At 9:15 he had a bad reaction to the blood transfusion... was freezing, shivering, shaking terribly. His temp shot way up, and he looked blue! They brought him warm blankets, gave him 10 mg. Lopressor, Benedryl, Tylenol, and some normal saline. He finally stopped shaking, and is relaxed... The Benedryl made him sleepy. His blood pressure is now very low...89/58. They have started the Cardizem drip again. Earlier, before the reaction, they had given him Cardizem by stomach tube.
The resident, Dr. Gupta, told me the Infectious Disease doctors had stopped the Cefepine antibiotic today after his morning dose. The Acinetobacter is apparently being resistant to it, and they want to change that treatment. Some of his trouble this evening could be from that infection.
His temp is now 101*, and heart rate is still 160. The Cardizem and Lopressor haven't help convert the heart rhythm, yet...
Monday, March 23, 2009
This afternoon they did an echocardiogram. They also did a CT scan at about 5:30. I haven't heard any results. Ron's hemoglobin was down to 7.5 again, so they are getting ready to give him 2 more units of blood. That will be 9 units in 5 weeks...
He's very tired today... has napped off and on all day...when no one was in here. His numbers look good; heart rate is staying where it should, in the 90's, and O2 saturation is 96. Respirations are 24. His bp has been fine all day, but a little low right now, 105/54. He is still getting Cardizem and Lopressor, but by stomach, not by IV.
I want to talk to the doctors again tomorrow. I want to know more about the acinetobacter pneumonia.
He's feeling nauseous, now like he might throw up... He did have a regular supper... His nurse is giving him something to help the nausea. He's not looking well at all right now...
Ooops! His heart rate just popped up to 165!! Great!! Here we go again!!
He's very tired today... has napped off and on all day...when no one was in here. His numbers look good; heart rate is staying where it should, in the 90's, and O2 saturation is 96. Respirations are 24. His bp has been fine all day, but a little low right now, 105/54. He is still getting Cardizem and Lopressor, but by stomach, not by IV.
I want to talk to the doctors again tomorrow. I want to know more about the acinetobacter pneumonia.
He's feeling nauseous, now like he might throw up... He did have a regular supper... His nurse is giving him something to help the nausea. He's not looking well at all right now...
Ooops! His heart rate just popped up to 165!! Great!! Here we go again!!
I talked to Dr. Tita, pulmonologist and critical care doctor, this morning. He was the Dr. who saw Ron last Sat. and Sun. March 14 and 15, and said his numbers looked good, and he was progressing, when his lung was actually collapsed. I asked how that happened. He said his lung is pretty much like swiss cheese, and it sounded the same when it was collapsed as it did when not. He said in retrospect, it makes sense that when he thought he pulled a muscle, it was his lung collapsing, but nothing in the vent or CO2 monitor numbers indicated a problem. Only a chest x-ray or CT would have shown the collapse, and of 100 people on a vent, only 1 will have a pneumo thorax, so it does not make sense to do a daily chest x-ray and expose him to all that radiation.
He said the secondary infection that he got has caused much more damage than they originally thought. His sputum culture shows that that Acinetobacter disease is still active. His lung has much more damage than strep pneumonia generally has. It looks almost like a staff infection (like the boils you get on skin) is on his lung. There are no more bubbles coming out through the tube, so it looks like the hole has healed, but he wants a CT scan done today. The x-rays are not as clear as he would like.
Dr. Maaieh, cardiologist, was in at about 11:15. He said his heart recovery from the tachycardia was "quick", which is good. He said sometimes it takes days to convert to a regular pattern. He said it indicates a healthy heart. He said the heart is such a sensitive organ, that the displacement and/or the lung disease could set it off. It could happen again... Ron is still very sick and at risk for tachycardia. Dr. Maaieh wanted to know if the pulmonologist had said when they plan to remove the chest tube. He ordered the Cardizem drip reduced by half.
Dr. Tita had said it needs to stay for maybe a couple more days. The CT scan will tell him more. When they are convinced the pnuemothorax is gone, they will cap off the tube, wait a couple hours, and see what the lung does. If it starts to collapse again, they will uncap and leave the tube in longer. If it looks OK, they can remove the tube.
Dr. Tita also has ordered the tube feeding turned off during the day -- just on at night -- so Ron will have room to eat regular food. I don't think his stomach is tolerating the tube food very well.
Dr. Jauregi, the Infectious Disease Center doctor wants his door kept shut. He also wants to see how the pneumonia looks on the CT scan. He is concerned about the acinetobacter. This strain of it is relatively new to this area -- showed up here about 2 years ago, apparently from the Far East.
We are not as far through the woods as we thought last week... It is still pretty scary!
Thanks for your continued prayers and good wishes! The support is SO appreciated!! Ron enjoys reading your messages!
Love,
EJ
He said the secondary infection that he got has caused much more damage than they originally thought. His sputum culture shows that that Acinetobacter disease is still active. His lung has much more damage than strep pneumonia generally has. It looks almost like a staff infection (like the boils you get on skin) is on his lung. There are no more bubbles coming out through the tube, so it looks like the hole has healed, but he wants a CT scan done today. The x-rays are not as clear as he would like.
Dr. Maaieh, cardiologist, was in at about 11:15. He said his heart recovery from the tachycardia was "quick", which is good. He said sometimes it takes days to convert to a regular pattern. He said it indicates a healthy heart. He said the heart is such a sensitive organ, that the displacement and/or the lung disease could set it off. It could happen again... Ron is still very sick and at risk for tachycardia. Dr. Maaieh wanted to know if the pulmonologist had said when they plan to remove the chest tube. He ordered the Cardizem drip reduced by half.
Dr. Tita had said it needs to stay for maybe a couple more days. The CT scan will tell him more. When they are convinced the pnuemothorax is gone, they will cap off the tube, wait a couple hours, and see what the lung does. If it starts to collapse again, they will uncap and leave the tube in longer. If it looks OK, they can remove the tube.
Dr. Tita also has ordered the tube feeding turned off during the day -- just on at night -- so Ron will have room to eat regular food. I don't think his stomach is tolerating the tube food very well.
Dr. Jauregi, the Infectious Disease Center doctor wants his door kept shut. He also wants to see how the pneumonia looks on the CT scan. He is concerned about the acinetobacter. This strain of it is relatively new to this area -- showed up here about 2 years ago, apparently from the Far East.
We are not as far through the woods as we thought last week... It is still pretty scary!
Thanks for your continued prayers and good wishes! The support is SO appreciated!! Ron enjoys reading your messages!
Love,
EJ
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