PICU Day 10

I hardly know where to begin today...it all started around midnight...Noah dropped his O2 sats to the 60's, and his lungs were so tight, he was no longer moving air. The attending was called as it looked like he'd have to be intubated. While waiting for her to arrive, Noah got 9 backtoback ventolin masks with some hand ventolation, and finally his lungs began to open up again. So it was decided to try to hold off on intubating and put him on BIPAP to take over even more of the work of breathing. With the BIPAP he began to settle. He was also started on Atrovent to help with bronchospams . A couple of hours later, our precarious central line became problematic and we completely lost one lumen of his double lumen line. This meant that there was no where to run the Pentoprazole, so it was decided to stop it. About an hour later, Noah began actively bleeding again.

That brings us to the day...his hemoglobin dropped quickly and he recieved another transfusion. As the blood was running in, we noticed his central line leaking blood almost as fast as it was going in. After a multitude of pokes, a peripheral IV was finally found and we were able to at least get some of the blood in him and restart the Pentoprazole. We are still using the central line for TPN, but there is a constant leak of fluid from the site and we may lose to whole line at any time. This evening we again lost his peripheral IV...Pentoprazole had to be stopped again...he began bleeding again...finally got another IV established. Praying this IV will at least last the night! It's been a crazy whirlwind day of just trying to keep up with one issue after another.

So yes, Noah's lungs are still a big issue, but the even bigger issue tonight is line access. Right now, this central line is Noah's lifeline. We cannot afford to lose it...if we lose all access, there is no way Noah can survive this. Our surgeon is away, and the surgeon who is covering for her was in no hurry to make any big decisions on a Sunday night. They did do an ultrasound to see if Noah even has anywhere to put a new line, and they think he may have a place, but it was unclear as to how scarred it is and whether it truly is a usable spot. They likely won't know for sure without trying. But trying means another trip to the OR...another intubation... which means likely not being able to extubate him again anytime soon. Tomorrow, this all needs to be addressed and some tough decisions made...we are between a rock and a hard place once again, with no good answers.

In the midst of all this, the kids came home today. We brought their gifts to the hospital and had a little Christmas with them here. It was so good to see them again and Noah was excited to see them too. They even got a smile out of him, despite how tuckered out he was!