His bipap was turned down to 25% this morning, but he's dropping to the low 80's so he's been bumped back up to 38% and he's hanging steady at 97. Once he's a little more awake they want to try him on the high flow oxygen cannula again. But since he's finally sleeping again, they don't want to mess with him. It would be like poking a sleeping bear-not worth it!
He was getting some Pediasure last night, at 10ml/hour. But he began having increased stooling (11 poopy diapers yesterday total) so they stopped the formula around midnight and switched him over to Pedialyte this morning.
They are also concerned he could be having a protein absorption problem, so they are going to order some additional lab work to determine. They will also be collecting a stool sample to help with that potential diagnosis.
He has also been receiving Rocephin antibiotic, and that could easily be contributing to the increase in stool output also.
His CRP came way down this morning-from 23 to a .8! Woo-hoo! It had jumped up that fast initially; from a 1.5 to a 24.1 in 24 hours so that is why they were searching for a source of Inflammation by doing the pelvis/hip/knee films. But it is a bit of a misleading lab value, because it can also just signify an illness, and in this case-that looks to be exactly what it was. They said they are seeing a lot of RSV kids here in the PICU that have the same type of crp response.
Unfortunately, they are also seeing this strain of RSV last 2-4 weeks for full recovery. That may mean that in order for us to get home with the bald kid some oxygen may be going home with us. Ahem. Not what I wanted, as I always feel like once we start something like that as a temporary fix, it becomes way too permanent. But this virus has really kicked his skinny little butt, and if it's what we have to do to get and keep him home and safe, we will do it.
I got a peek at his chest X-ray from this morning and wow, it's no wonder he's getting an increase in his lasix now. They just increased it up to every 6 hours instead of every 8.
It looks terrible. Full of fluid and patchy infiltrates. I think the official diagnosis was
'Increased interstitial edema'. Ya, no joke. When I can recognize it-it's bad.
We are still waiting on Vascular Access to get up here and get his subQ immunoglobulin done per Allergy's recommendations from yesterday. It seems it's a bigger deal than it really should be. Why am I not surprised?
So the plan today is continue to hold steady with him. No big changes, just keep trying to wean down the bipap and get him switched over to the high flow.
Get his gut moving in the right direction.
And hope he doesn't decide to throw any monkey wrenches in the process.
Isn't he the sweetest?
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