Sara was doing fine last week. I had been keeping up with Dr. Hospitalist and Dr. Pulmonologist regarding her weaning and she was doing great. They decided to go ahead and try a traech mask for her on Friday. That means she'd be disconnected from the supplemental oxygen and tubing. It is the last step before removing the traech from her throat and her going back to oral/nasal breathing.
Well, initially on Friday she did great. She had been on 28% oxygen and room air is 21%. Well, after a couple of hours her oxygen saturations dropped and she started laboring. So they put her back on the supplemental oxygen and ran it up to 40% to give her some relief and let her rest.
Later in the afternoon, they ordered a traech change from a size 8 to a size 6, and one that could accomodate a finestrated canula. (an internal tube with holes in the top so she can get air up into her mouth/nose and past her vocal cords). The initial tube is solid, so it is a direct replacement for the larger size. WHile this is a "cuffed" tube (has an inflatable donut around the base of the tube to keep air from moving past, they opted not to inflate. This was to further give her ability to move air at will. (and she's been blowing bubbles ever since.)
Unfortunately, the tube that was in there was lodged pretty good and it took a bit of force to get it out, and caused a bit of trauma in her neck and opening (which bled). The new tube also has the ability to move up and down, so it moves around a bit. That apparently tickles in her throat. It also caused her secretions to go up. The internal airway protects itself from trauma by secreting snotty mucus, and that has gone up quite a bit.
Initially we weren't worried about it, as this is actually quite normal. It did make her uncomfortable and she required a lot of reassurance. So I decided to stay with her until she felt more at ease. That kept me there well into the wee hours of the morning, as she really never was comfortable.
When moving her from the bed to the chair (which helps circulation and respiration - both good things) she started coughing (while flat) and coughed up a lot of stuff up into her tubing. It started choking her and the nurse jumped past the lift team guy and started suctioning her. Sara kept choking and coughing and her oxygen saturations started dropping. I saw this and jumped past the other lift team guy to get to her head and into her face. I put my right hand behind her head and started reassuring her and encouraging her cough, telling her the nurse was getting it. More kept coming and her sats kept dropping, below 90, below 80, 70s... I was calling the numbers out to the nurse as I could see them from my periphery. I told her we needed help (because I was getting pretty terrified at this point and Sara was downright freaked)
The nurse actually ran out of the room. I nearly passed out when she did. I couldn't believe it. I grabbed the suction canula and started going for it - SAra wasn't moving air. I heard the nurse yell for an RT and some help. I'm suctioning SAra like a vacuum cleaner, in and out without turning off the suction. I was worried I'd hurt her, but she was already hurt by this point and a little more trauma was not the issue. A lot of stuff came up and then when pulling back I could hear the raspy gurle of air movement. She pulled in a big breath and I suctioned again, getting more. The nurse was back now and another nurse with her. I dropped the suction as I pulled it out, and heard more air movement. She was breathing. I moved a little more up towards her head and kept my eyes on her, talking to her, assuring her that she was ok and Nurse-Carol was going to get the rest. Her sats were coming up - 80s, 90 - more deep breaths baby girl - 93, 94. She was breathing short and rapid, but moving air.
Then she started to cry. She was so scared. I cried with her. I was scared too. That was close, I told her. Good thing you can cough good. Better getting that stuff out than keeping it in. (like Nurse-Athie always says "better out than in..." I put my hand on her chest, feeling it rise and fall, her heartbeat riding quickly over the waves of her breaths. Slow down, deep slow breaths, time to calm down. Your numbers are good, you are moving air, i'm right here, you're ok. Steady stream of reassurance, for both of us. After a long few minutes she was upright in the chair and we were calming and watching some mindless TV. No doubt her thoughts were on what happened, as were mine, but we just sat there holding hands, feeling each other there.
That was Friday, Friday night and early Saturday morning.
Her father, Tracy, went to the hospital and saw his girl for a few hours Saturday morning. He had to suction her a lot himself, but she seemed to be doing ok.
Oop. gotta go. just got a call from the hospital. i'll have to update from there. KB
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