03-31-12 – END OF DAY 3 – CPMC/CHONY PICU – 26-22-3

The Good

• Faith is breathing on her own. She is breathing a mixture of O2 and NO which is therapeutic and helps keep the blood vessels of the lungs open and flowing.
• Starting about 7PM on Friday her “distressed” breathing pattern changed to a more normal one, less labor and a slower rate.
• Sedation has been cut quite a bit:
o Reason 1: One side effect is a slower/irregular heart rate which she started to have on Friday/Saturday night. Resolved after reduction in sedation.
o Reason 2: It’s for her comfort and compliance, as long as she is comfortable and is willing to mostly cooperate with what needs to be done we can use less.
o Cute story. Her nurse and I were doing something Friday night with her and she was struggling and got her nasal cannula out of her nose (Still taped to cheeks). I saw her hand headed for it ready to rip it from her face, stopped her and told her no. A few minutes later same circumstance, I wasn’t quick enough to get the hand. To both of our surprise she used her little fingers to push the prongs of the cannula back into her nose. I guess it helps and she gets it.
• NO vascular surgery. There is currently no benefit that outweighs the risk of either thombectomy or putting in a vascular filter.

The Bad

• We are suspicious that she had a bleeding/clotting disorder before surgery and before the central line was ever placed. Parent intuition. The ICU attending shares our suspicion. While not pertinent to current care it will affect future care.
• Now that surgery isn’t an option they will be transitioning from Heparin to a longer lasting more stable form called Low Mollecular Weight Heparin (http://en.wikipedia.org/wiki/Low_molecular_weight_heparin) specifically Lovenox (http://www.drugs.com/lovenox.html) . This is going to mean daily injections (2 a day) for the next 3-6 months.

The Ugly
• NONE — Lets keep this empty!


• Sedation much lower than before, more waking hours, eating by mouth and keeping active but in bed.
• Changeover from Heparin to Lovenox.
• O2 with NO
• Continue Wean from narcotics withdrawal from prior encounter at ICU