06/21/2007

Okay, I am a little excited, so bear with me.

VERBATIM ROUNDS

DR. B: What CPAP is he on?

NURSE PRACTITIONER: He's on a CPAP of 7 and doing great. Check out his blood gases.

DR. B: That CPAP is like nothing. When are we trying high flow? NURSE PRACTITIONER: At a CPAP of 6. Hopefully on Monday we can wean to a CPAP of 6 and then give him a few days and then try him on high flow.

DR. B: (To me) Has he ever had oral feeds?

ME: No. He's never been tried on cannula.

DR. B: When we get him to cannula we'll need to start bottle feeds to see what he can do. His theophylline is subtherapeutic... what do we want to do with that?

NURSE PRACTITIONER: Well, I have to talk to Dr. A, but I believe the plan is to discontinue it.

ME: I think Dr. A said he'd like to see if it could be discontinued because he said it's apparently hard to get at home.

DR. B: It is harder, but certainly if he needed it he could have it. That's not going to hold things up. Let's discontinue that. What is his diuretic at.

NURSE PRACTITIONER: ... says some numbers that for some reason my brain tunes out to.

DR. B: Discontinue the theophylline and the go up on the diuretic to (more numbers that make my brain go numb). We'll know soon whether or not he needs it. What about his morphine?

NURSE PRACTITIONER: I'm not in a hurry to discontinue it. He seems comfortable on it. He hasn't thrown up for over a day.

DR. B: We can discontinue that at home if we have to.... We can see the light at the end of the tunnel. The end is near...

So, anyway, that's exactly what was discussed at rounds. Now, go look at the pictures. Sometimes there are other plans in the works. So anyway, if you haven't figured it out yet, Emery's on high flow nasal cannula. His p.m. blood gases were good. Dr. A came by and said that we'd know within a few days whether or not Emery will succeed on high flow, but so far he's doing well. Let's recap the last 2 weeks. - Two weeks ago today there was one extremely large kidney stone removed from his ureter. He was on nitric oxide and the vent. - Thirteen days ago he was extubated and his fever broke. - Four days ago nitric oxide was discontinued. - Two days ago it became evident he was going to succeed off of nitric oxide. - This morning he was on theophylline. This evening he is not. - This morning he was on CPAP. This evening he was not. Consequently, I'm scared s**tless to bring him home. We can see the light at the end of the tunnel. The end is near.