We made the trip down and the trip back today in record time. Jerry said his speed wasn't excessive but I didn't get a definition from him on what exactly excessive refers to in his mind. We made it home in 1 hour and 10 minutes. Jerry, Jr.came by his heavy foot naturally! :o)
We did get some good news today. 'Jr's' blood pressure has been stable since the middle of last night incident, where his oxygen levels dropped rather suddenly to the 55-60% range. When we arrived today, it was 90-91% Much improved! His temperature, in spite of the fact that he feels warm, was 98.9, but just before we left at 10:00 p.m. it was up to 100.1, and they had turned on the cooling vest and blanket again, at 40 degrees. They are being as aggressive as possible with his ventilator settings, and his oxygen levels are steady, which is good. He has sepsis, and they have a special combination of 5 I.V. antibiotics that they give in this situation. They are Flagyl, Merepenum, Zocyn, Vancomycin, and Amykacin (sp?).
Then there was the rest of the news. His kidneys are showing signs of even more strain (his creatinine is up to 5.35 and yesterday was 2.4), so they put a line into his femoral artery to prepare him for renal dialysis. The hope, and the usual circumstance, is that this dialysis is a temporary thing, but the doctor who gave us information was clear that there is no way to know at this point whether his kidneys will survive the stress they're under. I'm praying that they do. I'm also praying that his fever will break, and that the antibiotics would do their job. He has ARDS (Acute Respiratory Distress Syndrome) which is something that goes along with the sepsis, I think, and is worsened by this pneumonia. The problem with his lungs is not getting oxygen into them to enter the blood stream, it is in getting enough perfusion, or oxygenated blood to the cells of the lungs themselves. Either there are blood clot issues in his lungs, or the pneumonia is not improving, or the fluid around his lungs in the chest cavity is pushing on the tissue, obstructing blood flow in the lungs themselves. This sepsis cocktail should help.
They will begin to evaluate him again after 24 hours on CRRT (continuous renal replacement therapy, or dialysis), to see if there's any improvement. They may have to give blood transfusions along with the dialysis, because the machine that clears the blood of all its toxins also can damage the red blood cells, causing a form of anemia. The trauma Fellow (a nice lady physician named Dr. Lee) said that side effect is common for most dialysis patients. They'll have a machine at his bedside that will do the work. His lungs are still not strong enough to transport anywhere.
They placed a chest tube in his right side during the night, to drain off extra fluid from his chest cavity, to hopefully decrease the pressure that the swelling and fluid is putting on his lungs, hypothetically decreasing their blood supply. They are getting oxygen into him, his levels are 91-94% this evening), but the trouble their having is with the actual blood supply to the lung cells and tissue itself. There's that area blocked by the clot, and the presence of the clot makes it even harder to deliver antibiotics to the area. They did an ultrasound to see if there was any sign of abcess or severe infection that they could go in and take out, but there was none! That's a good thing!!! Praise God! He is hearing our prayers and responding. Dr. Lee also reiterated that we need to be thinking in terms of weeks and months, rather than days and weeks, for his recovery, if he recovers.
She also made it very clear that he is still fighting for his life. He is not out of the woods. Currently, his prognosis is poor, and the picture bleak, but I know we serve a God who answers our prayers and cares deeply about the people we love. Let's continue to ask him for mercy for Jerry, and healing! When I was in the room today praying for him, I kept asking God to heal him. I couldn't find any other words to say, and was in faith, so I went with it!
Today, when we arrived, his heart rate was higher @ 123-129 beats per minute (bpm). Yesterday, when we left it had been in the 90's. His breathing rate was faster, 29-34/minute. The fluid draining from his chest cavity tube is clear yellow, and does not appear to contain infection, which is good. Some of his swelling has gone down, but not all of it yet. They actually have this machine that vacuums the fluid (and potentially any infection) out of the open wounds on his leg from the accident (I'm pretty sure I didn't bother to mention those wounds previously). Really cool! He is attempting to breathe some on his own, although it's not very full or productive breaths. His PO2 on bld gases is 88. He remains slightly acidotic, with a pH of 7.17 this evening, which was actually up from 7.14 earlier in the day. Some of that is from his kidneys shutting down and some of that is from his breathing, as I underst and it. The renal dialysis could help reverse the acidosis, but it will be a waiting game. The renal docs weren't sure they wanted to start dialysis yet, because Jr's still putting out urine, but the amount has decreased significantly since yesterday, and his creatinine has more than doubled. Some of the doctors were thinking that if his kidneys shut down, with his lungs currently so weak, (if not for the ventilator right now, his lungs would collapse) he'll not have much reserve to fight through that combination until the dialysis gets started. They said something about rechecking his creatinine around 2 a.m., and then deciding from there. I'd rather have him on it sooner than later, and was able to voice my opinion to Dr. Lee. She agreed, but apparently the orders will be written by the renal service physicians.... gets confusing!
They are concerned about possible permanent damage to his vocal chords from the ventilator tube, so getting the trach done is high on their priority list, but at his current ventilator settings, a trach wouldn't withstand the pressure. The respiratory therapist told me today that he's just not stable enough for a tracheotomy yet. But, it's been 10 days now on the vent, and I know they don't prefer to go over 10-14 days, if possible. So, we'll see. His CVP, (central venous pressure) was 17 just before we left, and that was down from 23-25 at about 5:00 p.m.
Like I said earlier, his temp was up a bit late this evening, and I asked about Tylenol. The nurse, Erin, said they weren't trying that anymore, because it hasn't helped yet. What has helped is the cooling blanket and vest, so they're utilizing those and they've been working well so far There are no other signs of infection at this point, but they continue to search for them, because he is so sick.
Bob, if you could send this to Tyler, I'd appreciate it, or get his email to me and I'll send it myself. Jerry, Jr's vent settings are: Peak: 37; Pmean: 27; PEEP: 8.9-34; I:E 1:3.9; fTOT: 29; VTE: 426-550; VE TOT: 14.8. I have some questions for him!!!
Also, I asked the nurse if Jr. was unstable enough that his life was in danger tonight. She felt he was stable enough with a steady blood pressure and good oxygen level for us to come home and rest. We'll be going back down tomorrow, or earlier if they call and say he's taken a turn for the worse. Dr. Lee also said that she is working hard to get him through the next 24 hours, but that at this point, anything can happen at any time. He is still fighting! We talked to him about how many of his friends are supporting him with their thoughts and prayers, and all of you who asked me to tell him you said "Hello", I did that today several times, and will again tomorrow.
Thanks for all the meals that have been brought by, and for the prayers for our finances, and other encouragement sent our way. God is faithful and is at work!
Love you all,
Jerry and Linda H.
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