Somehow I didn't have time to update the blog all day today. So tonight will have to be a summary version.
Manny had a very rough night. Woke up often, crying he was in pain. I'd reposition him (which requires getting out of the chair and walking over there) and it would help for a little while. Then repeat ... all night long.
By morning he was still miserable and then "unconscious" alternating.
11am, fever. Tylenol via suppository. (He didn't like that so he tried to push it out.) Well, then he had a major poop and voila! He felt much better. He even became a little more alert. That lasted about 2 hours. He wasn't himself. Wasn't talking (couple of words) but would respond. Like I said something about the word "Blink" (in reference to lights) and he did.
The rest of the day he was in and out of pain and consciousness. Then about 4pm, he spiked a higher fever. Pain increased.
By tonight, he's still a little more "awake". But his blood pressure is trending downward. His fever is trending upward. His bowel sounds are diminished. The pulses on his right lower legs are diminished. He is showing signs of mild respiratory distress.
Some new labs are coming back in and they're not good. The early labs were all fine but as they know what is going on, they are able to get better tests. Like a huge concern is for sepsis ... not through the central line this time, but from the gut. The blood cultures aren't back yet so they don't know but they are treating it like he is and he's showing some initial signs that could be that.
They also did a procalcitonin level. This has been correlated with sepsis. (And that test comes back within hours, not days.) His level on Saturday morning (upon admission) was 0.2 ... they consider 0.25 to be the cut off to consider it "likely positive". So in the gray area.
Then tonight, his PT and PTT times came back elevated. This is often associated with sepsis too... last time he had this on his decline ... and they gave Vitamin K (both times) to try to stop the slippery slope.
No matter what is going on, he's very sick.