To bleed or not to bleed...(Day 9 post 15)

She is still intubated.  The blood from her lungs is very small now.  It has improved by at least 80-90%.  I am very relieved about this.

The Dr’s transfuse blood for hemoglobin below 6.

Sun morn her hemoglobin was 6 something.  They gave her blood on Sunday.  Monday morning it was 9.  This morning ( Tues) it was 5.6.  That is a huge drop.  They rechecked and it was 5.9.  

They gave her blood.

Dropping that fast on her hemoglobin means she could have a major bleed somewhere and we don’t know where.  They did an ultrasound of her belly and organs to try and find the bleeding.

They did not find any blood.  So the alternate theory is that the hemoglobin of 9 was false and she has been low this whole time.  That would be better news than an unknown bleed.  This appears to be true so far since they did not find any bleeding.

On the ultrasound they did however find free fluid in her abdominal cavity.  So this is fluid that has leaked out of the veins into her abdomen ( not into the stomach...but the tissues and area around her organs).  Her body needs to reabsorb this and pee it out.  When you have inflammation your veins get leaky and fluid can come out.  It is not blood thankfully.  The lasix ( med to help her pee) should help her get rid of this fluid we hope.

CRP is still increased, but it is about the same as it has been ( this shows a level of inflammation in the body).

They are quite worried about her kidneys.  Her BUN and Creatinine are elevated.  Her urine output is quite low and she is fluid positive about 1.5 liters (retaining fluid).  They have asked nephrology to consult tomorrow.  For now nephrology just wants to push the lasix ( meds to make her urinate) to get some of the fluid off.  She will now be on a lasix drip ( constant flow of lasix ) through her IV.  They will also be lowering her oral potassium to help with renal ( kidney) function. They also did a renal Doppler to check blood flow to the kidneys ( they amplify the sound of the blood flow).  They mentioned that kidneys can be damaged by being intubated.  I need to find out if this is permanent damage or temporary.

Her glucose has been in the 300’s all day today.  This is high.  They are ok with this because they started steroids yesterday.  They are doing 3 days of steroids.

Her chest X-ray is unchanged.  I said it has been unchanged for 20 days.  They said, well she is still sick.

Immunology was supposed to come today, they did not.  Maybe tomorrow.

She passed her spontaneous Breathing Trial yesterday afternoon ( Mon).  She failed her trial they did at 4 AM.  I had told them that she would fail the one during the night.  She has no respiratory drive at night.  She has sleep apnea and uses bipap normally at night.  So why would you expect her to breathe at a time she is used to not breathing?  I said I wouldn’t fight them on it, but told them I thought it was silly.

They did another breathing trial today, but she was on her right side.  She doesn’t like to breathe on her right side.  So she failed again.

We will continue to try Spontaneous Breathing Trials tomorrow, but I made sure they are not going to do one during the night.

The other reason they do not want to extubate yet is that her PIP is high.  This shows that her lungs are not pliable and compliant, they are stiff.  They are not expanding the way they should.

They gave some albumin today.

Her face and neck are red again...maybe a reaction to the lasix?  Maybe the albumin?  Maybe the blood this morning?  Maybe the presidex?

ID told me yesterday that nothing grew out of the bronch sample...not even pseudomonas.  But today the ICU drs said the susceptibilities came back susceptible to avycaz.  I think the ICU drs were confused.  I need to clarify tomorrow.

We still have a ton of tests we are waiting to hear back.  I think they have sent every blood test known to man.  

We still have no real reason for the bleeding or inflammation.  We really need rheumatology or immunology to come up with something.

  Please pray for the Drs to be inspired.