Connor likes early morning drama...

Well, it was more of a major problem, but not really a setback.

Maybe 5 minutes after typing the last update and turning out the lights to get 1 more hour of sleep before going back to check on Connor, we heard loud pounding at our door. It was the unit clerk telling us the needed us back in the back STAT. We scrambled to find the lights and our shoes, but she told Heidi just to forget the shoes and run back.

When we got to Connor, Dr. Reddy was at the bedside with about 6 other staff. She was quite concerned about him. His oxygen sats (saturation) had remained in the 80s despite 100% oxygen. She thought perhaps it was a reoccurrence of the left pneumothorax, but wasn't sure. If that wasn't the problem, the only option Connor had left was the nitric oxide, so it was being set up.

They got a STAT bedside X-ray and took me and Heidi back to see it. These digital X-rays literally take no more than 2 minutes from the actual x-ray to viewing. We took 1 look at the lateral/side shot and noticed the pneumothorax so we instantly went back to the bedside to "needle him" - place a needle in his chest to siphon off the free-air around his lungs. She didn't even wait for the front view.

They siphoned off 70 mL of air. However, his oxygen saturation did not respond immediately, so she decided to start nitric oxide. About the time the nitric oxide got started, his oxyggen saturation finally started to reach the 90s and eventually 100%.

Dr. Reddy got a follow-up chest x-ray, but unfortunately since he was angled the picture wasn't that great. At this time we saw the frontal view from the original x-ray and realized he indeed had a tension pneumothorax - basically a recurrence of the problem he initially had in Allen that prompted the transfer wherein the heart gets shifted from the left side of the chest to the right side due to all the pressure caused by the free air outside of the lungs.

Dr. Reddy felt she had the chest tube in the right place, so she sutured it in place and got a 3rd chest x-ray which gave a great look. His heart is now back on the left side and there is no further pneumothorax.

His oxygen level is back to 100% on 100% supplemented oxygen and she is turning off the nitric oxide.

His blood pressure dropped in the process of all of this, but a little extra dopamine raised it back to appropriate levels (MAP 45).

One nice thing of note: his chest x-ray looks much less hazy than before, so it appears a decent amount of fluid is gone from his lungs. Also, a lot of the air from the pneumomediastinum (the free air between his lungs that wasn't supposed to be there and which prompted the change of ventilators) is actually resolved.

So, Dr. Reddy is happy again with his status. She said she got a lot of sleep during the day yesterday as Connor had "kicked her around like a football" the night before as she tried to get him stabilized.

We think Dr. Reddy and the nurses and ancillary staff here at Plano Presby are top notch. We have full confidence in them.

Dr. Reddy is a little worried about his kidneys. She's trying to figure out why he's having so many pneumothoraces (sp?). He has had good urine output and his BUN/Creatinine (kidney function numbers) are great, so it's less likely. I personally think it was just because the placement of the initial chest tube wasn't the greatest.

The final chest x-ray confirmed tonight the chest tube is in the right place and should function as well as the one on the right has.

So, when we left his heart rate was in the 160s (it had been up to the 200s at one point), blood pressure was good (MAP 45-50), and oxygen saturation 100%. They were getting a blood gas to see how his oxygenation numbers are.

Dr. Reddy told us to go ahead and get some sleep, although I don't know how much we'll sleep. Heidi has to pump again in about an hour.

Right before we left to go back to our room (Heidi still in her socks), Dr. Reddy said Connor was going to "keep us on our toes." :) Heidi said, "We'll take it."

So, our son likes a bit of the morning drama. Hopefully he'll give us and Dr. Reddy a break tomorrow night...