9/21 Update

Today was a much less eventful day than yesterday into the wee hours of this morning. Due to stacking signs of infection and clouded x-ray, the preliminary diagnosis was given of ventilator-induced pneumonia inducing sepsis. I was semi-prepared for the pneumonia because the risk was there and I was aware of the risks post-op, but sepsis? Nope. Seeing how awful Ethan looked yesterday and then hearing that there is the possibility of sepsis...not my idea of a fun time. His cultures are not back yet. His WBC isn't indicative of a major infection like sepsis, but this is Ethan; he doesn't do things by the book of anything so the chance the cultures will grow back is still there, but they are leaning toward this just being pneumonia.

Ok, so here's what we are watching (recap and updated info):

• heart rate
• Ethan is typically mid-high 50's resting. He was sitting low-mid 50's until today. Today, he's in the 80's which could be indicative of pain. He is on Precedex which is known to lower the heart rate, plus he's been given a bolus of morphine and tylenol and his HR is still in the 80's. ~ Due to the infection and fever, E's heart rate elevated
• oxygen
• he is on the ventilator and has been sitting at high 90's and even 100 oxygen saturation level, but today he's dropped to 89-low 90's. They have upped his PEEP from 5 to 7 and upped his oxygen level from 30% to 40% (room air is 21%). They are getting ready to do a strong suction and bag him to really make sure his lungs are clear. ~ Oy, this one is all over the place. He's currently at a PEEP of 12 and 90%oxygen but that is mostly because he was really suctioned out and his lungs did not respond well. Prior to that, he was at 65%. If possible, they will decrease his O2 as long term heavy O2 can have adverse effects too. These levels will go back and forth while he goes through the lung therapy and is on the ventilator.
• temperature
• he's running at around 102 degrees ~he finally broke the high fever and is currently 99.2 degrees. It was close to 105 degrees most of the night.
• blood pressure
• it has been all over the place from elevated on day 1, to "soft"/low, but his MAP is fair ~BP has also been all over the place, but it did regulate today after doses of Albumin. It dropped really low this morning it was 65/37 and his MAP was 31 or something close to that. It's currently low again but only because he was moved and his body is redistributing fluid. I should see it come up gradually over the next couple of hours.
• urination
• they removed the foley yesterday to give his body a chance to urinate on its own, but he hasn't. They had to do an in/out cath this morning and released over 500 cc's of urine. They are giving him until later this afternoon to pee or else the foley goes back in. They are trying to avoid it to decrease the infection risk. He has been given multiple doses of Nubain to help with the retention. ~After scanning his bladder after 10 hours of not peeing, the scan showed over 600cc's so the foley was put back in and the nurses were able to get 650cc out (what a relief!). Lasix was added to his meds and he's been producing. He is not on any additional fluids anymore- only his feeds and flushes.
• bleeding
• Dr. Runyan came in this morning and assured me that the blood drainage from the mouth and nose are normal and expected. He said we can do an Afrin spray to help close off the flow, but his labs still look good enough; they are lower, but not transfusion low. ~my freak out moment was around 3am this morning when I noticed his right eye had blood collecting in between his eyelids. This was/is due to the proximity of where his surgery was and his ventilator being through his nose and the sinuses being so close. He also still has bleeding from his nose and mouth, but the color is changing which is good. Whether it's nothing to freak out or not, it was something straight out of a M. Night Shyamalan film. No thanks.
• swelling
• today should be the peak of swelling. It's pretty intense as you can see above, but normal. We are putting ice packs on his cheeks for 15 minute intervals. ~still pretty swollen, but slightly improved except for his left hand. The coband was removed from the left cast to relieve some pressure, but his hand looks awful and the nurse is very concerned and wants to cut the cast off. I said it was ok and that I would even do it if they couldn't get the ok from plastics.
• feeding
• we restarted feeds last night at a super slow rate and he has tolerated them fine so far ~we've upped his rate and he is still tolerating just fine. He's also getting quadruple Juice Plus. :)
• extubation
• won't happen until Monday, likely. He's still too swollen now and will still be tomorrow, so it won't be done then, and they don't like to extubate on the weekends with a case like this. ~definitely not until at least Monday considering our setback yesterday.

The attending doctor this morning wanted to prone him, but they got really busy today and weren't able to. The idea of proning Ethan made his nurse internally have an anxiety attack, but the doctor said she'd be in here to do it with her, so no worries. It just never happened. I guess we will revisit that tomorrow.

Our nurse pointed out a situation on the back of Ethan's head. I took a picture but my iCloud photos aren't loading so I can't post it just yet. They are calling in dermatology tomorrow just to make sure it's ok.

Here's to an uneventful night. I'm old and I'm not sure I can do another night like last night (I finally laid down at 4:30 am and docs were in here at 6...#yawn).