Day +139/+140

Day +139
We are currently in the PICU, and Raul is intubated. This afternoon he stopped breathing after choking on a blood clot from a nose bleed, and went into cardiac arrest. They did CPR for about six minutes (with four rounds of Epi), but believe he was without oxygen for at least some time. He did not respond to being bagged, likely because his airway was blocked by the clot. And they had a hard time intubating him because of all the blood from his nose. It was horrible to watch everything he had to go through, and I am thankful for his sake that he wasn't conscious for it. 

Once he was intubated they moved him to the PICU, and continued to stabilize him there. They placed an arterial line to monitor his BP. At first he was not sedated, but pretty quickly they had to do bolus doses of sedatives, and then switch to continuous drips. He is now also getting a paralytic as he was fighting the vent too much and getting agitated. He has not opened his eyes since coding, but he has moved all his limbs while more awake. But for now they want him to rest and let the vent do its job. We did have to adjust his breathing tube once, as his oxygen sats were dropping, and we found that his breathing tube was a little too far down so his left lung was not inflating properly. 

They were considering doing CT scans tonight, but held off as his BP has been a bit low and they didn't want to have to transport him to the CT room unless they really had to. His blood gasses have gotten to be surprisingly good, and they have started to wean the oxygen on his vent slightly. Because he was already in Boston for work, my dad was able to make a flight out here tonight, and my mom will be coming first thing in the morning. Over the next few days we will get more of an idea of how he will recover.

Day +140
Raul had a good day. His BP was much more stable during the day than it was overnight last night. We have been weaning his Epi, and will hopefully wean it the rest of the way off tonight. We have weaned the oxygen on his vent from 100% to 30%, and will continue to wean towards room air as he tolerates it. The rate has also been dropped to 18 and he is taking his own breaths over that. 

He has been kept sedated so far, though occasionally does wake a bit and move around. He was especially unhappy when dermatology came to place more EpiFix on his knee and kicked his legs a bit. He will also put both arms up like he wants to fight when he gets messed with. He is continuing with his spunk even while sedated! He is getting a Fentanyl drip with his sedation, and is likely having some pain so he gets bumps of it when it seems like he might be in pain. Unfortunately, while it is to be expected, he did have quite a bit of skin loss from his chest as well as "at least one" broken rib due to the CPR. We will continue to give him pain medicine as he needs it to make sure he is comfortable with these issues. 

Tomorrow morning he is having a head CT first thing, and then a little later will be getting another PICC line placed as we have been using his dialysis catheter and that will not be possible tomorrow as he needs dialysis. We will most likely be starting continuous dialysis to be more gentle on his body while he is still intubated. He has gotten VERY puffy due to all the fluids he needed yesterday!

In terms of his labs and blood gasses, Dr. Tolar said this morning that he is basically improving as quickly as he can. Of course he still has a ways to go, but he is making good progress and they were pleased. Hopefully the scan tomorrow will give us more insight into any deficits there may be due to the loss of oxygen. But he is moving all his limbs and has a cough reflex, which are both good things!