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Sunday, February 13, 2011

VISIT TO JAIMIE

By JC Leahy, RN, BSN, MA

To my nurse co-workers who know him:

I went to visit Jaimie in the hospital today.  Intubated, on a vent. Cranial epidural sensor for measurement, not drainage, with ICP 7 and ABP 148/65, which makes his MAP around 93 and his CPP 86, doesn't it?  It makes one wonder why they're still running Levophed, since the goal is not NUMBERS but tissue perfusion, particularly the brain parenchyma -- and his baseline systolic is around 100.   I mentioned it at the bedside, but I don't think it clicked.  Levphed is such a double-edged sword.  You know what they say about levophed:  "Levophed leaves them dead."  You gotta be careful of that stuff.   Vent rate at 28, obviously blowing off CO2 to help reduce ICP, which was previously at 30 just after the Feb. 1 accident.   On a pentobarb drip, which replaced the original propofol.  Good move there. (With propofol, one must at least wonder whether the propofol made necessary the Levophed in the first place.)  Between the pentobarb and the hyperventillation, ICP appears to be well controlled.  He had a DVT and IVC filter, but contrary to rumor there was no PE, which is a mercy.  He does, however have pneumonia.  There is some pre-pentobarb reason to believe that his brain may be intact. 

I had a close encounter with my own mortality in a hospital bed 4 years ago and came back.  I hope Jaimie does too.  It's a slow process.  In the meantime the entire universe has collapsed to the size of his hospital bed.  You must have "been there" to appreciate what I mean by that.  I left him a card, talked to him, held his hand, and told him to telephone me when he is able.  Who knows?  Maybe he heard me.

I pray for him. Please do, also.  What else can we do?

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