Colby is 12 hours, 42 minutes after extubation, not that I'm counting. Today has gone "textbook" I guess they would say, without a problem, a hitch, a worry or an "incident." Here are the stats: Colby's home bi-pap pressures are 21/7 with a backup rate of 20, on room air oxygen (21%.) We extubated him on 28/8 with a backup rate of 22, bleeding oxygen at 50% through the bi-pap. We've taken 3 blood gases; they all look great. Actually his CO2 is a little low, 29, and I can't believe they haven't said something to me about changing something on the vent. Like I'd agree to it anyway. Only thing we've changed is gradually taking the amount of oxygen that we bleed through his bi-pap down. It's currently on 30%. That's it, read my lips, NO OTHER CHANGES. So help me, if they come in here trying to change these settings I will beat someone senseless. Oh wait, touching his vent settings this early after "e" would already make them senseless, so maybe I could beat some sense into them instead. He'll get another blood gas at 4 a.m. and we'll reevaluate from there.
Our RT today, Tracy, is a freakin' rock star!! She did an amazing job with Colby. We had every little detail down and were ready to roll when "e" rolled around. She monitored Colby closely and he was never even a few minutes late for his treatments. She took EXCELLENT care of him today. I'm really glad. She's the 1 who extubated Colby the day it only last 20 minutes, so this was definitely a better day in the Colby/Tracy "e" storyline.
Colby looks good. He acts more like the Colby I'm used to seeing. His oxygen has not dropped below 98% and his heart rate hasn't been over 110. Most excellent! Something I learned (the hard way) from the last "e" is cough, cough, cough. We didn't give Colby enough cough treatments last time, but by golly, we're on top our game this time around. We started out doing tmts every hour for the first 3 hours, then moved to every 1.5 hours, etc. He finished his last cough tmt at 11:15 and Penny, another 1 of our fav RTs, will come back at 1:30/1:45 for his next tmt. We're also doing MetaNeb tmts every other along with the cough assist.
Like I've said before, Colby is not in the clear just yet. The first 48 hours are usually the most crucial for SMA kiddos after "e." However, I'm very, very pleased with his progress so far. This is one of the smoothest "e" experiences we've had to date. I hope to keep reporting good news/progression tomorrow.
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