Laboratory Finding
Sputum Culture (Collected 17 Nov 08 , 6.22am)
Final Report
Heavy growth of Enterobacter cloacae
Tigecycline Etest MIC : > 256 ug/ml (Resistant)
Heavy growth of Stenotrophmonas maltophilia
Tigecycline Etest MIC > 256 ug/ml (Resistant)
Susceptibility Report
E Cloaca
Kirbybauer
Amikacin *S
Augmentin R
Bactrim/Septrin R
Cefaclor R
Cefepime *S
Ceftazidime *S
Ceftriaxone *S
Ciprofloxacin R
Gentamicin *S
Imipenem *S
Unasyn R
Antibiotic Tradenames
Amikacin - Amikin
Cefaclor -Distaclor
Ceftazidime -Fortum
Ceftriaxone -Rocephine
Ciprofloxacin -Ciprobay
Imipenem -Tienam
@2.30pm, Mark Lee contacted Dr.Lye after dialysis but he didn't come.
@5.30pm, given Tienam (500mg) , Bactrim (AM/PM) and Minocylin (AM/PM) , prescribed by Dr. Chiong.
10:15 update:
Dad was stable last nite. BP was on the low end 95-105/40-45 supported by 11ug/kg/min Dopamine. With fever & shivering quite frequent. Not so alert.
This morning,. Fever subside a bit after cool pad treatment.Heart rate fast >90, Breathing a bit heavy & chilling once awhile. BP low, Dr Jong give levophed.
Parameters:(7am)
HR=89-100, BP=87-94/40, BPM=29-31, SPO2=99%, SIMV=6, PEEP=5,Psupp=15,FiO2=35%,Ps=15.
ABG reults (2008.11.18 07:22):
PH7.478, BE(B)=+3.1mmol/L, tHb=8.5g/dL (low), O2Sat=98%, Ca=0.82
-> Dr Stop Bi-Carb @ 7:15am
Lab blood test results:(19.11.2008 @ 6:05)
Haemoglobin=9.4, RBC=3.00, Platelet=111, WBC=21.58, ucleated RBC=6
DRs Comments:
Dr Jong - Stop Sodium Bi-Carbonate as BE(B)=+3.0. BP low hence give levophed.
Dr Teoh - Tummy more bloated.
Dr Cheong - New infection, give Meronem & will see result in 1 or 2 days.WBC high which is no good.
Dr Lye - Fever, WBC high, not a good sign, new infection at tracheatomy entrance, waiting for culture result to identify the type of bateria & meantime cover with a new antibiotic - Meronem.
Dr Ting - tHb=8.5low, may need to transfuse 1 bag of blood.
Dr Tang - Condition not improving & with new infection.
Dr Lam - pessimistic outlook
To summarise, dad is not alert, condition is not improving. New infection at throat area. New antibiotic (meronem)is given to tie over before cutulre result come out.
5:00pm news
4 hours dialysis cut short to 3.5 hours as BP and heart rate were unstable. BP drops below 90. Fluide extraction volume is 500ml which is half of the target. Dopamine was increased to 13ug/kg/min at 2pm, and now lowered to 11. Dialysis finished at 2:30pm. Dad is tired and now sleeping. He has not opened his eyes today but did respond to closing his mouth when prompted. Dr Jong came and ordered ABG test.
Prayer Points:
1)God will strengthen dad's immune system to overcome all the bacteria attack.
2)Overall planning for dad, let God decide what is best for dad.
Wednesday, November 19, 2008
Tuesday, November 18, 2008
2008.11.18 ICU
10:00 am Update:
Dad was stable last nite. BP was on the low end 103-114/40-45 supported by 11ug/kg/min Dopamine. Not so alert.
This morning, dad is a little bit more alert. High fever with temp ranging 38-39oC. Breathing a bit heavy & chilling once awhile.
Parameters:(7am)
HR=79-81, BP=94-100/40, BPM=33-39, SPO2=100%, SIMV=6, PEEP=5,Psupp=15,FiO2=35%,Ps=15.
ABG reults (2008.11.18 07:22):
PH7.302, BE(B)=-11.0mmol/L (acidosis), tHb=8.6g/dL (low), O2Sat=97.3%, Ca=0.93
-> Dr Jong ordered Bi-Carbonate to neutralise the acidosis.
DRs Comments:
Dr Jong - give Sodium Bi-Carbonate to neutralise BE(B).Cleaned CVP line. New infection developed & ponder source is from where?
Dr Teoh - Tummy ok.
Dr Lye - High fever, new infection, add on 1 new antibiotic - Meronem.
Dr Cheong - New infection, give Meronem & will see result in 1 or 2 days.More alert today.
Dr Ting - tHb=8.6low, need transfuse 1 bag of blood.
Dr Lam - no comment.
Dr Tang - New infection, need 48 to culture inorder to know the type. Now cover with Meronem.
To summarise, dad today more alert but develop high fever(38-39oC) which means new infection. New antibiotic (meronem)is given.
11:00pm update.
Dad blood become very acidic, Dr continue to give bi-Carb to neutolise. Fever with temp ranging 38-39oC. Develop new infection.
Prayer Points:
1)God will strengthen dad's immune system to overcome all the bacteria attack.
2)Overall planning for dad, let God decide what is best for dad.
Dad was stable last nite. BP was on the low end 103-114/40-45 supported by 11ug/kg/min Dopamine. Not so alert.
This morning, dad is a little bit more alert. High fever with temp ranging 38-39oC. Breathing a bit heavy & chilling once awhile.
Parameters:(7am)
HR=79-81, BP=94-100/40, BPM=33-39, SPO2=100%, SIMV=6, PEEP=5,Psupp=15,FiO2=35%,Ps=15.
ABG reults (2008.11.18 07:22):
PH7.302, BE(B)=-11.0mmol/L (acidosis), tHb=8.6g/dL (low), O2Sat=97.3%, Ca=0.93
-> Dr Jong ordered Bi-Carbonate to neutralise the acidosis.
DRs Comments:
Dr Jong - give Sodium Bi-Carbonate to neutralise BE(B).Cleaned CVP line. New infection developed & ponder source is from where?
Dr Teoh - Tummy ok.
Dr Lye - High fever, new infection, add on 1 new antibiotic - Meronem.
Dr Cheong - New infection, give Meronem & will see result in 1 or 2 days.More alert today.
Dr Ting - tHb=8.6low, need transfuse 1 bag of blood.
Dr Lam - no comment.
Dr Tang - New infection, need 48 to culture inorder to know the type. Now cover with Meronem.
To summarise, dad today more alert but develop high fever(38-39oC) which means new infection. New antibiotic (meronem)is given.
11:00pm update.
Dad blood become very acidic, Dr continue to give bi-Carb to neutolise. Fever with temp ranging 38-39oC. Develop new infection.
Prayer Points:
1)God will strengthen dad's immune system to overcome all the bacteria attack.
2)Overall planning for dad, let God decide what is best for dad.
Monday, November 17, 2008
2008.11.17 - ICU
10:00 am Update:
Dad was stable last nite. BP was on the low end 100-110/40-45 supported by 10ug/kg/min Dopamine. Not so alert.
This morning, dad looks lethargic and not so alert. Mild fever with temp 38.0oC. Breathing a bit heavy.
Parameters:(7am)
HR=90-95, BP=102-106/40, BPM=29-31, SPO2=99%, SIMV=6, PEEP=5.0, FiO2=35%,Ps=15.
ABG reults:
PH7.362, BE(B)=-5.4mmol/L (acidosis), tHb=8.7g/dL, O2Sat=98%, Ca=0.95
-> Dr Jong ordered Bi-Carbonate to neutralise the acidosis.
DRs Comments:
Dr Jong-blood BE need to be neutralise, give Bi-Car.
Dr Cheong - 2 spikes of fever with temperature about 38.0oC. Infection still on, may be new one. gave a dose of bactrim yesterday afternoon. Consider another dose of Vancomycin but need Dr Lye opinion as it affect kidney function.Dad immune system is low.
Dr Ting - Nucleated RBC =2 means less degeneration of RBC that is good. Haemoglobin 8.7 low, need 1 bag blood transfusion. Platelet 84 ok. WBC=11.xx increased indicate new infection.
Dr Tang - less alert.
Dr Teoh - Tummy ok.
Dr Lye - got fever, will give one more single dose of vancomycin (@11:45am)
Dr Lam - came. No comments 7 said infection is take care by other Dr. (4.30pm)
To summarise, dad is less alert, may be due to blood acidity (ie BE(B)=-5.4) arising from metabolic acidosis . Will neutralise it with bi-carb. Will do dialysis today to remove 1.5 ltr of fluid & toxin & transfuse 1 bag of blood. Dad has mild fever, hence Dr Lye (under the request of Dr Cheong) will give a second single dose of vancomycin to treat the fever.(may be new bateria)
11:pm Update:
Whole day, dad is not alert.Did open eyes when called. Today dialysis remove 2 ltr of fluid. Develop fever with temperature. Breathing with effort.
Prayer Points:
1)Thanks God that kidney start flowing.
2)God will strengthen dad's immune system to overcome all the bacteria attack.
Dad was stable last nite. BP was on the low end 100-110/40-45 supported by 10ug/kg/min Dopamine. Not so alert.
This morning, dad looks lethargic and not so alert. Mild fever with temp 38.0oC. Breathing a bit heavy.
Parameters:(7am)
HR=90-95, BP=102-106/40, BPM=29-31, SPO2=99%, SIMV=6, PEEP=5.0, FiO2=35%,Ps=15.
ABG reults:
PH7.362, BE(B)=-5.4mmol/L (acidosis), tHb=8.7g/dL, O2Sat=98%, Ca=0.95
-> Dr Jong ordered Bi-Carbonate to neutralise the acidosis.
DRs Comments:
Dr Jong-blood BE need to be neutralise, give Bi-Car.
Dr Cheong - 2 spikes of fever with temperature about 38.0oC. Infection still on, may be new one. gave a dose of bactrim yesterday afternoon. Consider another dose of Vancomycin but need Dr Lye opinion as it affect kidney function.Dad immune system is low.
Dr Ting - Nucleated RBC =2 means less degeneration of RBC that is good. Haemoglobin 8.7 low, need 1 bag blood transfusion. Platelet 84 ok. WBC=11.xx increased indicate new infection.
Dr Tang - less alert.
Dr Teoh - Tummy ok.
Dr Lye - got fever, will give one more single dose of vancomycin (@11:45am)
Dr Lam - came. No comments 7 said infection is take care by other Dr. (4.30pm)
To summarise, dad is less alert, may be due to blood acidity (ie BE(B)=-5.4) arising from metabolic acidosis . Will neutralise it with bi-carb. Will do dialysis today to remove 1.5 ltr of fluid & toxin & transfuse 1 bag of blood. Dad has mild fever, hence Dr Lye (under the request of Dr Cheong) will give a second single dose of vancomycin to treat the fever.(may be new bateria)
11:pm Update:
Whole day, dad is not alert.Did open eyes when called. Today dialysis remove 2 ltr of fluid. Develop fever with temperature. Breathing with effort.
Prayer Points:
1)Thanks God that kidney start flowing.
2)God will strengthen dad's immune system to overcome all the bacteria attack.
Sunday, November 16, 2008
2008.11.16 Mt E - ICU
2008.11.16 11:30am update
Last nite,dad was tire & not so alert after dialysis but did had a good rest.
BP last nite was on lower end ranging 98-105/40.
This morning 8:30am, HR=75-83, BP=107-110/44, BPM=25-31, SPO2=100%,SIMV=6 (reduce from 8),PEEP=5.
Dad breathing is at ease. Dopamine 10ug/kg/min. Nepro F/S@38ml/hr (liquid food tube feed).
Yesterday lab blood test result:
Potassium=2.7 low but corrected last nite.
Urea=37.5 high (N2.8-7.7)
Creatine=173 high (N53-115)
Haemoglobin=11 ok (N=13.5-18)
RBC=3.58 low (N4.5-6.3)
Platelet=62 low (N140-460)
PT=15.4 (N10-14)
PTT=43.8 (25-41)
This morning 6:36am ABG result:
PH=7.414 ok, BE(B)=-0.8 ok, tHb=9.2 reduce from yesterday 9.8 but still ok, O2Sat=98%ok, all others ok.
Overall haemoglobin is reducing from 9.8 to 9.2, but still ok.(last blood transfusion was on 14/11, 2 days ago.)Dr Ting said platelet=62 is ok for the time being. Dr Lye give Eprex to boast RBC production. He declare today is the rest day for dad so no dialysis or other therapy will be done.Dr Cheong say dad got low grade fever is 37.8oc
Dad is well & alert this morning and breathing at ease.
All Drs ie Lam,Teoh,Tang,Jong,Lye,Ting&Cheong visited.
11:30pm update:
Dad urinated @ 4pm & 8pm. wetted diapers. This mean kidney jump started. Praise the Lord,He has heard our cry.
Experience mild temperature spike 37.oC, Dr Cheong ordered bactrim.
Prayer needs:
1. Praise point: Dr Lam (Cardiologist), Tang (Neurologist), Teoh (Abdominal) all give thumbs up to dad's condition this morning. The comment: dad is holding on well. At least now we can have the parameter to make tentative plan to travel back to Kuching.
2.Pray for the preparatory work in Kuching for dad's return for rehab. Enable different people in laying ground work
Last nite,dad was tire & not so alert after dialysis but did had a good rest.
BP last nite was on lower end ranging 98-105/40.
This morning 8:30am, HR=75-83, BP=107-110/44, BPM=25-31, SPO2=100%,SIMV=6 (reduce from 8),PEEP=5.
Dad breathing is at ease. Dopamine 10ug/kg/min. Nepro F/S@38ml/hr (liquid food tube feed).
Yesterday lab blood test result:
Potassium=2.7 low but corrected last nite.
Urea=37.5 high (N2.8-7.7)
Creatine=173 high (N53-115)
Haemoglobin=11 ok (N=13.5-18)
RBC=3.58 low (N4.5-6.3)
Platelet=62 low (N140-460)
PT=15.4 (N10-14)
PTT=43.8 (25-41)
This morning 6:36am ABG result:
PH=7.414 ok, BE(B)=-0.8 ok, tHb=9.2 reduce from yesterday 9.8 but still ok, O2Sat=98%ok, all others ok.
Overall haemoglobin is reducing from 9.8 to 9.2, but still ok.(last blood transfusion was on 14/11, 2 days ago.)Dr Ting said platelet=62 is ok for the time being. Dr Lye give Eprex to boast RBC production. He declare today is the rest day for dad so no dialysis or other therapy will be done.Dr Cheong say dad got low grade fever is 37.8oc
Dad is well & alert this morning and breathing at ease.
All Drs ie Lam,Teoh,Tang,Jong,Lye,Ting&Cheong visited.
11:30pm update:
Dad urinated @ 4pm & 8pm. wetted diapers. This mean kidney jump started. Praise the Lord,He has heard our cry.
Experience mild temperature spike 37.oC, Dr Cheong ordered bactrim.
Prayer needs:
1. Praise point: Dr Lam (Cardiologist), Tang (Neurologist), Teoh (Abdominal) all give thumbs up to dad's condition this morning. The comment: dad is holding on well. At least now we can have the parameter to make tentative plan to travel back to Kuching.
2.Pray for the preparatory work in Kuching for dad's return for rehab. Enable different people in laying ground work
Saturday, November 15, 2008
2008.11.15 Fighting on ...
11:50am update:
Dad had a good rest last nite.
This morning HR=86,BP=98-102/36-39, BPM=26-30, SPO2=100, O2 supp=35%, Dopamine=6 ug/kg/min. All looks good.
Blood test result : PH7.437, BE=0.6, Hb=9.8 (Yesterday=10.3). Also ok.
No fever & last nite no spike.
Dr Teoh said tummy ok. Stool (diarrhea) lab test not out yet.
Dr Jong said dad is stable.Lung stronger. SIMC reduce to 8 from 10, PEEP reduce from 6 to 5. All these indicate that dad lung is stronger now.
Dr Ting said the RBC breakdown likely is due to dad reaction to one of the drug, so he will find out more.
Dr Cheong & Dr Tand said lung is better & other parameters remain the same
Dr Lam said dad is coming out from DIC (Disseminated intravascular coagulation) which normally has fatality rate of 90%.He presribe potassium as it is on the low side.
Dr Lye said it seems that infection is less as WBC is reducing & haemoglobin is maintaing quite ok. Others parameters remain the same. Today dialysis will target to remove 2.5 ltr of fluid with toxin.
Overall, dad's condition is improving & stable.
Prayer points:
1. Praise point - Stable and bouncing back in all parameters.
2. Dad's spirit will remain high and faith is strong in the One who can heal him.
3. Degeneration of nucleated Red blood cell can be resolved as soon as possible
4. Infection especially chest area will continue to clear
5. Financial needs - favourable response from management board
6. Carers - United and faithful in nightly prayers. Remove our fearful and unbelieving hearts, put on the full armour of God and stand on guard in the intercessory prayers for dad & the medical team.
Scriptural verses to encourage our hearts:
Jeremiah 32:17 "Ah, Sovereign Lord, you have made the heavens and the earth by your great power and outstretched arm. Nothing is too hard for you."
Romans 9:16 "I raised you up for this very purpose, that I might display my power in you and that my name might be proclaimed in all the earth."
Ephesians 6:18 "And pray in the Spirit on all occasions with all kinds of prayers and requests. With this in mind, be alert and always keep on praying for all the saints."
Dad had a good rest last nite.
This morning HR=86,BP=98-102/36-39, BPM=26-30, SPO2=100, O2 supp=35%, Dopamine=6 ug/kg/min. All looks good.
Blood test result : PH7.437, BE=0.6, Hb=9.8 (Yesterday=10.3). Also ok.
No fever & last nite no spike.
Dr Teoh said tummy ok. Stool (diarrhea) lab test not out yet.
Dr Jong said dad is stable.Lung stronger. SIMC reduce to 8 from 10, PEEP reduce from 6 to 5. All these indicate that dad lung is stronger now.
Dr Ting said the RBC breakdown likely is due to dad reaction to one of the drug, so he will find out more.
Dr Cheong & Dr Tand said lung is better & other parameters remain the same
Dr Lam said dad is coming out from DIC (Disseminated intravascular coagulation) which normally has fatality rate of 90%.He presribe potassium as it is on the low side.
Dr Lye said it seems that infection is less as WBC is reducing & haemoglobin is maintaing quite ok. Others parameters remain the same. Today dialysis will target to remove 2.5 ltr of fluid with toxin.
Overall, dad's condition is improving & stable.
Prayer points:
1. Praise point - Stable and bouncing back in all parameters.
2. Dad's spirit will remain high and faith is strong in the One who can heal him.
3. Degeneration of nucleated Red blood cell can be resolved as soon as possible
4. Infection especially chest area will continue to clear
5. Financial needs - favourable response from management board
6. Carers - United and faithful in nightly prayers. Remove our fearful and unbelieving hearts, put on the full armour of God and stand on guard in the intercessory prayers for dad & the medical team.
Scriptural verses to encourage our hearts:
Jeremiah 32:17 "Ah, Sovereign Lord, you have made the heavens and the earth by your great power and outstretched arm. Nothing is too hard for you."
Romans 9:16 "I raised you up for this very purpose, that I might display my power in you and that my name might be proclaimed in all the earth."
Ephesians 6:18 "And pray in the Spirit on all occasions with all kinds of prayers and requests. With this in mind, be alert and always keep on praying for all the saints."
Friday, November 14, 2008
2008.11.14 HE Is Wonderful
8:00pm Update:
Dad had a good rest last nite as BP is stable & breathing is at easy pace.
Today whole day dad is doing well, BP 110-120/45, HR=70-80, BPM=25-32. (N4.5-6.3).
Today blood parameters are also very good. Haemoglobin increase to 10.4 (N13.5-18) from 7.6 yesterday. WBC also down to 9.27 from 11.55 (N4-11) which means less infection. RBC also increase from 2.53 to 3.5. X ray show lung is better. No dialysis is required today.
Overall, Drs are happy with dad condition today. Dr Tang said it seems that dad condition is bouncing back. Dr Teoh said dad's abdominal discomfort is ok, nothing serious for now. Dr Cheong said lung is better & Diarrhea may be due to antibiotic. Dr Lye said infection activities is reduced but still there hence continue to give 3 antibiotics & monitor closely. He also confident that dad's urine will be back when things are more settle. Dr Jong said dad is getting better & try to lift him to sitting position, Dr Lam also said dad is more alert & well.
All Drs, Jong, Teoh, Cheong,Tang, Ting,Lam and Lye visited & positive about the progress.
At 9am, The Methodist Church Healing Room ministry's director Mr Ronnie Yeo came with Ms Doreen (consultant lawyer) & her husband Pro Dr Lim. They laid hand over dad for healing. During healing time, Doreen saw Jesus in white glow came to dad. It was a great moment. We read scripture & sing hym to dad. It was a great moment. They left about 9:45am
This morning, Dr Jong reduced the respirator pressure & switch on talking mode to allow dad to talk. Dad told us that he still have stomach discomfort, and also said Praise The Lord and Amen (in Foochow). It was a great moment which lasted about 10 minutes. Dad was surround by mum, Ai Yiing, David & myself.
We have moved to #05-03 Elizabeth Tower A from York Hotel. God really provides.
We know, God is with us.... & He is unfolding his power & wonder to us every day. Praise be to God.
Dad had a good rest last nite as BP is stable & breathing is at easy pace.
Today whole day dad is doing well, BP 110-120/45, HR=70-80, BPM=25-32. (N4.5-6.3).
Today blood parameters are also very good. Haemoglobin increase to 10.4 (N13.5-18) from 7.6 yesterday. WBC also down to 9.27 from 11.55 (N4-11) which means less infection. RBC also increase from 2.53 to 3.5. X ray show lung is better. No dialysis is required today.
Overall, Drs are happy with dad condition today. Dr Tang said it seems that dad condition is bouncing back. Dr Teoh said dad's abdominal discomfort is ok, nothing serious for now. Dr Cheong said lung is better & Diarrhea may be due to antibiotic. Dr Lye said infection activities is reduced but still there hence continue to give 3 antibiotics & monitor closely. He also confident that dad's urine will be back when things are more settle. Dr Jong said dad is getting better & try to lift him to sitting position, Dr Lam also said dad is more alert & well.
All Drs, Jong, Teoh, Cheong,Tang, Ting,Lam and Lye visited & positive about the progress.
At 9am, The Methodist Church Healing Room ministry's director Mr Ronnie Yeo came with Ms Doreen (consultant lawyer) & her husband Pro Dr Lim. They laid hand over dad for healing. During healing time, Doreen saw Jesus in white glow came to dad. It was a great moment. We read scripture & sing hym to dad. It was a great moment. They left about 9:45am
This morning, Dr Jong reduced the respirator pressure & switch on talking mode to allow dad to talk. Dad told us that he still have stomach discomfort, and also said Praise The Lord and Amen (in Foochow). It was a great moment which lasted about 10 minutes. Dad was surround by mum, Ai Yiing, David & myself.
We have moved to #05-03 Elizabeth Tower A from York Hotel. God really provides.
We know, God is with us.... & He is unfolding his power & wonder to us every day. Praise be to God.
Thursday, November 13, 2008
20081113 Maching on
2008.11.13 7:15pm Update:
Dad finished dialysis at about 4pm, added 2 pints of blood & 500ml of Plasma, 1 ltr of fluid was removed.
CT scan (without contrast) done at about 5pm and now waiting for report.
Now, dad is sleeping peacefully, BP130/45, HR=75, SPO2=100%, BPM=29, Breathing is easy.
I notice that this evening dad's tummy a bit bloated & firm. Dr Lam didn't visit dad today.
---------------------------------------------------------------
2008.11.13 4:15pm update:
Dr Lye came about 12:30pm. Culture from tubes from all the 3 sites are free from bateria. So he suspect the infection may from from abdominal. Hence he ordered CT scan without contrast to be done today 4:30pm. He also confirm to transfuse 2 bags of blood as hamoglobin id low (7.6) and 2 bags of plasma. Due to excess fluid going in, hence he ordered dialysis to start at 12:30pm.
----------------------------------
2008.11.13 11:20am update:
Dad last nite went thru a tremor... BP drop to 57(systolic) and heart rate below 60. There was a panic call about 11:30pm. Arterial Blood Gas (ABG) test was done and found that dad's blood is too acidic. PH7.286 (N7.35-7.45) and Base excess -13.8 (N=0). Sodium Bicarbonate was administered to balance the acidity. Dad BP back to normal about 105/45 about 45minutes laters. PTL. The cause likely is due to metabolic acidosis.
Dad slept about 2:30am peacefully & restful till the morning. This morning, he is more alert when Dr Tang tested him. All Drs are happy about his alertness. All parameters about the same, x ray show lung is clearer now, but haemoglobin is low (7.6) despite 2 pints (700ml) of lood was transfused yesterday. Hence, today 2 more pints of blood will be given. Dr Ting ordered G6PD test to find out the cause of RBC disoder. Dr Cheong suggested to use bactrim antibiotic to wipe the bacteria infection but was worry about the IMPACT on the kidney, hence Dr Lye advise is needed. Dr Teoh said dad abdominal condition remain the same.
Dad still on antibiotic minocycline,tygacil & flagyl. Heart still supported by Dopamine(7ug/kg/min).
Parameters:
HR =78, BP =116/40, BPM=32, SPO2=100%, O2 support=35%.
Haemoglobin=7.6, RBC=2.53, WBC=11.55,Nucleated RBC=28,
Prothrombin Time Patient =18.6(N10-14), PTT=48.3 (N25-41)
Reported by Simon
---------------------------------
Dad finished dialysis at about 4pm, added 2 pints of blood & 500ml of Plasma, 1 ltr of fluid was removed.
CT scan (without contrast) done at about 5pm and now waiting for report.
Now, dad is sleeping peacefully, BP130/45, HR=75, SPO2=100%, BPM=29, Breathing is easy.
I notice that this evening dad's tummy a bit bloated & firm. Dr Lam didn't visit dad today.
---------------------------------------------------------------
2008.11.13 4:15pm update:
Dr Lye came about 12:30pm. Culture from tubes from all the 3 sites are free from bateria. So he suspect the infection may from from abdominal. Hence he ordered CT scan without contrast to be done today 4:30pm. He also confirm to transfuse 2 bags of blood as hamoglobin id low (7.6) and 2 bags of plasma. Due to excess fluid going in, hence he ordered dialysis to start at 12:30pm.
----------------------------------
2008.11.13 11:20am update:
Dad last nite went thru a tremor... BP drop to 57(systolic) and heart rate below 60. There was a panic call about 11:30pm. Arterial Blood Gas (ABG) test was done and found that dad's blood is too acidic. PH7.286 (N7.35-7.45) and Base excess -13.8 (N=0). Sodium Bicarbonate was administered to balance the acidity. Dad BP back to normal about 105/45 about 45minutes laters. PTL. The cause likely is due to metabolic acidosis.
Dad slept about 2:30am peacefully & restful till the morning. This morning, he is more alert when Dr Tang tested him. All Drs are happy about his alertness. All parameters about the same, x ray show lung is clearer now, but haemoglobin is low (7.6) despite 2 pints (700ml) of lood was transfused yesterday. Hence, today 2 more pints of blood will be given. Dr Ting ordered G6PD test to find out the cause of RBC disoder. Dr Cheong suggested to use bactrim antibiotic to wipe the bacteria infection but was worry about the IMPACT on the kidney, hence Dr Lye advise is needed. Dr Teoh said dad abdominal condition remain the same.
Dad still on antibiotic minocycline,tygacil & flagyl. Heart still supported by Dopamine(7ug/kg/min).
Parameters:
HR =78, BP =116/40, BPM=32, SPO2=100%, O2 support=35%.
Haemoglobin=7.6, RBC=2.53, WBC=11.55,Nucleated RBC=28,
Prothrombin Time Patient =18.6(N10-14), PTT=48.3 (N25-41)
Reported by Simon
---------------------------------
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