These past two days have been rather calm. Hannah is recovering from Thursday and is still hooked up to the ventalator and a lot of medicine. They haven't made any real changes with her medical care for about three days now and that is why Sam has allowed me to write the blog today because there isn't anything exciting to write about. I must warn you now that this blog is very informative about our situation and may be a little dry so continue on at your own risk.
The nurse was in here a minute ago and started to wein Hannah off of one of the medicatioins. Yay!!! Right now we are watching her CVP number, which tells us her central venus pressure (how hard her right side of the heart is working). Yesterday Hannah's CVP number was 20 and now it is down to 15, ideal is 8 to 10, so we are almost there. The reason why this number is high is because her heart is not used to the changes that the doctors made during the surgery. Her heart continued to work extra hard after it was off of the medications and caused blood to start backing up to her kidney. Blood started to back up into her kidneys because she has narrow pulmonary artearies and also because the two valves on the right side of the heart that prevent backflow aren't functioning properly (all of this is common with tet babies and for certain reasons it was more pronounced in Hannah's situation).
Since Thursday I've had a lot of time to look into Hannah's situation. The reason why all of the doctors came running into her room and hooked her up to the machines again is because her lactic acid numbers were elevated to 22 (normal is 1.5 and critical is >45). Things that I've learned: What possibly caused the lactic acid levels to be elevated in Hannah's body was due to heart or kidney failure (she didn't have kidney failure but it was getting backup with excess blood from the heart), or due to the lower blood flow (she had a low heart rate, 80 to 95 bpm, and her hemoglobin was significantly low). Because she had low blood flow this would have caused her oxygen saturation levels to drop (Hannah's O2 level was anywhere from 92 to 84% when the sensor was working) and low oxygen levels cause an increase of lactic acid production. Some other signs that Hannah had were rapid breathing (Hannah had 60 to 80 breathes per minute and normal is 20), serum pH less than 7.35 (Hannah's labs showed her pH at 7.3 and normal is 7.35 to 7.45), and she looked pale.
Yes, I learned all about lactic acidosis. Doesn't that sound fun?
Is it too much to expect a nurse to recognize that something wasn't right with Hannah's situation when there were both visual (Hannah looking pale) and technical signs (the numbers on the monitor and lab result) telling her that something was wrong? In hindsight it may seem obvious that something was happening to Hannah, but isn't that their job, especially with an infant that just had major heart surgery. Unfortunately we had to go through this experience but since then we have been satisfied with the nursing care that she has received. The great news is that she is progressing ever so slightly and will be coming home sometime within the next few weeks.
Ricky
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