Family Update 1/16/17 9pm

• PneumoMediaStinum:  (aka Air in the Middle of the Chest) Air escaping through small (microscopic) holes in the lungs to the middle of the chest - the area around the heart. 
  • The air will need to be absorbed by the body
  • There as some air in Altaview Xray ~9:30am
  • There as twice as much when he got to IMC - 12:27
  • By 8pm - it has reduced significantly - able to see some air in the lungs
  • X-rays give a GREAT visual
• Hypotension: Low blood pressure - see Dopamine
• Blood Clotting not perfect: see Fresh Frozen Plasma
• Full Bladder: Catheter
• Treatments
  • Dopamine - Increases blood pressure throughout body
  • Morphine - Pain killer and relaxant -
    • Prevents urination, requires catheter (@10pm he dropped 80 mg)
  • Melamine - Vasicular Vessel relaxant and increase heart pumping
  • Fresh Frozen Plasma (FFP) - Increases Clotting (3 measurements: 20/15, ~55/55, 150/120), increase blood volume, and blood pressure
• Pre-Saturation O2 Levels
  • The right arm and brain come from the same branch out of the heart.  What can be measured in the right hand is what is going to the brain
• Post-Saturation O2 Levels
  • Measured in the toe, is what the O2 is for the rest of the body and organs
  • The difference is caused by a shunt that should close for full term babies that prevents the blood coming in from a Vein from Mixing from the oxygenated blood out to the rest of the body. 
  • With the Lungs being compressed, not all the blood can get to them and is forcing this shunt open- mixing the blood and lower O2 saturation
  • As the lungs inflate correctly, the more blood can enter, the less pressure on the shunt, the better the post 02 sat stat
• Paralytic was given at ~6:30
  • Wore off by about 7:30
  • When this was given things got worse…because the ventilator was only pushing O2 in, but not pulling out…the intent was to let it escape naturally.
  • When this occurred, switched to a different ventilator that push oxygen in and pulls it out ~200/ min
  • While the paralytic itself did not help, the process allowed the docs to figure out that a different ventilator was needed
• Status: 
  • Stable - if things remain as they are, things will improve
  • Pre 02 Stats: 95, Post 02 Stats 87-90
  • PB: 64/43 (53)
    • Want to keep systolic above 60 and mean above 40 (# of Gestational weeks)
• Next Steps: 
  • MAINTAIN  CURRENT STATS!!!
  • See Goals
  • If stats improve to 100% will decrease Oxygen from 100% down to 40%
  • If stats degrade drop to 80% saturation, need to transfer to Primary Childrens for an EKMO
    • http://emedicine.medscape.com/article/1818617-overview
    • https://www.ucsfhealth.org/newsletters/heart_and_vascular_center_news/winter_2008/ecmo/
    • https://intermountainhealthcare.org/ext/Dcmnt?ncid=520408193
    • https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation

• Goals: 
  • Get 02 status high enough the the Oxygen can be turned down from 100% to 40%