PICU - day 10 continued....

Emylie has had a mellow day. She tolerated the vent changes from this morning. I think I had mentioned that the left side of her face was swollen...well now both sides of her face are swollen and the figured out the cause. Simply put...she has air in the tissue in her face. I will try to explain it as Nate, the nurse did for me. In relationship to this picture: On the left lung along the bottom you see what looks like grapes at the end of the branch, these are called "alveoli". They are all throughout the lungs. Alveoli are tiny grape-like sacs where gas exchange takes place in the lungs (oxygen and carbon dioxide). When you breathe out, the body delivers carbon dioxide to the alveoli, and you release it in your exhalation. When you breathe in, oxygen fills the alveoli and then enters the blood, so it can be delivered to the rest of the body (Wikepedia).



The alveoli have blood vessels running through and around them. If your lungs are inflated to much then it can cause the alveoli to enlarge and restrict the exchange of gases. The alveoli next to the outer edges of the lung may have broke and let air escape into the surrounding tissue. If the air escapes on the inner side of the lungs (closer to the trachea) it will escape into the mediastinum and then can travel up the neck and into the face. This is what the believe has happened (it may also be related to when the chest tube was pulled out or a combination of both factors) and why Emylies face looks swollen. She also has a little air in the tissue in her collar bone area and some in the abdominal cavity as well. Poor girl can barely open her eyes and has chipmunk cheeks. They will continue to follow this on xray and make sure it does not affect her breathing or anything else.

Emylie and I took a nap at the same time this afternoon. Crystal the nurse kept the door closed so it was quiet. I didn't sleep well at all last night so it felt good to get a little rest in. I almost forgot to each lunch too...Crystal reminded me at 3:45 that I hadn't eaten. She was so kind to keep me in line. :) I went and got something to eat, took a short walk outside and then stopped by the KSL radiothon. It was fun to see all the volunteers answering the phones to take donations for Primary Children's Medical Center. A short time after getting back to Em's room Cory Kartchner (one of the Nurse Practitioners), stopped in to see how Emylie was doing. He, Crystal and I visited a little, I got to see pictures of his darling children and hear some fun stories. We originally got to know Cory and Crystal during Emylie's first PICU stay.
My cousin Curt brought Dave and I some dinner and stayed for a visit. Dave got to visit with him (I went home for bit) and also with Eric Bowles the first nurse practitioner we met during Emylie's first PICU stay. The nurse practitioners are amazing and have always been so helpful to us. We would not be where we are today without them and they each have a special place in our hearts. It wasn't until this visit that we have also gotten to know a couple of the Attending physicians which we are growing to love as well. We feel so blessed to have people who really care about Emylie watching over her care.
Sometime after 8p tonight, Dr. Larsen and Grace, the nurse practitioner checked in on Emylie. Dr. Larsen turned the PEEP setting down from 11 to 8!!! I wasn't hear when it happened and so my first reaction when Dave told me was "WHAT! - that is way too fast. It is only supposed to be one every 12 hours. Slow and steady....that is too fast." After further explanation from the nurse I felt a little better. I would be lying though if I didn't say I still was concerned...I don't want to go to fast and have her have to go back up. But they felt confident in the change and Dave said the doctor stayed at Emylie's bedside for at least 20 minutes to see how she handled the change.
I think that is about all for today. Emylie is sleeping comfortably right now. She will occasionally lift her right arm up and then back down. I am grateful for the progress of today!