*January 10th -18th 2015* Sabrina is starting to come out of delirium and is answering yes or no questions by either having her squeeze a hand for yes or no or when she can nodding her head yes or no, She has been placed in a specialized therapy air bed called the dolphin to help heal her bed sores and for better comfort, "She really likes it's" Physical therapy has been coming to work with Sabrina, She get's moved from her bed to a cardiac chair to sit up and do a few things with her hands, She is so weak she can barely hold her head up for more than a few seconds and tires quickly, She demonstrates such bravery and determination time and time again, When she's asked if she wants to do it she nods yes, Even when she is really sore and feeling nauseated, This is very scary for her and it hurts her to be moved, It is also quite a process to achieve with all the tubes and IV's that must follow, It takes 4-5 people to slide her from the bed to the chair, On 01/12/15 Sabrina was looking around the room sporadically, her parents sitting there with her asked her if she was OK, Her mother reached for her hand, Sabrina pulled her mom close and with everything she had gave her mom a very long embracing hug for the first time in the hospital, It was a beautiful moment, On 01/13/15 Sabrina lifted her arm and waved hello to her brother recognizing him and acknowledging him, It made Brindan so happy he was gloating and talking about it to everyone, Sabrina had been interacting with mom and dad for a few days now so when she waved at brindan and grinned it was very special for the two of them, On 01/14/15 she was all but out of her delirium state, She was communicating by writing with her left hand (Her right wrist and arm is very sore and has a arterial line in) She also has a communication board she can use to express herself, She is very aware of all that is going on around her and is involved in the discussions and decisions that affect her long term needs, Sabrina is very tired of the Endotracheal tube that is taped to her mouth and it has been an issue for some time now, Sabrina, her parents and the doctors have all agreed it would be in Sabrina's best interest to have a tracheostomy, This will help Sabrina's mobility and get the tube out of her mouth, Also her broviac (central line) on her right upper chest needs to be replaced/exchanged, The staples in her groin need to come out and replaced with sutures, And her open abdominal incision/skin needs to finally be closed.
*January 19th 2015* Sabrina undergoes a big surgery today and knows excactly what they plan to do, She is very scared and nervous and also amazingly brave and understanding of her situation, She is taken to O.R. and sedated, The surgeon's prepped Sabrina's right groin removed the staples, Then the dead tissue edges were debrided sharply, Her skin was then brought together without areas of separation with sutures, antibiotic ointment was then placed along her wound, Then was covered with mepilex ( Soft foam dressing),
They then prepped her right neck and chest with the existing central line prepped into the field, A wire was passed down the line, which was then removed and passed off, A stab incision was made on her anterior right chest and the broviac passed through the tissue to the wire site using a tendon passer, The catheter was passed down the sheath, which was removed, Fluoroscopy showed the tip with a kink in the catheter as it crosses the clavicle, There was good return of blood upon aspiration of both ports, They packed the ports with heprin, they secured the catheter with sutures and the wire site closed with sutures, Steri strips were placed over the wire site and the incision from her prior ECMO cannulation, They then applied sterile dressings.
*January 19th 2015* Sabrina undergoes a big surgery today and knows excactly what they plan to do, She is very scared and nervous and also amazingly brave and understanding of her situation, She is taken to O.R. and sedated, The surgeon's prepped Sabrina's right groin removed the staples, Then the dead tissue edges were debrided sharply, Her skin was then brought together without areas of separation with sutures, antibiotic ointment was then placed along her wound, Then was covered with mepilex ( Soft foam dressing),
They then prepped her right neck and chest with the existing central line prepped into the field, A wire was passed down the line, which was then removed and passed off, A stab incision was made on her anterior right chest and the broviac passed through the tissue to the wire site using a tendon passer, The catheter was passed down the sheath, which was removed, Fluoroscopy showed the tip with a kink in the catheter as it crosses the clavicle, There was good return of blood upon aspiration of both ports, They packed the ports with heprin, they secured the catheter with sutures and the wire site closed with sutures, Steri strips were placed over the wire site and the incision from her prior ECMO cannulation, They then applied sterile dressings.
They then removed the wound-vac along with the ostomy bag, Her skin surrounding her open abdomen wound and ostomy were cleaned, With the ostomy excluded from the field, Small subcutaneous skin flaps were generated with electrocautery, her abdomen was now closed, sutured and antibiotic ointment was applied followed by a sterile dressing,
The area of Sabrina's tracheotomy was marked out, lidocaine with epinephrine were then injected in the her incision site, a 15 blade was used to make the incision, A Jake was used to bluntly dissect and separate the strap muscles down to the trachea, Skin and fat were retracted and the four quadrants of her stoma site were matured by sewing her skin to the tracheal fascia, A vertical incision was made through the second and third tracheal rings, two silk stictches were placed on either side of the cartilage for stay sutures, The vertical stoma site was enlarged and the endotracheal tube was retracted, A 6.5 pediatric cuffed trach was placed into her stoma with good return of CO2, There was no leak, The cuff was not inflated, A flexible scope was then used to perform a tracheoscopy with visualization of the carina, Confirming satisfactory placement of the trach, No complications noted and Sabrina was moved to the recovery room, Then back to the P.I.C.U. ( This was a four and a half hour surgery )
*January 20th 2015* Sabrina gets rid of her left chest tube, She is very sore today and is recovering from her surgery.
*January 21st 2015* Sabrina get's rid of the right chest tube today due to fluid no longer coming out of her chest wall, They also try to transition her to a smaller ventilator machine called the trilogy, Sabrina's parents did not agree with this as she was still so sore from surgery and she didn't need any undue stress, They went for it and Sabrina could not breathe at all she was terrified and gasping for air, her oxygen saturation dropped off to 55 before they were yelled at to connect Sabrina back up to the machine she was on, ( Reason she failed is they never turned the oxygen on as well as the return flow )
*January 22nd 2014* Sabrina Has her first trach change done and she was successful in transitioning to the trilogy vent (home vent) Sabrina's Physical therapist put her on the side of her bed and she dangled sitting up, holding her head and body up for the first time for 2-3 minutes, It was truly humbling to see the determination and strength it took for Sabrina to achieve this.
*January 23rd 2015* Sabrina leaves the P.I.C.U. for the Neuroscience Trauma Unit (N.T.U.)
"After 36 days and nights"
(Continue to next page)
The area of Sabrina's tracheotomy was marked out, lidocaine with epinephrine were then injected in the her incision site, a 15 blade was used to make the incision, A Jake was used to bluntly dissect and separate the strap muscles down to the trachea, Skin and fat were retracted and the four quadrants of her stoma site were matured by sewing her skin to the tracheal fascia, A vertical incision was made through the second and third tracheal rings, two silk stictches were placed on either side of the cartilage for stay sutures, The vertical stoma site was enlarged and the endotracheal tube was retracted, A 6.5 pediatric cuffed trach was placed into her stoma with good return of CO2, There was no leak, The cuff was not inflated, A flexible scope was then used to perform a tracheoscopy with visualization of the carina, Confirming satisfactory placement of the trach, No complications noted and Sabrina was moved to the recovery room, Then back to the P.I.C.U. ( This was a four and a half hour surgery )
*January 20th 2015* Sabrina gets rid of her left chest tube, She is very sore today and is recovering from her surgery.
*January 21st 2015* Sabrina get's rid of the right chest tube today due to fluid no longer coming out of her chest wall, They also try to transition her to a smaller ventilator machine called the trilogy, Sabrina's parents did not agree with this as she was still so sore from surgery and she didn't need any undue stress, They went for it and Sabrina could not breathe at all she was terrified and gasping for air, her oxygen saturation dropped off to 55 before they were yelled at to connect Sabrina back up to the machine she was on, ( Reason she failed is they never turned the oxygen on as well as the return flow )
*January 22nd 2014* Sabrina Has her first trach change done and she was successful in transitioning to the trilogy vent (home vent) Sabrina's Physical therapist put her on the side of her bed and she dangled sitting up, holding her head and body up for the first time for 2-3 minutes, It was truly humbling to see the determination and strength it took for Sabrina to achieve this.
*January 23rd 2015* Sabrina leaves the P.I.C.U. for the Neuroscience Trauma Unit (N.T.U.)
"After 36 days and nights"
(Continue to next page)