Day 12 ~ ICU, 8pm

Apologies in advance for the length of today's post. I try to capture as much as I can, both to adequately share with everyone, and to thoroughly document everything so when Bob's ready and able, he can read about all that's happened. Today was a long day (I stayed 13 hours) and a LOT happened!

Swallowing Trials

   Bob wasn't able to pass his first swallow screening this morning - his esophagus' muscles and epiglottis were too weak and he began coughing. Aspiration is a big concern, so they had a speech therapist come in the afternoon to administer his second attempt. That one he passed! They've removed the NG tube and are now giving him a nectar-thickened clear liquid. He says it's terrible - it tastes like lemon flavored water with cornstarch and he can't believe that it's better for you than plain water is. It's hard for him to understand right now about aspiration precautions. And since he passed the second swallow screening, his NG tube is OUT!

Lung Treatments

   Although there's not too much fluid remaining in his lungs, this morning's chest Xray showed that a mucus plug has formed in the upper lobe of Bob's right lung. This causes his lung to not expand as large as it should (called atelectasis) which decreases volume and oxygen exchange. They've started him on Chest Physical Therapy (CPT) where his lungs are being drained through mechanical percussion and vibration that is applied to his back. Noisy but effective!

   They're also giving him nebulizer treatments of Albuterol to dilate his bronchial tubes, and having him breathe into a "flutter valve" that mechanically vibrates the air he's exhaling, causing alveoli to pop back open. They're combining therapies to hopefully break up and remove the mucus so his lung will open more fully.

Wound Vac Dressing Change

   Today was the second time the vacuum sponge in Bob's belly wound has been removed and replaced. They stopped part-way through and gave him 2cc of Morphine for the pain. Hopes are when the wound begins healing and there aren't as many exposed nerve endings, the dressing changes will be less painful.

Edit: 

   Wound Measurements: 

   *Measurements at dressing change #1 (11/29): 21cm long x 7.9cm wide x 4cm deep

   *Measurements at dressing change #2 (12/1): 20.5cm long x 7.6cm wide x 3.8cm deep

ICU Delirium (aka ICU Psychosis)

   This is hard for me to write about. Bob began having apparent comprehension problems this morning, very similar to temporary dementia. It's from so many days of paralytics, sedatives and decreased brain oxygen while on the vent. He is confused about who people are, his birth date, what's happening, where he is. It's strange that he almost seemed better yesterday than today, but previously he was only "surface chatting", and now he's being asked to comprehend and effectively process what is being said to him or asked of him. This is a temporary condition, and could last six days or six weeks, depending on the severity of the infection, fever, etc that accompanied his treatment in the ICU. I'm patiently waiting for all of his sharp mind to return, and feel confident that will happen very quickly.

Physical and Occupational Therapy

   Bob's left side (arm, hand, neck) is markedly weaker than his right, and much of his hand-eye coordination has to be re-learned (his brain has to be reminded). Today they worked with him lifting an empty styrofoam cup off of his table and bringing it to his mouth. He had a few failures before he finally got the cup to his mouth, and then was so exhausted he couldn't set the cup back on the tray without assistance. 

   Tomorrow they're going to try to get him to sit up with support. For now they are periodically adjusting the head of his bed from 30°, to 45°, to 85°, and then back down again, to familiarize his muscles with the feel of those positions. The more physically capable he becomes, the quicker we'll get him moved out of the ICU.

Current Medications

   As of 6pm today, Bob now receives only the following (he's finally receiving less than 20 medications!):

   * Antibiotics: IV Micamine continuous drip; IV Maxipeme every 12 hours

   * Anti-fungals: Nystatin mouth rinse for thrush (fungal infection on tongue and gums) 4 times a day; IV Flagyl drip for skin around belly wound

   * Pain meds: Oral Norco every 4 hours; IV Morphine 2cc per hour when needed

   * Insulin: Levemir (long term insulin); Novalog (short term insulin). Blood sugar has been in high 200s. Sepsis in the abdomen messes with all the organs!

   * Digestion: IV Pepcid twice a day, oral probiotics, nectar-thickened clear fluids, IV Lasix twice a day to continue to flush excess fluids from abdominal cavity and lower body

   * Respiratory: Albuterol nebulizer treatments every 4 hours; CPT (vibration & percussion) every 4 hours; inspiration spirometer and flutter valve sessions once an hour; continuous humidified oxygen 4% via nasal cannula

   * Circulatory: Heparin injection every 4 hours; oral Lisinopril

   * Temperature: Of course, Tylenol for any fever over 101F. Today he stayed between 99F - 100F for the entire day.