Baby Eagan - NICU Day 45 - Crash Cart

 The crash cart, the gigantic thing they roll quickly down the hall when a baby unexpectedly codes. Instead of going quickly down the hall, the cart stayed in Eagan's room all night last night and all day today. I will start at the phone call. You know, the one you never want to get in the middle of the night. Eagan's CVL (central line) was in the right position, but managed to leak into his pericardial sac, or the sac around the heart. Because of this Eagan had gone into cardiac tamponade, a life-threatening, rapid buildup of fluid around the heart that makes the heart unable to beat. A pericardial tap was preformed by a cardiologist. He took a gigantic needle, stuck it into Eagan's chest, and pulled out the fluid. During this time, Eagan got very weak and could not continue to keep working so hard. His ventilator was turned up and he was given large amounts of blood pressure medicine. The TPN fluid is very dangerous when it comes in contact with organs, but it does not appear to have damaged his heart.

His doctor has only seen two other babies with a leak into the sac around the heart. Both leaks were found in their autopsies. Even his nurses have never seen a baby survive this. Eagan is my little exceptional miracle. We came very close to losing my little boy today. Every time anything alarmed in his room, his nurse was ready for emergency action.

But of course, in true Eagan fashion, the complications keep on coming. His CVL obviously needs to be removed, but there is a large clot that could come loose in the removal process and he not survive that. With the crash cart still ready, the CVL was removed very easily and the clot came out with it. Still, his doctors were worried.  The removal of the CVL after such a trauma could still cause him to code, so the crash cart stayed in our room for a while longer. Finally, they think we might be in the clear and once again, Eagan has proved all of the statistics wrong.

 

Here is a run-down of his current status:

Weight
With all that Eagan had going on last night, he wasn't weighed.

Breathing
Eagan is on the conventional ventilator. His settings were at 60 breaths per minute this morning and are now down to 36.  His oxygen rate has been between 100%-28%. The pressure that the ventilator puts in his lungs is at 25. 

Vitals
Eagan's blood pressure was low today.

 

Vein and Artery Access
Eagan has an internal jugular line that was placed in surgery.

The arterial line is in his head.

His CVL, central venous line, on the left side was removed today. 

Medications

Hydrocortisone, for blood pressure and stress response, is at 2 mg.

Eagan is on Meropenum, an antibiotic.

His Vancomycin was stopped due to high levels in his blood. 

His Morphine was previously given every two hours but now his is on the same dose, but as a constant drip.

Caffeine has been started as a diuretic to try to speed up his kidney function.

Lasix has been temporarily discontinued because he is back on blood pressure medication.

Eagan is back on the Dopamine between 15 and 9 micrograms.

He is also on Diflucan as a preventative measure.

Nutrition
Eagan's only sources of nutrition right now are his TPN fluids. 

His lipids have been stopped for now.

 

Output

Eagan has a foley catheter in place. His urine output was not good today.

Transfusions

May 23 - Transfusion #22