Twin Details Jan 22nd and 23 - Tue, Jan 24, 2017 at 10:20 AM

Sunday Jan 22

Afternoon

• Exhibition Failed:  He was breathing well on his own via the ventilator, however after the tube came out his through swelled (closed??? - don’t know) but he had a hard time breathing.   The re-intibated him and is doing OK now. 
  • CO2 76% (HIGH)
  • RR - 60/min
  • O2 30%
  • They had to suction out a little blood
  • He is on 3 doses of Desemethazon (aka - dekadrone) every 12 hours (Q12) to reduce the swelling
  • @ 8pm blood gas is normal
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• Feeding: 
  • he is getting 70 ml / kilo which meets 1/2 his nutrition needs
  • upped his breast milk feeding to 32 ml / 3 hours … ~8 ounces/day

Plans for Tomorrow

• MRI is scheduled for tomorrow afternoon
• Attempt to re-extibate after the MRI

Monday Jan 23

9:30 am : Tyler

• He is doing fine
• Status 
  • O2 - 24%
  • CO - 41%
  • Blood Gas results good
  • RR - 60 / min - machine is doing 40 
    • He is on PSV Mode  - which supports him with each breath by providing press when he breaths
    • ISMV Mode - this will be switch too before re-extibation, this make him do the work of breathing all in and all out. It also make sure that he get a certain # of breaths a minute
• MRI - Will happen today, but not yet scheduled
• Out of Milk, needs more by 11:30am 
  • They can do Pasteurized Human Breast Milk, but it is expensive
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• Exhibition is planned for 4pm 
• What to Visit? 
  • Cares are done Q3 - 8:30, 11:30, 2:30 etc. These are good times to come and interact with him. 

11:00 am - Visit and milk run

• Changed a diaper
• He was crying and visibly upset, but no sound due to the tubes
• He was calmed as we placed hands on his little body
• Finally calmed after Tyler put a warm blanket on top of him

6pm - Call from Jen - NP

• Did NOT do the extibation
  • Decided to give 3 more doses (1/2 amount) of desemethazone 
  • Give more time for the swelling in his throat to go down
    • (What are the additional side affects of dsemethezone???)
  • Still on Supported Mode on ventilator
  • doing 33 RR on his own
  • 02 - 21% to 28% (GOOD)
• Off of Bilirubin Lights 
• doing X-Rays Weekly to ensure the PICC line is still in the correct place
  • As he grows it can move out of the optimal spot
• MRI Results - ALL is NORMAL!!!
  • The ischemia found in the head ultrasound could have simply been a shadow
  • Again - All things are normal with the MRI
  • Interesting note: They did a test of the gas (aka - blood gas) in the cord blood immediately after birth. the results showed normal levels which meant that his brain was not starved of oxygen at birth