Sunday, August 06, 2006

Loose ends

A key part of the Friday intervention was the presentation of Woody's test results as it relates to his CO2 levels. Since he hasn't gotten this number down below 70 in six weeks or so, the reasoning went, it is pretty much a waste to try another extubation attempt. Apparently Woody has heard this and responded, because his blood gas test this morning has his CO2 down to 62. That's not all-- his bicarb is down to 33 (not great, but waaaaay better than 45), his chloride (electrolytes) are up to 102 (normal range), and his prealbumin* test, which measures how well he's dealing with protein-related issues, is almost up to normal this week, and last week it was pretty far down there.

In short, there is a greater than zero chance that the talk of a trach is yet premature. If Woody comes out of the eye uncertainty with declining CO2 levels, he'll get a chance to be extubated first.

Woody's eye exam is Tuesday, at which point we'll get the verdict on eye surgery. If he does get eye surgery, he'll get the ROP treated with a laser under general anesthetic, and then will need to be kept quiet and comfortable for about a week in very high oxygen sats (they said in the intervention that it would be at 100% oxygen; nurse M2 clarified this morning by saying that his sats would need to be held to close to that level. They'll probably set his alarm at 95% and let me tell you, that will be not so fun to hear the dinging and the beeping with that sort of parameter).

In short, the trach issue and the eye issue are hanging over our head this week, and until we know how that resolves we won't really know what's happening with him. He seems, subjectively, to be very feisty and strong the last couple of days. He's done with the strong IV antibiotics from his UTI and is now on an oral dose for a while just to make sure. And his O2 needs are really beginning to drop; he's now down in the high 30s/low 40s most of the time, which is very good (recall that we're comparing to room oxygen, which is 21%).

*I always wonder why they're testing for some precursor to egg whites, anyway. I wonder if anyone has said this before-- is an eggshell an albumin cover?


At 1:18 PM, Blogger Bill Hooker said...

is an eggshell an albumin cover?

*kicks norm lovingly in the shins*


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