7am
Pnuemothorax developed since yesterday..upper right lung
Breathing heavier since 4am...dropped to 40 b/m with morphine around 6am
O2 down to 38 starting at 10ish last nightBp 61/35 mean 43Dopamine dropped to 12 mg\minVrntilatoe at 14.3 pressure 7 hz 25 amp20 NOO2 statss. Pre 93 posot 97
Dr Anna says breathing is ok and even wanted if other stats staying correct
Dr ostrand neonuero doc
Basal ganglia , eschemia ...there is an scemia between the basil ganglia which might indicate damages tissuen. However cant tell anything. Eeds tonwait for mri. Will be done in a week
10 am Rounds: -Meeting with all doctors, nurses, etc about 10 people
- Lowering Mean Pressure down to 13
- FITO2 - ~33
- TCM is up to 50 (normal is up to 55)
- PO2
- Meds
- Ampicila
- Hydochortzon
- PRN mornphine
- PRN Atavant
- Dopamine: 12
- Morphine Drip of .1
- Melrnone
- No Grown on Blood Culture drawn yesterday
- Xray just done shows the pneumothorax is stable and the same from 4am
- Starting TPN
- Lowering to havel sodium acetate
- Echo Reported from Yesterday
- Doing a followup today, but not yet ordered- Ana doesn’t want to do it…going to skip
- Plan to wean off the ventilator and 02
- Xray every Q12 from 9:15
- Keeping mean to 40 - 45
- Light level is 11???? - this is where the level where lights are done, he is currently at 5
- Neuro Standpoint
- Possible eschema, likely to wait a week to MRI
- No more antibiotics as of now
- Do echo tomorrow and use that to determine what to do with the melrnoe
- Get an RFP in the morning -Blood test "Renal Function Panel"
- Today is a rest day
Evening
6:30 pm: Nurse Hilary
Dropped Dopamine to 3 down from 11
O2 is between 30-40%
Ventilator is still at 7hz, 13 Pressure, 27 Amp
11:52 pm - Nurse Sara
All off the dopamine
Cares - @ 9pm flipped to tummy
Appears to be comfortable and likes it
30% on O2
No other changes to the ventilator
X Ray in the morning
Blood Gas as well
TCM - CO2 - is at 45 -> 48
Sucking on his tubes … yahoo!!!
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