Rough Night :<

The nurse paged the attending resident last night (not from ID) and she came up to explain why they are giving the vanco. She had come by earlier to tell us but we were out to lunch. She said the same thing the nurse told me, that it is a gram positive cocci that started growing after 24 hours. They will not know what specific organism it is until a little later because they had so little to work with they had to let it multiply then see what it responds to. The called ID and they recommended the treatment. Since the process to culture the organism takes so long, hospital policy is to automatically start him on vancomyacin. The resident couldn't answer any of my other questions. I also asked the neuro-surgery residents this morning and they said I have to ask ID. Neuro did tell me this morning that the organism is not strep pneumo. It did not grow in the "Petri dish only in the broth" so that could mean it was a contaminant or it could mean it is staph. Once again they referred me to Infectious Disease. His CT on Monday showed 2 abscesses but they are too small to drain. From what I understand they are encapsulated so the presumed organism that is inside would not show up in the CSF. Yet another question for ID.

His night was pretty rough again. He started a big storm at about 10:30 and his HR slowly increased to 198 over the course of 2 1/2 hours. The nurse ended up paging the resident to give his Clonadine 45 minutes early (@11:15). They turned off his drain for the allowable 30 minutes because he had dumped 30 cc/h20 in one hour. He was still agitated so they gave IV morphine. He calmed down a little around 1:00 but it didn't last very long.