Sunday, January 3, 2010

"She's a very sick little girl"

Well, I wish I had better news to report, but "the news is the news". Evs did fair through the night last night (outwardly, anyway), but overall today was up & down, and the doctor's prognostications of "it'll get worse before it gets better" seem to have held true. Tonight left us teetering on the brink of intubation, but so far, holding off.

The quick run-down of the day:
  • As of this morning (chest X-ray), Evs' right lung is ~75% "crudded-up" - this is a "marked" degradation overnight from the previous night
  • Her left lung was "hazy", but "okay" (for now)
  • Labs this morning showed a little more conclusively that it is bacterial (rather than viral) pneumonia
  • This means it was a likely result of aspiration, which we'll have to re-evaluate the cause & future prevention of - e.g. it could be anything from her coughing & aspirating what she coughs up, to aspirating some of what she eats, to have some level of reflux & aspirating that.
  • Her antibiotics were upgraded to stronger, broader-spectrum antibiotics - Vancomycin andMeropenem.
  • We added a Vest to her treatment regimen, which is essentially an inflatable ... well... vest, that can have air-pressure and percussions applied to it, to help "squeeze & shake out" the mucus in her lungs.
  • Evs really just struggled up-and-down over the course of the day - sleeping, for the most part, but not getting much rest, due to constant "huffing and puffing". She stayed reasonably oxygenated (over 90%), but her heart rate was consistently 160-170 bpm (peaking at 180), respiratory rate 60/min (that being a breath a second, sustained!), and by later in the afternoon, her blood pressure started to dip (which is also likely contributing to her increased heart rate, etc).
  • The low blood pressure was likely due to her own body not quite reproducing enough new blood cells due to the infection, and her just working so hard all day to breathe.
  • Evs' supplemental oxygen flow (well, heliox & other associated breathing treatments included) topped out at 15L - this, if nothing else, is indicative of the day she had - 15L is huge. We're still pretty new to the respiratory world, but at home, we considered 2L "bad".
  • Dopamine was added (IV drip) to help with the blood pressure, but it didn't seem to completely do the trick, so she risked slipping into shock. Thereby, late in the day, a blood transfusion was started, to combat the falling blood pressure. New IV sites for that wouldn't hold (means more worthless sticks... :-( ...), so they started a central line (femoral IV).
  • If her blood pressure, respiration rate & heart rate don't stabilize - she will likely be intubated & ventilated.
  • We will likely start a 7-10 day course of IV antibiotics via PICC line tomorrow.
As you can see - quite a day!!

On the positive side, while having an X-ray taken to verify the placement of the central line, they could pick up some of her lower lungs on the film - while not the entire lung (as it wasn't the subject of the X-ray), what they saw did seem to show that the infection was clearing some - so that's heartening. Also, as of this writing - the blood transfusion is about half or more complete, and her heart-rate has dropped a good 20-30 bpm's or more, and her blood pressure is looking better. As long as she can maintain where she's at or better for the night, we should be able to avoid intubation - so here's to hoping for that!

In short, I think my dad summarized it best earlier today - "she's a very sick little girl". It's also just been a good long while since we got a proper "waiting room debrief" from a gowned doctor, which coupled with their sincerity in relaying the seriousness and relative precariousness of Evs' situation - is a little unnerving.

Anyway, other than monitoring her various rates overnight, the next "big check" will be early tomorrow morning, when another chest X-ray is taken, to see how her lungs are looking. More then, or as news breaks!


Anonymous said...

I am glad for the PICC line so no more poor IV attempts for her, right?

You know I am very concerned about the aspiration pneumonia. I hate that she is having to work so hard for each precious breath. Those are some powerful antibiotics. They did wonders for me and my lungs and weak body. I so pray they have the same effect on Evelyn.

Your dad gave an excellent summary. Very sick indeed.

I can't tell you how hard I am hoping and praying for good news!

Hugs and love to you all!
-- Melanie

Nikki Cross-Patrick said...

We're so sorry to hear the news, but are praying for her swift recovery and a return home for Evs and the whole family. I've been emailing with Kim and am around every night this week and through the weekend- ANYTHING you need, we're happy to help. I've got you guys incorporated into my menu planning, so I'll have a dinner (and a dog bed, oddly enough) next time I see you.

Much love to everyone and all our prayers for a speedy recovery!