Job is now sleeping peacefully. He's on a great deal of respiratory support (85% oxygen - compared to the 21% "room air" that you and I breathe - at 10 lpm of flow). He received a broad spectrum of antibiotics in case of pneumonia. He received some steroids to help with his throat inflammation and hidden those airways. And he receieved a dose of Tylenol.
He has a NG tube and two IVs as well as the hi-flow nasal cannula. We're waiting on the results of his viral panel and echocardiogram.
Since this is a respiratory (rather than cardiac) issue, SCH was comfortable allowing us to stay at Mary Bridge here in Tacoma as their PICU ought to be sufficient for Job's needs. We could have insisted on transport to SCH after he stabilized, but there's just enough risk in doing so that I couldn't justify it for a non-cardiac issue. It is odd being in such an unfamiliar location with such unfamiliar names and faces, though!!
Yesterday Job had a cold with a mild cough and was uncomfortable, but kept his sats up sufficiently until this morning when I called in to SCH and they told us to come up to their ER.
Typically the oxygenation of your blood should be at 98%. Job, because of his CHD and subsequent surgical reconfiguration of his circulation, will always live at 75-85%. He has needed oxygen support since September to maintain that 75% but has been weaning off of said support since his axillary fistula in March (from 1 lpm to .25 lpm).
When he got sick, I turned him up to .5 lpm. This morning, when I saw his increased work of breathing and growing cyanosis, I turned him up to 1 lpm. He was satting at 55% and the increase of oxygen didn't help, so I started packing our hospital bag while calling in to cardiology.
They told us to come in to their ER and I turned Job up to 2 and then 3 lpm without much responsiveness. My dad was able to drive the three boys and I, so we headed north on Portland Avenue while Job's sats dropped. By the time I spoke with 911 (so many rings!), Job was hitting 23%.
They dispatched an ambulance and we pulled over. I had Job up to 4 lpm on my low-flow tank, which is about as high as I can go through his regular nasal cannula without making him so miserable that it's no longer effective. The paramedics got Job and I into the ambulance and put him on hi-flow at 10 lpm with a mask and he finally started responding.
I held him, sitting on the stretcher, while they sped to Mary Bridge. I've never been in an ambulance before but I was surprised by the speed! It was even a bit hard to stay on the stretcher as they hit some of those corners!
We were rushed into the ER and his room filled with people. I had been relaying information to the paramedic in the ambulance with me, so they were pretty well prepared for us. I probably have a bit of prejudice against any hospital that is not my beloved Seattle Children's, but I was so pleased with the care Job received from the paramedics and ER staff!
There have already been lots and lots of calls and emails flying between SCH and MB about Job, so it seems as if the two providers do and will communicate well. A cardiologist from the Tacoma SCH clinic came by and assessed Job and is reading his echo right now.
Job hasn't slept much today, so after his NG tube placement he cried himself to sleep. They're going to start continuous feeds pretty soon, which is always preferable to IV fluids. Once he gets down to 6 lpm on hi-flow (down from the 10 he's at now), he can have oral feeds.
No comments:
Post a Comment