PICU rounds

So here's where we are...

Respiratory:
Chi's chest x-ray is still pretty cloudy, but clinically he is doing better, so that is good. He is still being treated for pneumonia. Crazy that after six months mostly spent in the hospital, this is his first respiratory infection. The plan is to keep him on antibiotics and start weaning his vent back to his normal home settings.

Cardiovascular:
Heart rate has been good. Blood pressure has been good. The blood transfusion immensely helped with his blood oxygen levels. Today he is on an oxygen support of 35% and sating 80%--perfect! The only other change is that with the long-term port in his chest along with the two shunts he has in his heart to help with bloodflow there is an increased risk for a blood clot to form. For this, he will be adding lovenox (a prophylactic anticoagulant) to our already massive list of medications. With the antibiotics he's current on while inpatient, this brings the grand total to just under 30--actually closer to 35 with all the one time doses of supplements, pain meds, and sedatives.

Nutrition:
Through the night, Chi stopped tolerating his feeds. He was puking most of it up. So, they are switching from 140ml over 1.5hrs every 4 hours to a continuous drip of 35ml/hr. Poor guy. I don't think his little belly will ever feel full :(.

Infectious Disease/Immunology:
His blood cultures and things have come back negative for growth at least 24 hours. If they are still negative tomorrow, then one of his antibiotics will be stopped. Also, his cyclosporine (an immunosuppressant) level is SUPER low. Dr. N wants his level to be around 200. Yesterday, it was at 80 or 90 (low) and today it was 20 (SUPER LOW). So it will be important to also get this corrected before going home. Malachi is super agitated and I have NEVER heard him cry this much or for this long. He's hurting and NOT happy whatsoever. Nothing I do is consoling for him. Poor thing. The pain and agitation could be do to his immunosuppressants not being at an appropriate level for his condition.

So before we can go home, he needs to be back to his home vent settings, off the antibiotics (they are given IV), and his cyclosporine needs to be at an appropriate level. Also, we are hoping to have a care conference with docs from the following specialties in attendance so that we can hopefully get on the same page with what direction we are moving with Malachi's care: Cardiology, Immunology, Developmental Pediatrics, Pulmonology, and ICU.