First, some corrections:
Sam still has his pacemaker leads in place, but the pacemaker itself is no longer attached. The wires are just coiled up and taped to his chest. Also, both drain lines are still in place and won't be coming out until they stop producing fluid. One of the drains is in the chest while the other is in his abdomen. Sam is aware at times with his eyes wide open, but I don't think he's looking for a toy just yet-- perhaps he is just soothed by tactile sensation. Yesterday there wasn't much swelling. Today we have swelling-- not necessarily localized to the chest, but just general swelling all over like fluid build up. The decision was to put him back on a diuretic (Lasix) for the time being and work to step down the dose over the next month to zero. He's been on this drug since he was about 2 weeks old. His body is used to it.
Sam was moved out of the PICU today into a "step-down" intermediate care floor. There are 6 beds and 2 or 3 nurses. Up in the PICU he was on a short-acting pain med which worked fairly nice for him. As that wore off, they tried to manage his pain with Morphine. It was given in two half-doses. When the first one didn't have an effect and Sam was still moaning/crying after quite some time, they went with the second half dose. That also didn't cut his pain. Finally called in the "pain team". [what a name]. They delivered with PCA (patient controlled analgesia)-- pain meds with a push button control. It took what seemed like forever to get the stuff from the pharmacy, then get all the apparatus hooked up and delivering meds. Even then, it still wasn't a slam dunk. The morphine has a side effect of causing skin to itch, so Sam was scratching at his face continuously. As you might have guessed, there was another drug to counteract that effect. Finally around 7:30 or 8:00 pm, he started to get relief and rest comfortably. Today was harder on Sue and I than yesterday.
Sam still has his pacemaker leads in place, but the pacemaker itself is no longer attached. The wires are just coiled up and taped to his chest. Also, both drain lines are still in place and won't be coming out until they stop producing fluid. One of the drains is in the chest while the other is in his abdomen. Sam is aware at times with his eyes wide open, but I don't think he's looking for a toy just yet-- perhaps he is just soothed by tactile sensation. Yesterday there wasn't much swelling. Today we have swelling-- not necessarily localized to the chest, but just general swelling all over like fluid build up. The decision was to put him back on a diuretic (Lasix) for the time being and work to step down the dose over the next month to zero. He's been on this drug since he was about 2 weeks old. His body is used to it.
Sam was moved out of the PICU today into a "step-down" intermediate care floor. There are 6 beds and 2 or 3 nurses. Up in the PICU he was on a short-acting pain med which worked fairly nice for him. As that wore off, they tried to manage his pain with Morphine. It was given in two half-doses. When the first one didn't have an effect and Sam was still moaning/crying after quite some time, they went with the second half dose. That also didn't cut his pain. Finally called in the "pain team". [what a name]. They delivered with PCA (patient controlled analgesia)-- pain meds with a push button control. It took what seemed like forever to get the stuff from the pharmacy, then get all the apparatus hooked up and delivering meds. Even then, it still wasn't a slam dunk. The morphine has a side effect of causing skin to itch, so Sam was scratching at his face continuously. As you might have guessed, there was another drug to counteract that effect. Finally around 7:30 or 8:00 pm, he started to get relief and rest comfortably. Today was harder on Sue and I than yesterday.
posted by Bob_and_Sue at 9:35 PM
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