ICU Day 1 - PM

The pulmonary critical care (PCC) docs decided to keep Andre attached to the ventilator. Results of his several spontaneous breathing tests (they turn off the ventilator and have him on “sedation vacation” so Andre can be awake) show that he’s doing great in terms of his respiratory rate and his blood gases. But because of the pain and discomfort, Andre then gets highly agitated and his blood pressure shoots up. The docs would rather take out his breathing tube tomorrow morning when they’ll have the whole day to monitor him instead of doing it tonight. They think it’s also helpful for Andre’s chest muscles to relax for another night by having the machine assist with his breathing. They think this will help synchronize his left- and right-hand sides when he breathes.

Earlier today, the PCC docs called an anesthesiologist for a consult. They wanted to know if Andre can have an epidural. The anesthesiologist said that an epidural would be risky because of Andre’s low platelet and white blood cell counts, so the pain meds will just have to stay systemic as is the case now (via I.V. or through Andre’s central line). He also said that the pain management will have to be done by the PCC docs. He recommended to the PCC docs to use Dilaudid on a PCA (delivery of the pain med is controlled by the patient with a push of a button) but since Andre is not conscious enough, this might be tricky. We’ll see how they’ll do this tomorrow.

It’s a little past 8 PM and I’m still here in Andre’s room because I wanted to check with the surgeons when they go on their last round of the day (they’re supposed to do one in the morning and one at the end of the day). But guess what? One of the PCC docs just informed me that if the surgeons haven’t come by yet, they are likely gone for the day. His advice: go home and come in early to catch the surgeons’ when they do their morning rounds.