Daniels Twins Details -- Thu, Jan 19, 2017 at 10:24 PM

Summary: 

    Mom and James were finally able to make it home. Watching James’ Billiiruban count, but eating and sleeping well. 

    Joseph:

• Continues to be critically stable. He breath 5-15 times on his own in-addition to the 30 breaths per minute from the respirator.
• They have started to lower his Nitric Oxide from 20 ppm to 15, then 10, 5, then 4, 3, 2, 1.  Each change is done every 6 hours and then he is assessed to determine if the next drop can be done.  We are watching for Hypertension. 
• His oxygen requirement is still between 28-33% (GOOD)
• They all say he is strong and a fighter
• The x-rays done this morning show very little air still in the chest cavity.  the Pneuma Thorax (sounds like something from Dr. Seuss) is hardly there at all. And the pneumomediastinum (say that 5 times fast) is nearly gone as well.  The NP really can’t see either one on the x-ray (EXCELLENT)
• Even with all the progress, it will still take at least a week or two from him to come home.   

8:00 am: Diane  -  

• Continues on new ventilator
• Blood Gas is good
• Got fussy around 6am
• Repositioning didn’t help, and got a dose of morphine
• Breathing Good…38-40 on his own
• Ventilator still on 30
• Looking to take out Arterial Line soon
• Sleeping Quietly

Insurance Approved through 1/20 - 

Authorization #: 611631

Dr Needs to call and give 

What is the upper limit: 

What is the daily 

Rounds 11am - NP - Kim

• 4 Days
• 3660 down 90
• D11.5 papery ell
• D5 morphine
• Portent 2.7
• Urin 3.3
• Tmp 36.7
• HB 178
• erst 30-48
• Mean 61 mean 41
• on SA and B
• Peep of 6
• Foo 26 -43 …currently 28
• Blood Gas : 73.5 49.58. 26 Hemo 20.5
• Meds: Hyd
  • Hydro cot
  • .015 Morphine .4 PRN
  • Ativan - ???
•  Bili 8.4
• Blood culture is Neg
• Small Volume Feed? What about   10 m/ kilo?
• Diaressing
• ??Per art line was discontinued . . . 
• Picc line is 
• “Couldn’t appreciate it
• 8 Ribs expanded
• Start weaning of NO2 - by 5 every 6 
• Echo when don with NO2
• Waiting to wean off the Morphine
• “He is really strong"
• Taking the tape off of the artialian line? 
• Should decrease the Morphine?
  • Ana says yes, others think Not
    • Wants to get him off
  • NP - Try and drop Morphine 
• Drop 
• Hydro one more for today
• He  is orange on exam. . . 

On Xray . . .can’t see it this morning

Likes new ventilator

O2 is going down

N02 will drop 

6:45pm 

• Continue to be stable and continue dropping N02, now down to 10 PPM
• Will drop 5 more at 12am and then at 6am will start dropping one at a time ever 6 hours
• The point at which problems usually arise is during the 5 ppm to 4 ppm
• O2 stats continue to be stable between pre and post
• ranging between 28 -33%
• Does get agitated when Cares are done and needs a dose of Ativan