this is night #5 of a 7 consecutive shift stint with the sickest patient i've ever taken care of (I think).
some highlights of the clinical situation thus far:
*maxed out on dopamine, added levophed drip
*H/H =7.0 / 21.2...2 units PRBC transfused
*gram negative sepsis as seen in the blood stream and BAL...Aztreozam Abx therapy
*pre-renal failure (>10cc/hr for 15 hours) despite fluids going at 1000cc/hr
*patient CXR showing patchy infiltrates and fluid: patient not oxygenating or ventilating well
*SWAN Ganz inserted. Cardiac output > 13, Wedge high 20's, CVP 28-34.
*started on Xigris
*PTT > 150...xigris stopped...4 units FFP transfused
*ABG: 7.22/55/67/18...FiO2 on 100%...8 sets of ventialtor changes made
*8 liters of bed drainage per shift
*1 liter of diarrhea in 3 hours, C.Diff samples sent~positive growth...rectal tube inserted
stay tuned. 2 more nights to go.