10/28/13, Evening

It feels like it's been a week here, and yet it's only 48 hours. On the other hand, it feels like it was a few hours ago we took the call from Michaela.

Mid Morning the treatment team rounded on Nicole and included us in the discussion.  A couple items came up which were concerning to us but we were reassured that the issues were not life-threatening and not unusual with the length of time she had CPR.  It looks like there is likely some cracking around her sternum, and the lower part of her left lung is somewhat collapsed.  On the other hand, new information came out that she had been more purposefully responsive than thought earlier in the ED and ambulance prior to sedation, which all speaks to good neurological outcomes.  The team also discussed how they expect a more rapid positive trajectory for her recovery to independent breathing.

Sooo, the plan:  They do not expect to remove the ventilator until tomorrow morning at 6AM.  The muscle-relaxing medications will be stopped around 6pm, and the expectation is that she will take 12 to 24 hours to clear.  The treatment team will be looking for several issues prior to removing the ventilator.  One: they are looking to decrease the amount of assistance the ventilator provides and watch to make sure her brain is telling her body when to breathe and how much to breathe. Two:` they will be watching her oxygen saturation to make sure she is getting good distribution of oxygen from her lungs into her blood.  And then, Three: the reduction in assistance from the ventilator will put added strain on her heart, so they will be watching closely for changes in her cardiac function.

The team also expects her lung to re-inflate with a little assistance from laying her on her right side and also having a therapist provide some procedures.  However, it is more likely she will need to be awake and help with the therapies to get most benefit.  The condition of her ribs is not unusual, especially given how long she was given CPR. They will heal, but may be a source of pain to be watched.

The good news has come back about the team's concern regarding a virus infecting the heart.  The labs are negative and they have not seen an inflammation in the area around the heart.

The cardiologist "electrician" specialists are expecting that her predilection to have conduction problems with her heart will mean that she will need an implanted defibrillator.  This is a cool device that is placed totally in her body with sensors/electrodes to the heart. It monitors the heart function many times every second.  When it senses the heart is starting to beat irregularly or stop, it provides a shock that puts the heart back into normal rhythm! Amazing technology.  More to come on that as we see her progress through the next day or so.

During the day, Nicole behaved quite nicely with no acting out from her heart rhythm.  The treatment team started providing her with TPN (nutrition through her IV), and the plan is to move her to nutrition through an NG tube (tube into her stomach) tomorrow, pending her transition out of sedation.  I know she will be looking forward to getting her macerated steak and potatoes tomorrow!

Tonight, as the muscle relaxer medication is wearing off, the nursing staff are masterfully orchestrating a variety of medications to help Nicole rest and not be anxious while trying to avoid/minimize medications like narcotics which supress her breathing.  Nicole is a feisty one, and (given how she was in the ED and ambulance) she is likely be fighting to wake up.  That seems to be the course so far, and that feisty-ness will really help her as she tries to take charge of her breathing. On the other hand, it means she is fighting the breathing tube which she still needs..... So, we're playing her favorite (quiet) music, reading to her a little, to help her try to rest, relax, and wake up slowly.  The nurse, Trish, is so calm, quiet, she is making me relaxed!

In the real world, outside the hospital, Nicole's sister Alexandra is doing well, thinking a lot of her big sister.  Today, she found a heart-shaped leaf that she wants to send to Nicole.

Looking to be a long night.  Hang in there, Nicole! You're a fighter, but right now, try to relax and rest.