Monday, November 15, 2010

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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