Sedation and blood pressure issues....again. His blood pressures are
still very soft -when he is asleep- but when he wakes up they jump up
too high so he's on and off the norepi a lot(like 60s at rest and 160's
minutes after waking). Last night SuperDoc started to change up the
meds again so he is a little more even keel and the pressures won't
change quite so fast.
Methadone was increased and dilaudid was
also increased and is now given continuously instead of a just bumps
when he gets agitated. They also went up on the precedex and down on
the pentabarbitol. When he wakes up, he doesn't seem like he is in
pain, but irritated and agitated. He seems itchy too and his eyes are
really blood shot. Some of it may be withdrawal symptoms. Some of it
may also be an inrritation to the dilaudid. Dilaudid is in the
morphine family and morphine makes J throw up, so... The pain docs
doubled his oral narcan to see if that will take away some of the
itchines sand irritation. They are also looking into dilaudid a little
more and possible solutions and alternatives if this is indeed causing
his problems. The pain and sedation plan is a work in progress, as
always.
Yesterday his belly fluid grew a culture. He may have a
gram positive rods infection and we should find out more today. It
could really be an infection or it could have been from a contaminate
somewhere when culuturing. I guess this type of infection isn't very
strong so it seems unlikely for him to have this on the antibiotics he
is on. They took more cultures of the fluid and also took viral and
fungal cultures to see if anything grows. Additionally, he had
abdominal xrays last night looking for pockets of air but they showed
nothing.
Mid-update- sedation woes continue. We're in the throes of
pentobarbital withdrawal, sensitivity to dilaudid in the form of itchy
eyes/face and probably nausea (similar to his vomiting episodes in St.
Paul with plain morphine, but knowing for sure he is wretching with a
trach and NG tubes is not perfectly clear). Yes, a crappy day so far as
his breathing rate gets into the 50s, heart rate in the 180s, blood
pressure in the 160s. Now it's a matter of adding more meds to try to
mitigate the side effects before abandonig his current regimen of pain
killing and sedation.
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