Little more challenging this morning

Everything was looking great until 600a. At 600a, Keane was so hungry that he ate an ounce right out of the haberman bottle for the second time (first time at 230a). He was angry when the bottle was finished, so I asked if he could have another ounce. It seemed like a good idea at the time; however, coinciding with finishing the bottle, or because of the increased food in his tummy, extreme discomfort occurred after his 600a feeding. He had sustained tachycardia (195), increased respirations (50s) and prolonged desaturation (O2 sats in mid- to upper- 80s). Since we are used to now seeing him looking pink and healthy, is was pretty traumatic on Mom to see him blue and dusky.

I have concerns that the night nurse was too delayed in giving him his Tylenol, which can be administered every six hours. His last dose - after my request - was at 1045a. When I went to bed at 330, he was due for Tylenol at 445a. I woke up at 600a and he had not had any Tylenol. He also had not had any narcotic pain meds since Saturday at about 9a. I believe the lapse in Tylenol, combined with his still labored breathing, receipt of a Tylenol suppository, and an upset stomach from eating/increased GI gas, made him extremely uncomfortable. I requested morphine at about 645a. He then rested comfortably until Ben arrived at 730a. Again, tachycardia, increased respiration rate and blue baby reoccurred. The entire ICU team came to respond. He calmed down again after a few minutes and a very unpleasant suctioning.

He is now a little raw from being suctioned so much. During rounds, his team made a plan to attack the "wetness" in his breathing aggressively. He is on increased diuretics and high flow O2 via nasal cannula. He did have a repeat chest x-ray at about 800a that showed a still large heart, but no alarming issues with his lungs.

Dr. Kirby, the attending intensivist, is going to come back after rounds to check in. Also, we expect to see someone from his surgical team today - in Keane's anger and discomfort, he pulled out one of his chest tubes almost completely (which lead to more anger and discomfort). As you will see shortly, he is now resting comfortably.