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Mon Jan 9 20:46:49 GMT 2006

Is it possible his gastrostomy is misplaced? He would thus be receiving 
no nutrition and have a rapidly developing intra-abdominal collection 
that might account for his worsening state. Or would this be immediately 
obvious in other ways?

KMATTOX at aol.com wrote:

>This was FORMERLY Mediastinal Traverse and I am getting tired of the case,  
>so I am going to FAST forward about a week.   Remember that this was a  case of 
>injury to both lungs, heart, esophagus, whose OR was staged.    He corrected 
>his coagulopathy without rVIIa, and was slowly getting better,  without any 
>appreciable drainage from chest tubes or the T tube in the  esophagus.   We were 
>feeding him via J tube and sucking on gastrostomy  tube and NG placed into 
>mid esophagus.    Still intubated, but  waking up.    Remember he had Hep C 
>positive.    
> 
>Now we are about a week out and he is developing an infliltrate in the R  
>lung.   Bronchial aspirate and BLOOD has grown out Pseudomonas and  
>Acinedabacter.     His INR is beginning to creep up  (2.3) as well as his TEG is becoming 
>abnormal.      Actually he arrested ONCE, was successfully resuscitated at 
>which time his blood  gases were fairly good, but his pH was creeping down (7.2) 
>and his base deficit  was high AGAIN (-20).   His Liver function tests were ALL 
>abnormal and  after the arrest his blood sugar was TEN, yes 10, and he had to 
>get a lot of  sugar IV.    Lots of sugar IV.    
> 
>What is going on here?  
> 
>Does he need Xigris?
> 
>Is there a danger to giving Xigris?
> 
>He was on Lovenox, Cephalosporins, Tube Feedings and  sedation.     
> 
>k
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-- 
Tom Hurst
Anaesthetic SpR - Manchester - UK

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