A New Rhythm

Joey continues to do well, and has surprised us with a few things overnight and this morning. I mentioned that arrhythmias are fairly common after heart surgery with bypass, and yesterday we found out that he had a brief run and then brought himself out of it right after surgery with no intervention. Last night he was having too much fun (he must have been playing soccer in his sleep) and his heart went back into this arrhythmia. The good news is that his heart got over it before, so it is likely to do the same thing again, hopefully within a few days. The other good news is that there are still pacing wires going into his heart left from the surgery (intentionally, of course!) and they can "pace him out of it." This means that although the monitor looks a little funky, Joey is not in danger from this rhythm. If it persists there is the possibility that it could compromise his blood pressure, but right now the doctors are not too concerned about that.

The other topic of interest in the question of when to extubate, or remove his breathing tube and take him off the ventilator. They changed his sedation medication to one that does not dope him up quite so much, but he's been breathing over the vent for several hours anyway! The process is to wait until the medications are flushed from his system, usually about an hour, and he starts to wake up a little more.

Ironic: Last night they had to constantly give him bolus medication because he was not as sedated and was getting feisty. He kept waking up and moving his head, which is not a great idea as it can cause swelling around the breathing tube. This morning they're ready for him to wake up and he's sleeping happily.

So as they were talking about beginning the "Extubation Readiness Test" (ERT) the doctor looked over and noticed that the attending doc had already switched the vent settings, and that Joey was breathing on his own! (He is still, and will remain for right now, intubated on the vent.) What this showed us is that he's ready as soon as we are. For the next couple of hours they will keep him on the ventilator to help him flush out those meds, and check his blood gases to make sure his heart is happy with this situation.

Patrick and I are probably going to use this opportunity to go see our girls at home. Joey is stable and sleeping with a nurse all to himself, a time when we don't need to be right at his bedside and are striving for balance between life at the hospital and life continuing at home.

Joey's Goals for today: watch that heartbeat - hopefully his blood pressure will stay stable and he's able to come off some of the heart medications. Watch the breathing - if he keeps taking those deep beautiful breaths we can take the breathing tube out this afternoon! Those, at least, are our goals for Joey. We'll see what he has to say about that.