Dad in hospital…

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Cherise77

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Joined
Jun 18, 2018
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72
Reason
Loved one DX
Diagnosis
07/2018
Country
CA
State
BC
City
Vancouver
My Dad is not doing good. My parents are on a cruise right now. We all tried to talk my Dad out of going but he wanted to go as his brother and sister were going and they’ve never all been on a trip together.

My Mom just called this morning to tell us my Dad is in the hospital on the ship and they’re transporting him to the Seattle hospital when they dock tomorrow.
They say his lungs are full of fluid, his blood pressure is high and his oxygen level is 88. They almost intubated him last night but he improved enough that they didn’t have to.

What is happening? His choice is to get a trache. Is that what we’re looking at now? I’m so devastated. This all feels like it’s happening so quickly.
 
He could have pneumonia or a mucus plug that requires hospital suction...this is not necessarily a permanent loss of respiratory function that would require a trach to keep going. However, he and your mom should be prepared to confirm his choice of a trach if that comes up ... the time to discuss it and understand the implications as a family is before he gets to the hospital.

What hospital is he going to?
 
We don’t know yet. I think the doctors on the ship are still trying to confirm where they can take him. Somewhere in Seattle.

Blood work doesn’t show an infection but they have him on IV antibiotics anyways.
The X-ray shows his lungs are full of fluid. Would this be because of mucus plug? I wish we could be with him and my Mom.
 
So sorry to hear. He will be in good hands soon.
 
Thinking of you and your family.
 
Yes, being unable to expel mucus could lead to aspirating it into his lungs and basically reducing their ability to move air.

He has a BiPAP, right? If not already done, I would turn off the backup rate and target volume, instead using a fixed IPAP/EPAP, starting with IPAP 10, EPAP 4 and adjusting from there as needed.
 
He has a BiPap. He’s been using for sleep for about 3 years now.
I’ll pass on the setting changes they should make to my Mom, thank you.

Right now the doctors on the ship are alternating between his BiPap and oxygen. I’m a little worried about the oxygen as I’ve heard that CO2 can build up in ALS patients and be very dangerous.
 
They should only be using oxygen WITH BiPAP not instead of it. CO2 buildup is a risk with supplemental oxygen because it is sending more O2 in than the person would normally have to convert to CO2 and exhale. So normally it is not recommended except at altitude, but when there is acute compromise like your dad has, it can be the lesser of two evils. But oxygen should be used with the BiPAP at the same time to help the lungs and muscles regulate the air flow and support exhalation as much as possible.
 
The bipap should have an "input" port that you attach the oxygen line to. The second port is "output " for the air hose to PALS. If you dont have this type of bipap, request one. And, the hospital should allow you to use your own bipap.
Photo attached.
 

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I was just about to write the same thing, Tomswife. His machine should have an output section, so they can attach the oxygen feed tube to that. That way, he's getting two-way oxygen and not building up CO2.
 
He’s at the hospital now on a V60 ventilator. A BiPap, oxygen, nebulizer. It seems to be helping bringing his oxygen up but his heart rate is still high. CT scans and X-ray show large amount of bacterial pneumonia. He wants to get home so we’re trying to arrange an ambulance transfer to get back to Canada.

Thanks for all your advice. Anymore you have is appreciated.
 
I am sure they already are considering or have administered a low dose antihypertensive infusion depending on his BP vs. pulse. Also, reducing the backup rate on the vent (with a careful eye on his sats) can reduce the work of breathing that has been overtaxing the heart, and of course knocking down the infection with abx will also reduce his heart rate.

Just as well not to transfer to any hospital on a Sunday, but certainly understand that he wants to get home.
 
My Dad was intubated last night, just a few hours after getting to the ICU in Canada.
He had tested positive for Covid in Seattle before he was transferred. He now has Covid pneumonia on top of everything else.

Has anyone in here been intubated before or your pALS and successfully gotten off intubation? How is that process?
 
Cherise, I am sorry that your Dad has Covid and is intubated. I am thinking about you and your family.
Have you been able to see him? My PALS was never intubated.
 
Yes, we’ve been with him the whole time. Except late at night when they kick us out.
 
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