Sepsis Question

[booger73]

>Booger, are you in the medical field? By your posts is seems that you work in the hospital. I am just wondering because the info you have given is good.

Academic/teaching Internist and hospitalist =)

First off for you and your family. I am sorry to hear you father is very sick. I am an ICU RN and I have read these posts and Booger has given very good info. I see sepsis day in and day out, it is a up and down hill battle. If the dr's are asking to you get your family together then please do so ASAP. Sepsis itself is a very nasty infection, and then with his history of cancer his immune system is down and his body will require more support. Like other have said sepsis can effect all of the major organs. When his blood pressure goes low the body will take the blood from the not so vital organs and give it to the heart,brain,lungs, and kidneys.

I do have to respond to a PP regarding turning the patient and to be sure it is getting done and that the hospitals lag in doing this. I just have to add that just because the RN is not physically in the room turning him doesn't mean the bed is not turning him. Yes repositioning him is a part of daily care but if his BP is low and he is not stable they cannot turn him, it will only make matters worse.

Also check to see if the ICU that your father is in does daily rounds, and if so ask if you can join in, this way you can get a lot of info and what is happening to your father. Also if you are home, in the waiting room, or eating a meal and you think of something that you want to ask the nurse please write it down so you can ask the RN or the MD. Please do not be afraid to ask questions, but do remember that the RN is busy so write down a few questions and then ask her when she has a minute, and no question is stupid if you are asking it then there will be an answer.

I also believe that all patients including your father can still hear you, so please talk to him (unless the RN does not want him disturbed), also ask if you can bring in a radio and some CD's he would like to listen to. I personally turn the TV on so that the patient does not just lay in the bed and listen to nothing but the machines working.

Also please be sure to wash your hands when you are entering his room and leave, it will protect you and your father. Please feel free to PM me if you have any questions, I will try and help you. I will also so a prayer for your father and you that you will both be strong through this long process.

Spoken like a wonderful true ICU nurse.. all the things that she said, sunnyday, is very important.. I may have given you some of the 'clinical'/doctor side to this, but disneylover is right-on about some of the things you definetly should/can do..

write down questions, try to make the room a little more 'homey'..
nurses are there and can give you sometimes more information than the doctor, since they are there 24/7 - us doctors are sometimes just in/out because of all those 'other things' we're doing.. the nurses are the ones really providing the on-hands good care though, trust me

if they're having trouble finding an 'obvious source', it might be a hidden infection (abcess or other thing) - most people with sepsis are bacteremic (i.e. a bacteria grows out pretty easily in the blood, and we go 'aha.. that bug (staph, for example).. it probably should have grown out by now, although it doesn't always.. if it hasn't, it sometimes means the infection isn't easily found or is hidden in an area that is causing all the systemic effects but just isn't into the bloodstream.. (usually worse, and needs surgery, etc).. if it started with kindof a leg thing/scratch i'd suspect staph or a leg abcess or what not.. if it's not there, have to look elsewhere.. I'm sure he's on 'appropriate' abx with 3 - just have to find the source and appropriately fix, before anything else will turn around...

hang in there....

 

[JerseyJanice]

I'm so sorry you're going through this, SunnyDay.

You know it's not good. I have one relative who survived it twice. Third time, not, but it was secondary to being treated for leukemia. I don't know how your relative wound up with it, but I suspect surviving it can depend on how and why he got it in the first place.

Sending prayers, positive thoughts, and a hug your way.

 

[tar heel]

I'm so sorry you're going through this. It's really hard. I hope you're not by yourself. If you are, mobilize your support network. I hope your dad is able to get well -- keep in mind that his recovery is likely to be long, and you will need support.

My dad has had sepsis more than once and recently celebrated his 75th birthday. His doctors say they've never seen anyone like him. One of the hospitalists told him he was "way too stubborn" to die. My mom and I had some really long nights, though, and felt like we were riding a rollercoaster that kept changing its course. I've spent many hours sitting in his room and watching the monitors, hoping his blood pressure would be higher next time. He was in intensive care for almost a month.

 

[C.Ann]

Can't add much more than the others have posted here, but wanted you to know that I will include him in my prayers tonight..

 

[sunnyday123]

Thank you all.....

They said tonight he's not better, but not worse. He's getting a fever though and his blood pressure keeps stablizing, then it will go down to the 70's and they need to give him more medicine to bring it back up. A big concern is that he's on very light sedatives, and he's way more unconscious then he should be.

Family came in from Florida, New Jersey,Arizona and the Poconos. Thank God no one asked to stay with me, I would've handed them the keys and checked into a hotel.

 

[charming23]

More for you. I hope you have someone you can lean on during this difficult time so you don't end up sick yourself. I am keeping you in my prayers and thoughts.

 

[LisaRN97]

Hugs to you and your family. Sepsis can be very hard to manage, I have seen people go both ways. Hang in there and I hope your father is a fighter.....

 

[LuvOrlando]

I know how times like this just take your breath away so I just wanted to give you a

 

[Tigger2252]

Sunny Day, my prayers are with you and your dad. There is nothing I can say that will ease your fear or make you feel better. I was in your situation a year ago and I know exactly what you are going through, and still remember the fear and the rollercoaster that this infection puts you through. My father had a living will, but I was his health care proxy so final decisions came down to me regarding advanced treatments, etc. I hope your family arrives soon to lend their support to you. I will be praying for all of you.

 

[left210]

As everyone has said sepsis can be fatal but I would like to give you some hope. My mother is 66 years old and has a history of COPD was diagnosed with sepsis, pneumonia, congestive heart failure, and several other things last July. She was on a ventilator for 6 weeks and in the hospital for 3 months. She survived. I will tell you her pulmonologist told us to keep praying because he could not believe it when she started making progress. He basically said our prayers were being answered as he had no medical reason for her to still be alive. With that said, there is hope. She has to live with a trach and oxygen now but is living and happy to be alive. She had a long road of recovery because she lost all ability to lift a finger, walk, etc but has recovered with some limitations. She still has a quality of life and still lives at her home. She does need some assistance but just know that you can survive sepsis even in the most serious situations. Thankfully for her it never affected her kidneys but there was concern about that at one time. Also, my grandmother was in her 80's and had it once and they told us she would die but survived it and lived for another 1 year after that. I know your pain right now and my prayers are with you and your family.

 

[LuvOrlando]

Sunnyday, at this point the sample should have been cultured out and they should know what kind of antibiotics it will respond to. How are things? Is your Dad responding to treatment? Are you ok?

 

[Mandy_in_NC]

Thanks again, everyone. I just got back and th Dr wasn't there, they were getting him ready to get a CAT scan on his leg to see if there is anything that needs surgery, although I don't think he would be a candidate for any type of surgery at this point.

He's on medication to stabalize his bp, but to me it doesn't seem to be working. It was in the 120's/56 when we got there, but then went down to 74/46 then to around 90/64....I know this can't be good on his organs. His kidneys aren't functioning where they should be but he did seem to be breathing easier, even though he's on the ventilator, and they said he would probably be on it through the weekend. His color looks a little better, he's not gray like he was this morning, but still pale. The infection hasn't changed, they are still trying to figure out exactly what it is, but he's on about three anti-biotics. They also think he may have an UTI, which I'm sure isn't good for his kidneys.

I just want to crawl into a closet and close the door.

I hate to be the bearer of bad news but I am. First of all no matter how bad you want to you can not hide in the closet. Your father sounds alot like my did when she was taken to the ER. The hospital could not get her blood pressure to go up and stay up. They were pumping fluids in and giving her meds to raise it but it didn't help. She also went into renal failure so she had very little kidney function. She went into the hospital late Friday night. Was addmitted early Saturday morning moved to ICU Saturday night. When I saw her after they moved her to ICU she was more alert and she looked better. She wasn't pale and grey. She was put on a vent Sunday morning after she coded. They managed to get her back. I made arrangements for me kids and went home to get some stuff and I had been home less then 10 mins when I got the phone call that she was coding again and I needed to make a decsison on what I wanted them to do. I told them to work the code and that I was on my way back to the hospital. Truth be told I was very selfish when I told them to work the code a second time. But I didn't want my mother to die alone. I called my brother who was in Hi and asked him what he wanted. I also called my Aunt. We decided that if they had gotten her back that we would let her go. I got there and the Dr met me at the ICU doors and said that they had worked a slow code on her and that they were paceing her heart. I told the Dr that it was time to let her go. They gave us time to go in and say our good byes. Then they came in and turned the vent off and cut the pacer off and she was gone. My mother has been gone since Aug 30 2009. I hated having to be the one that had to make the decision to take her off of life support but I knew she didn't want to be kept alive like that. My mother was an RN and I am an EMT and my hubby is a Paramedic so we all know what hell goes on when somebody is coded. She made her wishes clear all of my life. I hope that I have helped you. But you have to be strong right now and think of what your father would want you to do. Having to make the decision about life support is the hardest thing I have had to do so far in my life. And that is saying something considering I had to face my father's murderer in court in 2001. Be strong and I will keep you and your family in my prayers.