Day 6.... Seems so surreal!
Bad news ... he has an infection. The labs, sputum tests, and gram stain all came back indicative of infection. His white blood cell count is up. His temperature is hanging around 100. Since the sputum sample came back positive, so it is in the respiratory tract,... possibly pneumonia.... but they are still awaiting his daily lung x-ray report. He has been on Clindamyacin for his entire stay here. Based on the gram stain results (Rod negative), they know the category of the germ he has. It will take 2 days to actually culture to know the exact germ. Clindamyacin is effective for the rod negative category of germs, so the may just increase the Clindamyacin dosage, or they may add another antibiotic to it. They are awaiting Pharmacy recommendation.
His systolic blood pressure went up to 177, so they gave him blood pressure medication last night.
They took out his arterial line that measures his blood pressure. It just isn't staying as much as he moves with that arm. So they now have him on a blood pressure cuff.
Pulse rate is staying between 90 and 106, which is super high for Scott, who is typically around 60, but not unexpected with the infection.
They also took the wrist strap off his left arm and put a mitt on, so he can move more freely, and possibly could knock his tubing off, but can't grab at it.
His blood sugar remains normal.
They do still plan to transition him to a trach collar today despite the respiratory infection. They don't want to keep him on the ventilator too long and he is able to breathe on his own. So... they will remove the tubing that Scott keeps pulling at and replace it with the collar. The collar will basically assure an adequate oxygen concentration on the air he breathes....kinda' like having an oxygen mask on... it mists the oxygen in the area, then he actively breathes it in on his own.
They took the Foley catheter out and replaced it with a condom catheter...less infection risk. His urine samples are normal. No infection there.
Still no bowel movement. Adding Miralax and prune juice to his feeding tube today.
He was very fidgety all night, until his bath, so his sedation was increased to 30.
Respiratory therapy just entered .... crackling in the upper lungs, lower lobes sound fine. Although, they sounds cleared out when they suctioned him, so it was just mucus. The mucus was clear...no ugly colors, which is good. His respiratory rate (how fast he is breathing) is high today (26 beats per minute. 14-22 is normal). So they will hold off on transitioning his to the trach collar, thinking that would be too stressful for his system right now. They will try later today. He assures us it is safe to wean him off the ventilator, even is he does have pneumonia.
And... they are expecting to discharge Scott later this week to a LTAC facility. We have made a final decision. We will transfer him to St. Joseph's in Phoenix. The other LTACs are free-standing buildings. They are new and beautiful and would be more comfortable for the family, But... not so good reviews online and not such good feedback from professionals here. St. Joseph's is attached to a hospital and is in the same medical complex as Barrows. We know he will have ongoing medical needs, not to mention all of the surgical follow-ups. At the other facilities, he would have to be transported by ambulance for every MD consult. At St. Jo's, the MD can just walk over, making consults faster, easier, and cheaper. Also, St. Jo's will allow us to choose his attending physician, so we can choose a Barrows MD, which would allow for better continuity of care. St. Jo's is an old hospital with small rooms, so the environment won't be as uplifting and comfortable, but these are secondary to us. St. Jo's would be best for Scott. Also.... Scott did a clinical rotation there a few months ago, so he will know people there. and... out of all of his clinical rotations, Scott has only taken Ashley to 2 of them to show her (although, I suspect he would have taken her to Cottonwood, if it was closer. He LOVED it there, too. He really was so excited about this last rotation/was loving anesthesiology/was so excited to get up and go each day.): Luke AFB and St Jo's and Barrows. So... we feel that Scott would choose these facilities given the opportunity to make the choice himself.
Sounds like I had a typo in an earlier post. When I was talking to Ryan (Scott's brother) he said I mentioned the left arm not moving much. His left arm moves a ton! His right arm has not moved much. We have seen it move, but not lately. There could be possible nerve damage in that arm, but it is harder to check when he is not conscious, so we will "wait and see" for now.
Okay... that's what happened over night.... I'll "talk" with you later and update you on how the rest of today goes.
We love you all!
Patti
We're sorry to hear about the infection but it sounds like they're catching it fast and doing what they can to stop it. It's good to know he's breathing on his own. Thank you for all the updates. Love you both!
ReplyDeleteThe Bakken family