30 May 2014
We've had a rough start to the morning. Yesterday's heart repair went great and all is well there. We were told to expect some puffiness throughout Luke's body following him being on bypass. He was extubated last night and afterwards he was doing well so we went out of the hospital, across the street for dinner and a much needed break following a long and stressful day. When we returned to the hospital, Luke was extremely puffy and his left side was extremely distended, including his chest, neck, back, face and especially his left eye which was swollen shut. The thought at that point was that it was dependent edema from him sleeping on his left side while we were gone. The swelling didn't decease and by midnight, they began X-rays to attempt to figure out what was going on. The X-rays were then repeated at 6:30 and 10:30 AM. They are showing air under Luke's skin, which indicates that he has subcutaneous emphysema. The emphysema in and of itself apparently isn't very concerning, the real issue is trying to figure out where the air is coming from and why there is a leak. The plan is to repeat the X-ray this afternoon and if it shows that the amount of air hasn't decreased, he will go back to the operating room under general anesthesia for some exploratory looks inside his esophagus as there is a concern that he may have an esophageal perforation or tear that is allowing air to escape and travel under his skin when he takes a breath. The thought is that damage could have been done to his esophagus during an echocardiogram scope procedure through his esophagus during his heart surgery or possibly when he was extubated last evening.
With the concern of a tear in his esophagus, he isn't allowed to have anything orally, including medications or food. Additionally, he has ripped out all of his IVs over the last 18 hours so he was just sedated again and there is an IV tech here now attempting to re-place two IV lines so he can receive medication and fluid to keep him from becoming dehydrated since he can't eat. He is extremely irritable and "hangry" as we say in our home (hungry and angry) and also seems to be in pain from the heart surgery incision and all of the swelling. He will likely remain in the ICU through tomorrow, if not longer.