Monitor the Patient, not the machines


Day 3  Cagayan de Oro Medical Center
May 14, 2012

Vitals:  
Blood Pressure – 120/70
Temperature: 37.3
Heart Rate: 60
O2 Sat: 100 
Respiratory Rate: 20

The endotracheal tube

Our attitude:

This woman lying in bed with tubes attached is not just a comatose body, she is our loved one. So, we will pay attention to her rather than depend on the machines which monitor her.

Our Observation:

Today, the heart rate in the monitor went flat, for one hour. But we looked at her and she looked okay and was breathing. We decided there is nothing wrong with her; there is something wrong with the machine. We did not call the doctor.

Our doctors said:

Melit remains stable, that is – her vital signs are within normal ranges,  although the suctioning of phlegm and saliva discharges because of the pneumonia became more frequent.

Our Action:
At this point, we familiarized ourselves and thoroughly studied the various machines and tubes in Melit’s ICU Unit.
1. The mechanical ventilator – this machine breathes for her, this is attached to an oxygen source on one end, and to Melit’s endotracheal tube on the other end. It looks monstrous, fortunately, it is a new model thus it is not noisy unlike those we see in the movies that sounds like a dragon sleeping (assuming that you have seen a dragon sleeping and lived to tell about it).

2. The oximeter – a round-the-clock monitoring of her oxygen saturation and heart rate. Unfortunately, it is out of order and only measures O2 Sat, while the heart rate goes flat the whole time, raising the alarms of the guests. After three days, it became a standard introduction to new arrivals – by the way, the heart rate monitor above is not functioning!
3. The ECG monitor that functions in behalf of the failed oximeter.

4. The suction machine – this machine sucks! Literally! It acts like vacuum to drain the mouth from fluids. Melit cannot spit, cannot cough, cannot sneeze and cannot swallow properly. Thus it is dangerous if she swallows saliva so the fluids have to be suctioned regularly.
5. The infusion pump –is a small machine attached to the IV line to control the flow of a medicine called Dopamine. See entry on Dopamine and the comatose.

6. The nasogastic tube – or commonly known as NGT is a tube used for oral administrations such as feeding and oral medicines. It goes directly to her stomach. It is unsightly and makes Melit look like having a long nose hair that grew out of proportions. But thoroughly useful.

7. The Endotracheal tube – or ET is probably designed afte extraterrestrial beings. One of the ugliest inventions of medical science, fortunately it is just a temporary solution. A tracheostomy will be performed later in the recovery stage.

8. The indwelling catheter – is attached to her bladder to drain urine, not so visible and not as unsightly.

At the end of the second day, Lita’s vitals were very much stable and she was off any sedative, and the family found a rhythm. Thus, it did not become stressful. All doctors came for their rounds. Fr. Butch gave the anointing of the sick, cousin Bebec and her group  the Community of Love and Mercy came to pray over here.

Our Feelings:

Sad but hopeful. We felt medicine is not rocket science, it is fairly easy to understand, and its logic is easy to deduce.

Our Conclusion:

Melit will have a long journey, and we pray for the removal of these attachments, one tube at a time!

Meds today: MannitolDopamineRanitidineCiticolineLeviteracetamKalium DurulesOxacillin, and Axera.

Diagnostic Tests today: X-Ray, HGT, and CBC

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