This Tuesday morning Sydney vomited a couple times when she was agitated. The nurses gave her some Tylenol, Ativan and morphine which helped calm her down. They didn’t make any changes to her tube feeds. The nurse saw some brown specks in her vomit so the next time she vomits they will send it down to the lab to check for any blood. Otherwise we have not noted any active bleeding. Her platelet count remains low at 29k while she’s still on the continuous heparin drip to prevent more blood clots and aspirin to keep her stent in her heart open. Hemoglobin is stable at 15.7.

She had her wound vac dressing changed this morning and she tolerated it well. The wound care team reported it is looking good and healing well. They are concerned with her index finger. The necrotic tip should have fallen off by now. They are concerned that there is some bone involvement. They consulted the orthopedic surgeons to come look to see if she needs to have some of her finger surgically removed. The ortho team says they will continue to monitor her finger but right now it doesn’t appear to be infected so they will leave it attached to fall off on its own. 

Her heart rate has been elevated consistently higher than 140. Her baseline is in the 120s to low 130s.  Still unsure why so the doctors drew blood cultures off her transhepatic line.  Even though she hasn’t had any fevers they want to make sure she doesn’t have an infection they are missing.  Her white blood cell count remains elevated at 26.57 (normal 4-16). With 1% bands present (normal is less than 5%). She remains on the prophylactic antibiotic, Amoxicillin, and the antifungal, Fluconazole. 

Surprising with her elevated heart rate her lactate level has remained around the lower 2s all day (normal is less than 2). Her blood gases show she is starting to  retain to much carbon dioxide and her blood is becoming acidic. Her RAM settings remain the same with a pressure support of 28. Her oxygen needs have increased to 35%. She continues to breath about 50 times per minute. 

She will have her ECHO on Monday then if her blood clot looks stable she will be sent to the cath lab to look more closely at her heart.  We learned today that the doctors have no intention on extubating (removing the breathing tube) her after the test is done like we were hoping for. Instead they have decided she needs to have a trach placed.  This is because she hasn’t been able to tolerate weaning down the pressure support on the RAM and her heart is working harder. The doctors think if they can give her more pressure support her heart will work less harder and we will see her heart rate go back to normal as well as her lactate levels. Even though we are disappointed and feel discouraged we have agreed to have the trach placed; we are willing to do anything for her.  We hope it helps her heart. 

She’s weighing 14 pounds 7 ounces today.  The dialysis team hasn’t made any changes to her regimen. Her kidney function remains the same. BUN is 23 (normal 6-22). And creatinine is 1.31 (normal 0.21-0.54). 

Mom spent the evening decorating her room. Sydney is ready for football season (Go ISU) and fall weather!