the pneumonia. Also last night they did a blood culture of her arterial line (measures internal blood pressure and it is where they draw all of her blood from) and it was positive, so once again the antibiotics that she is currently on should cover any type of infections that are brewing.

Either way they have tweaked her vent settings and given her a round of PRN Morphine and Versed to help keep her from trying to breath over the vent, and it seems to be helping. Her last set of blood gases were all in the normal range, so of course when they look that good they have to decrease the vent settings just a little bit to make sure that she is still having to do a little bit, and not getting lazy on us. Currently her oxygen saturations look pretty good mid 90's and she is on 63% oxygen. Dot is going to get another set of blood gases at 4 to make sure that they didn't turn things down too much and that she is tolerating everything well. Either way I feel like I am living one blood gas to the next. Hopefully everything will get settled down pretty soon, but as of right now Elli is still extremely critical. Brian and I have pretty much been sitting by her bed talking to her and holding her hand since her surgery. She is one tough cookie, I actually wish that I was as strong as her. More of the Elli drama to come soon and some new pics (daddy changed his first diaper..Yeah!!)