Answers/Up All Night

Given the pace at which events are changing I'll probably be up all night and probably on a plane Monday.

To answer Abby's question:

Do the docs still think he has pneumonia as well as septic shock??

Yes, both of those things are symptoms, which leads to Arthur's question:

Jon, how can it be septic shock without serious infection? Can you explain?

Odds are that there is an infection. We just don't know what it is yet.

We've been here before, and going back helps outline what we are looking at. On December 12th, 2007 we wrote:

The main issue so far is controlling the infection. So far TJ may not be responding to the antibiotics that he has been given, and, as noted, the pneumonia has started moving into the right lung.

[...]

Basically, the sepsis dilates the blood vessels and makes the lungs "leaky." This leads to [congestive heart failure], which means that the heart isn't pumping enough blood and can lead to a drop in blood pressure. An analogy, the blood vessels are pipes which have expanded, but have the same amount of fluid is flowing through them so they no longer have the pressure that they should.

The sepsis can also evolve into septic shock, which is mostly simply defined as sepsis that is severe enough that fluid starts leaking into the lungs, the person becomes confused, and eventually myocardial dysfunction will occur (heart attack). If septic shock occurs it can clear in as little as 24 hours, or stay for days. Depends.

The next day we wrote:

Tj is in septic shock and a primary concern here is the loss of blood pressure. During the night his blood pressure dropped below 80 several times. The doctors are very concerned with the pulmonary edema (fluid in the lungs) because it can lead to respiratory failure.

We will be looking at the same things here, hence why he was so rapidly put on Vancomycin, to control whatever infection is there. TJ's blood pressure has not dropped below 80 so far (at least so far as I know) but it wasn't far from it last time I had a number (around 6:00pm).

A moving pneumonia would be quite scary here (all we have is the baseline right now, so whether it is moving or not is undetermined) possibly indicating a move further into septic shock, which has a mortality rate of about 50%.

So, yeah, we are officially into the "very concerned/scary" stage of things. Past this we are getting to the "scared of death" stage. I made such a remark a year ago and was later chastised for it, it made a lot of people upset. But it was the truth. We aren't there yet today, but only moving in that direction and rapidly.