Walkie Talkie pt. that tanked.

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Specializes in Med-Surg/home health/pacu/cardiac icu.

I had a very LARGE patient that had a simple procedure. He had a cath for 6 hrs. because he couldn't void all day. He spike a temp of 103.3 and was very lethargic, and Dr. said to D/C Foley and C/S green purulent discharge from urethra and give Tylenol. He was on a PCA pump for 2 days for pain control. Temp came down and I had him up and walking for non-urination for 8 hrs after removal of catheter(100 cc after ambulation) and then in AM during report he tanked. (Why do they always tank during report?) He had 6 shots of Narcan and still did not come around, usually they are jumping out of their skins. 30% on a non-rebreather, and was non responsive. His % came up to 82% but still not responding to stimuli. BS 290, HR 112, BP 80/50, temp 97' and RR of 22. Labs showed ph of 7.28. All other CBC,PT, INR, BMP and ABG's were normal. He was moved to TCU still unresponsive. At first, I thought too much meds, but after 6 shots of narcan and no response, I'm thinking he had sepsis or maybe threw a clot. What do you think? I've never had a patient that was a walkie talkie just tank like that.

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Green drainage from his urethra? Urosepsis. Hope ya'll did a U/A and C&S when you put the cath in.

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Specializes in Oncology.

With a normal CBC (no elevated or decreased WBC) I'd tend to not think sepsis. Often the temp will drop suddenly when the sepsis is getting quite bad. How long had it been since the tylenol? The BP is obviously concerning, but the HR is lower than I usually see with a BP like that in sepsis.

With the decreased O2 sat, a PE seems more likely. Was he on anticoagulant at all?

Was an EKG done? Was a mag checked? I just ask specifically about mag because I know it's not typically in a BMP and you said the BMP was normal.

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His CBC was normal after or before he tanked?

ETA: My broken thought process was clinical signs point to urosepsis absent the labs. And with my second post here I was trying to figure out the timeframe for the labs. I still think urosepsis.

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Specializes in Med-Surg/home health/pacu/cardiac icu.

His mag was normal, his CBC was normal and this was after he tanked. His temp went from 103.3 to 97.8 to 97 within 2 hrs. I rechecked every hr. The C/S was done after I took out his foley due to the purulent drainage. I didn't get a UA because he had no urine in his Foley and the Dr. didn't want to straight cath to get a UA. An EKG showed multiform PVC's. He had to be intubated during his surgery because his RR dropped and they couldn't get his FIO2 back up.

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Specializes in Oncology.

Did he have to be intubated when he tanked? We don't give tylenol for high temps, so I'm not really sure what type or drop in temp is expected with tylenol or if that's a clinically significant drop.

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Green drainage is a sign of pseudomonas infection. the only pt i have seen with it went down hill very quickly.

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Specializes in Med-Surg/home health/pacu/cardiac icu.

After he was moved off my floor, he was intubated because they couldn't get his O2 up.

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Specializes in Oncology.
After he was moved off my floor, he was intubated because they couldn't get his O2 up.

Now that he's off your floor, is it likely he'll be moved back when he's better? I'm curious how this ends and what he's diagnosed with!

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Specializes in Med-Surg/home health/pacu/cardiac icu.

I was thinking green drainage could indicate STD's and a previous infection before his surgery but his WBC were normal. He's got me stumped because I don't know what happened to his. I thought urosepsis but then I thought a clot too.

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Specializes in Med-Surg/home health/pacu/cardiac icu.

Yeah, I would like to know what happened too. I go back Sat. to work. Hopefully, I'll find out.

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Specializes in Critical Care.

It does happen like that sometimes. I'd personally lean towards early urosepsis...even though your white count wasn't up, it was still early..may not have shown spike yet. The blood sugar is also concerning, initially I thought about starting to go towards DKA.....which could also account for his ph of 7.28...I'd be interested in seeing the rest of the ABG's...even if they were "normal" were they leaning more towards the acidotic side?

PE is definitely on the differential...but you also stated he had to be intubated due to a low RR??? Possibility includes atelectasis, mucous plug could also be possible. Lung sounds? Wet or dry? Rhonchus? Also can't rule a VAP...ventilator assisted pneumonia.

I'd also delve into his history for possible issues and as I don't know what procedure he had done (was something implanted?) that could also be a source of developing an infection.

Anyway, just some thoughts.

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