Category Tom’s Journey So Far

A day of strange results for Thomas today. Started off positive with his infection markers still decreasing. Down to 17 now so his sepsis really seems to be under control. However his APTT ( blood clotting) results came back very high so there is question if this an an anomaly, a line contamination or a problem with his heparin dosage. He was presenting as quite jittery this morning so he was given a brain scan just to check that there was no bleeding in his vein (which was a huge worry to me when I was told!). His brain scan showed all was good though which was a huge relief.

Later this evening some swab results came back as positive from growing an airborne infectious bacteria called CPE which he’d been swabbed for 10 days ago...

No extubation today. Aiming for tomorrow. They want Thomas to have a rested day on CPAP minimum ventilation and to work ont he pressure that keep his lungs partically open. This has been left at ‘8’ for a while now and they would ideally like it down to 5/6.

Other than final ventilation weans, a settled day was planned and that’s what he had.

He was put back onto bipap over night to give him a rest to get him ready for tomorrow…his big day! Come on Thomas!

Thomas went for a CT angiogram today to have a look at how his heart and respiratory system are working in relation to each other.

He was taken off in his bed and went on a journey all the way to radiography!

The official report is not yet complete however I have been told that the CT showed positive results regarding his airways and vessels and that they married up with yesterday’s bronchoscopy results showing that his airways are in a better state than was originally thought. Good news! Aiming for Extubation tomorrow.

Today hs been mostly about waiting for results to try and get to the bottom of what happened yesterday evening. Thomas has been kept under paralysing drugs until about 3pm to let him rest and recouperate. Once he woke ups, small ventilation changes were made but nothing too big for now. He needs to get over what ever caused him to have this setback and get him back down slowly to his lower ventilation settings.

There is a plan to look down his airways tomorrow using a bronchoscope to see if he is not tolerating lower ventilation due to his tracheobronchomalacia.

Today was huge progress with the ventilator. Thomas got down to the least settings he had ever been on, and the ventilator could not be set any lower.

Extubation was planned for later this evening after he was given a blood transfusion. Everything was looking very positive. However…

This changed very rapidly. Within 30 minutes of being given blood, Thomas had a bad apneoa moment when he refused to breathe. The ventilator was set to only give him minimal breaths so as he was holding his own he desaturated rapidly and required bagging to bring him back up. He then wouldn’t tolerate the ventilator at all and was fighting everything. Since no one ias sure what happened, he was given a dose of rocuranium (paralysing muscle relaxant) and required full SIMV ventilation.

We are not sure what ha...

Thomas’ infection markers are still on the way down today from yesterday’s 72 to 44. Really good news!

There was some more weaning on his ventilator to lower rate and pressures and he was stable all day.

Today has mostly been a plain sailing type of day. Stable and happy with minimal intervention, just some slight ventilation changes to get his pressures and rate lower.

It was noticed in the afternoon that Thomas’ legs looked a little swollen  and red so he was given an ultrasound to check that there was nothing more sinister than just fluid causing this. Unfortunately it was found that he had a large blood clot sitting in his femoral and iliac veins, stopping just below his kidneys. This is a concern as it’s a clot that has possible infection risk that could cause us further issues. He has been started on a treatment of heparin to thin the blood to stop any further clotting happening and hopefully to then allow his body to start to break down this clot over time...

Thomas’ infection markers have come down from 177 to 156. This is good news.

The large rash turned out to be a clot that had formed in his vein that had burst and come to the skin, looking like a large bruise. Hopefully this will fade quickly now it has come to the surface.

He has been having a problem with his blood pressure being low, so one of his heart medications has been stopped. This has caused him to have a few SVT episodes so has been started on a new medication to control his heart rhythm.

Thomas has also had to have his feeds stopped due to him having a few episodes of vomiting all of them back. The dietician will see him and decide how to move forward with this.

Thomas has sepsis 🙁 His infection markers were very high this mourning at 177.

Blood cultures taken showed that his central line going into his right groin is the source of the infection so it has been removed. He also had a central line in his left groin which will be removed once he has a new line put in his neck.

He also has a very large bruise like area that has appeared on his leg. This is thought to be as a rbig suit of a blood clot forming by his central line. He’s been given two types of antibiotic to help with the infection.

We no just need to wait for this to start to clear before making any more progress with his ventilation. Small changes on rate and pressure were made but just to make sure he wasn’t being over ventilated.

Get better soon please Tom!