Saturday, July 26, 2008

Still Intubated!

Kaitlyn slept through the night from 11:00pm to 4:00 am when the next physio was done. No coughing this time. After physio she went back to sleep until 6:00am when routine x-rays were done. Fentanyl was stopped at about 5:30 am (started at 2ug/kg/day which was cut to 1ug/kg/day yesterday - seemed to be well tolerated). Since 6:00am she has been awake more than asleep. Only a brief nap around 10:00 am. Now just waiting for Dr. Soder(PICU Intensivist) to come yank the tube out.

Kaitlyn was successfully extubated at 2:00pm. She was given a dose of glycopyrrolate before we got ready to extubate her. We coughed her through the endotracheal tube, three rounds of five breaths, suctioned her tube and mouth and then pulled the tube. We decided to also pull the NG-tube as we didn't feel that it would allow us a good enough seal with the bi-pap mask. Her G-tube is still vented to drain. It is working as I could hear lots of air coming out. We changed her bi-pap settings to 20 over 5 from her normal of 17 over 3. She was soooooo happy to have that tube out, she grinned and grinned. She is left with a larger than normal gap in the middle of her front teeth. She was testing out her own voice and seemed pleasantly impressed that it worked again. Her sats are 95-97% and her heart rate is nice and low 90-120bpm. Respiration rate is 30-50 on bi-pap.

Kaitlyn's Lasix and Aminophillan were stopped prior to extubation. Her potassium came back low so she is getting a bolus dose now. Currently she is on her TPN, maintenance, potassium and antibiotics. Her heart rate has been a little erratic, anywhere from 50's to 1 teens. she settles out when she is awake. She is extremely talkative!!! She has the nurses and resident doctor in stitches tonight. She is babbling and calling for a-la-la-la(Alexander), and go-go-go, and go-go car-car. Her temp. is back to normal, mid 36's. She is handling coughs like a pro, no problems at all. She came off of bi-pap for about an hour after evening physio and coughs. She did really well, maintained sats and heart rate stayed low. All in all a successful day!

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