Still in PICU

Kaitlyn was awake this morning at six due to radiographs. We did physio coughs and then she stayed off of bi-pap without any issues. She is maintaining sats of 95-97% off of bi-pap. She is about a percent higher on bi-pap. She seems uncomfortable, she is a little quick to fuss and sometimes whimpers in her sleep. She is already getting tylenol around the clock, as per Dr. Brisseau, her General Surgeon. Dr. Brisseau was in and is happy with how she is doing. He wants to leave the Jackson-Pratt drain until after feeds are established to make sure that no feeds leak out through the drain. She can lose the arterial line today, and the urine catheter. Tomorrow we will elevate Kaitlyn's G-tube extension to see if she can tolerate the liquid in her stomach(normal stomach fluids) with just the air venting. She may have to have some dye injected into her bowel to check for leaks.

We will continue to give Kaitlyn all her meds by IV and PR until she is tolerating some stomach feeds. I asked if Kaitlyn could receive her full strength TPN and he said that there is no reason why she couldn't have had it all along. This makes me so mad because the poor little thing doesn't need any further starving. Yet another thing to be monitored the next time she needs TPN. I think that we always sort of feel like the doctors know what they are doing!

Dr. Soder(PICU Intensivist) was in at 2:00pm and said that Kaitlyn's dips in heart rate are a sinus vagal response, completely OK and wouldn't cause her any problems down the road. Her blood pressure is always stable. Dr. Soder says that a lot of these diseases of the CNS have some autonomic involvement, but he doesn't know to what level SMA may be affected. Dr. Soder and Dr. Brisseau discussed antibiotics and Dr. Brisseau is interested in stopping the Vancomycin in favor of something a little less harsh but that would still cover the gram positive bacteria and then leave her on the antibiotic trio for a full week. She will be on Ceftazamine, Ampicillian, and Flagicil. She will be going upstairs (on the floor)tomorrow, and Dr. Brisseau wants her to go to 7th floor south or east so that she will be on medical teams because of all of her respiratory and GI problems. So that she will be followed by all the necessary teams. Dr. Brisseau promised that somebody from surgery would be up to check on her every day. I think that he will follow her extra close and treat her extra nice because her stay here is not by choice! So far he seems really concerned that she get the proper care while she is here.