0612 phone call from hospital.

Calling to tell me that they will be extubating shortly because he is Vagaling ( heart rate dip) every time they move him or position the tube. As he became more aware through the night his responses became more extreme. He had a large event and desat that his spo2 went as low as 12… It should be 96…

I get dressed and run up to the hospital. 

He is extubated but not yet on CPAP. His heart rate is high, 215bpm. Spo2 84.

He is a little bit angry. They put him back on bubble CPAP. Nasal prongs. I work on calming him down. 213bpm, slowly coming down. I give him a milk swab and it helps a little. 205 Bpm. 70% oxygen.

I try the binky. He keeps his mouth shut but does a small smile. He does not want the binky. He now has some slight aversion to things going in his mouth. Something we will work through.

Down to 60% oxygen.

I ask what CPAP he is on. 6. He is doing good for being on only a CPAP of 6. He is supposed to be on a CPAP of 8. They put the tube deeper in the water. Now a CPAP of 8.

RT has had a blood transfusion ordered. His red blood cell count is low. Crit of 24. He is working hard to carry all his oxygen.

I continue talking to him, and giving him hand hugs.

0730 down to 178 Bpm

I notice the water level is slightly low on his bubble CPAP. Low level water also means less pressure because the tube isnt submerged as deep. They add some water.

Someone turns off the neopuff air flow and the black bag because he doesn’t need them on currently.

He gets weaned a few percent oxygen at the same time.

He desats pretty quick down to 65 spo2. I say He isn’t bubbling so we lost pressure. Did someone turn off the wrong valve for the black bag. As it turns out it was the wrong one that was turned off. They turn on the pressure again. He starts to bubble again.

When we first moved to this bay we noticed only 2 wall connections instead of 3. Normally a red for neopuff. A green for respiratory and a yellow for black bag. There is no yellow.

We asked about it the first day we moved ino this spot and were told it shouldent be an issue.

Normally the one on the left is for neopuff which it is, the one on the right for black bag. Since he doesn’t have a third connection they disconnected the black bag and connected the bubble CPAP when he came off of NAVA. Which caused the confusion.

I’m glad I’m familiar with the unusual set up they have and caught it quick.

0822 50% oxygen

0848 weaned to 43% oxygen

Rough morning so far. Glad I’m here to make sure things happen correctly. So far wrong CPAP level, not enough water, and having his vent accidentally turned off.

Atleast he was extubated today.

0800 blood gas is good, temp 37.5 slightly warm, probably from workin harder to breathe.

Diaper just pee.

No desat from the movement but he does get angry with the diaper change. He makes Some small squeaks.

0924. Heart rate 159, he is more relaxed now.

0945 blood transfusion started.

Hopefully no big events and it was just because the tube was pissing him off. So far it looks that way.