It Hurts When You're Full Of It

We've had some pain management issues and anxiety issues.  I came in this morning to visit and Carlos was snowed big time.  I guess he was screaming like a little girl this morning so they gave him our good ole friend Ativan.  They hand that shit out like it's candy around this place!  He had some pain medicine all through the night as well.  He looked like a PSA for drug abuse by the time I got here.  Anyway, I got them to get an order for a smaller dose of ativan, and encouraged Carlos to try not to take it.  He's hanging in there.

They have done a couple xrays to try and determine any concerning source of the pain.  Turns out, Carlos has a lot in common with one of our cats (those of you familiar with the issues of Fatcat will get the reference).  'We' are working on that issue and once resolved, may decrease his pain level a good bit.

Other than these issues, he is doing well. I did the sterile dressing change without any difficulty. The nurse said I could get checked off Monday when the VAD coordinator comes to do an educational session. I'm sure the nurses would be thrilled because that would be one less dressing change for them to do! I hooked Carlos up a couple times last night also - kind of intense because the LVAD computer beeps loudly until the plugs are connected. I did fine but the noise makes you feel a sense of urgency even though you only ever unhook one at a time. They haven't decreased the primacor any further. I guess they do it pretty slowly.

More Good News

Carlos is finally getting his act together and listening to my lectures on behavior.  Maybe he figures it is the only way to shut me up -lol :)

So he did well through the night.  They decreased his oxygen on the vent to 50%.  The stopped the ativan and replaced it with precedex, which is a sedative also but makes it easier for the patient to wake up.  They added dobutamine  because he continues to have periods of ectopy and NSVT.  So they continue to titrate the medications.  He is getting another unit of pRBCs, as he likely will every day for awhile.   He's starting to diurese a bit more, which is good as he has gained 18 pounds since his admission....although 5 of it might be hanging out in his bowels :p They plan to work on that today.  The critical care doctor (one of several)

I guess he misbehaved a bit this morning but straightened his ass out by the time I got here.  I have some pictures to post but am having trouble uploading them on my tablet. I'll put them on Facebook. Possible extubation by tomorrow morning.