Day 4 ~ Leave Room 421 & move to ICU

Concerns

  Today is the hardest day so far. Bob continues to do worse throughout the morning and afternoon. His color is gray, he's unable to sit up, the pain is becoming unmanageable. His abdomen is distended, swollen and hard. His fever is slowly creeping higher. He isn't drinking, he has started to feel nauseated, and the painful hiccups are now non-stop, are interfering with his breathing, as well as increasing his pain. The surgeon has been texting with the nurse throughout the night and early morning, and is coming in to see him.

Timeline

 -10am: Surgeon examines Bob and immediately puts in an NG (naso-gastric) tube. This is a tube that is inserted into Bob's nose and goes all the way down to his stomach. Immediately fluids come up, and over 500ml are vacuumed out in the first 20 minutes! The doctor tells us he can't believe Bob hasn't been vomiting. He tells us Bob's not out of the woods yet, but he wants to give the NG tube some time to remove some fluids, with the hopes that will be the most intervention he'll have to do. 

Placement of the NG tube

In preparation for a likely emergency surgery, the surgeon then places the following orders:

  *An abdominal CAT scan

  *Placement of a continuous heart monitor

  *An EKG

  *A respiratory therapist to do an assessment, including an arterial blood sample to check for oxygen saturation in the blood

 -11am: Respiratory therapist listens to Bob's lungs, agrees there is some audible diffusion in the lower right lung. Takes artery blood sample. Increases O2 cannula from 3 to 5 units.

 -12noon: Blood sample shows lower O2 perfusion than they're comfortable with, so Bob is changed from nasal cannula to full mask with forced air. This calms him a little since he isn't working quite so hard to breathe, and he gets a little bit of rest. Heart monitor is placed and being tracked by cardiologist. EKG is ran and cardiologist clears for likely surgery. NG tube has now drained over 1,250ml out of his stomach and small intestine in just 2 hours.

Addition of heart monitor and full mask with forced air

 -1pm: Charge nurse accompanies Bob down to CAT scan, and it shows that the lower right abdomen (flank and pelvis) are filled with considerable amounts of fluid.

 -2pm: After reviewing all test results, surgeon orders Bob be moved to the ICU. He wants Bob's BP, heart rate, oxygen perfusion and fever to be aggressively managed and monitored, since surgery is likely.

 -2pm to 5pm: ICU works to get Bob's vitals as stable as possible. He is becoming septic, his fever is climbing, his BP dropping, his oxygen saturation unsatisfactory. He has a central line placed into his large vein in his neck (superior vena cava) and they are pumping him with medications to try to stabilize him for the surgery.