Welcoming fall, good and bad!

It's October, and that time of year again.....

Cooler weather
Sweatshirts and flannel jammies
Hot cocoa and apple cider
Weston Irish Fest
Irish car bombs and Seth drinks ( hot apple cider and cinnamon Schnapps-yum!)
Halloween
Hospital stays
And new this October- a newly licensed driver in our house!

Yep, Hailey got her license this week, and has tried to think of any and every excuse to leave the house.  I could really work that to my advantage.
 Need groceries?  Hailey. 
Need gas?  Hailey.
Need prescriptions picked up?  Hailey.
Brothers need a ride somewhere? Hailey.

We'll see how long the newness lasts at that rate!

I'm sure most of you know by now that Ethan was admitted to Children's Mercy on Tuesday evening. He's been on a slow decline for a couple of weeks now, all finally came to a head and here we are 4 Sutherland Room 5.   His sats are crappy-he was 86 on admission. They got him 92 on 5 liters of oxygen by face mask, so they tried switching him to a nasal cannula, but he kept dropping to high 70's with 5 liters.  So they went  back to a face mask, but at 8 liters couldn't keep him above 87.  Respiratory came in and decided to switch him to a different mask called a Venturi mask that delivers 40% oxygen, still on 6 liters, but hanging at 96. This mask helps tell how much oxygen he is truly requiring, as it mixes oxygen with the regular air we breathe. And I may be completely wrong on that explanation-it's how I understood it. I'm an RT, but not that kind!  Since Ethan is a mouth breather, it makes it difficult to tell how much he really is needing.

They drew blood cultures, and then gave him a dose of Rocephin and Vancomycin-antibiotics.  Transport team mentioned they were starting right off with the big guns for him!  Yeah, we can't afford to mess around.  Blood culture results won't start showing up for 12-24 hours, depending on if there is an infection brewing.

Immunology has been consulted tonight. They had no suggestions at this point, but will get involved if needed as labs come back.

X-rays of chest and abdomen were taken. No big pneumonia on the chest. So concerning for high O2 need and fever of 102.  No results on abdomen films yet.

Labs show sed rate elevated-which is an inflammatory marker indicating a process of some type going on. White count NOT elevated, so kind of confusing.

They think he is having febrile seizures, as he seems to have these funky quivers of his legs. Or they think it could  be shivering from being cold, but having a fever. His hands and feet are mottled and cold and blue.  So even with the fever they have piled on the warm blankets.

One of the nurses at CMH North knows Ethan well, and said she knew he was sick when she stuck him, and no one had to hold him down.  Only 3 sticks to get blood and an IV, and only one more for cultures.   At one point they were talking about getting access by way of IO if needed. Glad we didn't have to do that!   IO means intraosseous, where immediate access is gained by injecting directly into the bone marrow. This is obtained by putting the needle right into the leg below the knee cap. I say needle, but it's much more than a regular IV needle. Google it-it's creepy looking. And painful looking.  Again- glad we didn't have to go that route!  They are keeping him on the antibiotic doses, and he's getting his second dose of Rocephin now-which clearly burns going in by the reaction I'm getting. And he will get another dose of Vanc in the am. Hoping the little hand IV he has holds out
for these heavy duty drugs!    

The big question in the back of my mind, and I think the team's mind is the million dollar one. Is his leaking new pulmonary valve the culprit here??  This is the same crap we went through a year ago before finding out he was in heart failure and being admitted to the ICU-after 3 separate admissions just like this.  I have asked for his BNP-Brain Natriuretic Peptide to be drawn, but the residents on tonight are punting that decision to the attendings in the a.m.  Don't think I'm letting that one go. It's the one test last year that gave us a definitive answer he was in failure. On a scale of 1-10 in kids- his was markedly elevated at 3300. I don't want it to get that bad if we can help it.   

I may have to pull out the pitiful cancer card to get my way if needed. 

If not, I'll try throwing myself on the floor kicking and screaming.  

This same post will be on his carepage for those of you who check that too!  

Gotta go, sats dropping again, getting a roomful of concerned nurses.  More later.