Day 5 ~ ICU

Concerns

  Bob had a very bad night (Thurs) after the emergency surgery. Today (Fri) has also been a very difficult day. His surgeon told us that Bob was going to get sick before he got better, due to the sepsis, and boy was he right!

Vitals/Stats
 -Fever: His temp was 39.5C/103F when he came out of the OR. Throughout the night it climbed to 40C(105F). This extremely high fever was mainly a result of his body responding to the full attack of the sepsis. Throughout the entire day, his temp only dropped to 38.9C(102F), but at least it was decreasing.

 -Blood pressure: Very, very low following the surgery. Averaging any where from only 55/35 to 80/45. This was a top priority, and large amounts of forced fluids were being pushed, and "pressors" were being given via IV - Bob received norepinephrine and a few other pressors to force his vessels to constrict, and his cardiac activity to increase, which in turn made his BP begin to slowly climb out of the extremely low danger zone.
 -Heart Rate: His pulse raced in the 150s before the surgery, due to the infection. After the operation, it continued to be tachycardic (beating too fast), around 125-130 (normal is 80bpm). This fast pace was because of the fever and the medications used to raise his blood pressure. Lowering this heart rate was also a priority, especially with Bob's cardiac history.

 -Oxygen/Ventilator: The Respiratory Therapist had a real challenge on his hands with Bob. Once out of the surgery, Bob INSISTED that the tube was going to come out of his throat. Even with an attached bite guard on it, he still tried to bite through the breathing tube! They wedged additional large bite splints between his top and bottom teeth on each side of his mouth that basically forced his mouth wide open, and then attached the guards to his face and chin. Frustrated by that roadblock, Bob then began trying to reach up to his mouth with his hands in an attempt to pull out the tube, so they placed splints on his elbows so he wouldn't be able to bend his arms. 

  To be honest, I was thrilled when I saw him doing this. That meant he was ticked off about the tube, and he was digging in his heels, determined to figure out a way to get the vent out of there, even while he was still sedated from emergency surgery! I was happy to see that fight from him. That's what he'll need to keep drawing on to get through this ordeal.

  By the way, Bob spent much of Friday slowly manipulating those added mouth guards by pushing them with his tongue and chewing on them with his teeth. I think it was distracting his brain from the immense pain, the fever and the diaphragm spasms. Believe it or not, by the end of Friday, he had them more than halfway pushed out from his mouth! The ICU nurses said they had never seen another patient manage that, especially while under sedation. They've never had Bob for a patient. =)  

The blue, canoe-shaped ventilator bite guards in position 

when he first arrived from the OR

The bite guards after he spent all day Friday working them out