Father in hospital, possible resp crisis. Couple questions

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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RicaLynn
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Father in hospital, possible resp crisis. Couple questions

Post by RicaLynn » Wed Sep 17, 2014 1:22 am

Bit of a rant ahead followed by some sincere questions. I can't sleep at the moment (though I am going to pop a melatonin shortly to help) because of my father's condition at present, and his CPAP therapy (or lack thereof) has me concerned, probably because it's something over which I may exert a modicum of control in this uncertain time.

Background: 71yo male, stage 3 COPD, SEVERE sleep apnea, CPAP supplemented with 2L O2 (last I checked anyway) hx of hypertension, has one stent, has had hernia repair and esophageal reconstruction roughly a decade ago. Habitual drinker, unk quantity

Thursday in the wee hrs of his first night in his new rental home, he gets SOB and calls the ambulance. Bp was 200/110 so he was admitted while they tinkered with his meds to get it back in line. Saturday when we spoke he sounded fine, tired but lucid, and mentioned they may be discharging him Sunday. Great, I'll be in town very nearby for church, give me a call. Sunday comes and goes, no word from dad, even in reply to my mid afternoon text.

Monday afternoon after work I drop in and he's looking rough. Slightly disoriented, still complaining of shortness of breath, and asking me to adjust his O2 up to 2L though the RT had just left the room moments before and he was on 0.5L. I check the bedside to be sure he has at least a loaner coal, and they've given him a decent Respironics with a full face mask -- he uses pillows at home, but any CPAP is better than no CPAP. Spoke with his nurse who informed me that he's on ethanol detox protocol, which may account for some of the disorientation. I asked about blood gases as he's had elevated CO2 in the past with many of these same symptoms. She informed me his labs were all ok, not great but ok. I feel confident that this is the DT's doing this and decide to give it another day.

Today when I visit, he is dozing upright in the recliner with just his O2 cannula and the bed alarm under him. He is severely disoriented, bordering on hallucinatory, repeating questions. I had unfortunately cut my time short and had to leave to get my daughter before I could speak to his nurse, but I am greatly concerned about his mental status at this point. I stewed over it all through the evening and finally broke down and called the nurse's station about 9:45. Asked again about blood gases, and was informed they were done on 9/12 and were wnl for his COPD. Stressed to this nurse that I've seen this before and he really needs an ABG. She assures me she'll call the doc on it prior to morning rounds.

My question: would it be beneficial for me to chase down HIS CPAP and take it to the hospital with me, or am I putting the cart before the horse?

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Last edited by RicaLynn on Wed Sep 17, 2014 1:39 am, edited 2 times in total.

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RicaLynn
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Re: Father in hospital, possible respiratory crisis. Couple ques

Post by RicaLynn » Wed Sep 17, 2014 1:23 am

Editing to add, stupid fingers!

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Re: Father in hospital, possible resp crisis. Couple questions

Post by Guest » Wed Sep 17, 2014 1:49 am

RicaLynn wrote:My question: would it be beneficial for me to chase down HIS CPAP and take it to the hospital with me, or am I putting the cart before the horse?
I thought you said he has a cpap in hospital? Make sure the pressure is set correctly, it may not be. The only thing bringing his cpap may do is get lost or broken. Can you be sure they will use it if you do bring it?

His mask may help but that too can get broken in the wrong hands.

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RicaLynn
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Re: Father in hospital, possible resp crisis. Couple questions

Post by RicaLynn » Wed Sep 17, 2014 2:27 am

That is the other concern. He's Medicare/Medicaid so getting a replacement mask might be an issue (especially since he goes through lincare, don't get me started). I just know that his breathing sucks right now, so anything I can do to help get his co2 down is all I can think about. He has a CPAP loaner, yes, but he uses pillows and a chin strap at home and they've got an already disoriented man using a FFM that's new to him.

I'm 25 mi from the hospital, his home is ten miles the opposite direction from my house. I'd rather not get to the hospital tomorrow only to have them tell me to bring his setup. I don't know what his settings are, I seriously doubt HE would know what his settings are even if he were lucid. Fortunately his most recent sleep study is <1yr old and he's said before that it was working well for him.

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Re: Father in hospital, possible resp crisis. Couple questions

Post by Guest » Wed Sep 17, 2014 2:56 am

So pick up his machine and check his settings. Take the machine with you to the hospital in case it can be used. Getting his settings right can be a huge help.

fwiw - I put all my settings including mask on the list with my meds. Using painters tape (or a gummed label) with the machine settings on it and stuck on the machine might be another idea.

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RicaLynn
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Re: Father in hospital, possible resp crisis. Couple questions

Post by RicaLynn » Wed Sep 17, 2014 2:58 am

Yeah, were going to have a nice long chat and a teaching session about what an AMBU-bag is and why you need a HARD COPY of your current meds list with you.....

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Re: Father in hospital, possible resp crisis. Couple questions

Post by Guest » Wed Sep 17, 2014 3:07 am

RicaLynn wrote:Yeah, were going to have a nice long chat and a teaching session about what an AMBU-bag is and why you need a HARD COPY of your current meds list with you.....
IF you are his Healthcare Representative you can get all that info input to his hospital record if it isn't already there. If you aren't get that settled ASAP.

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Julie
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Re: Father in hospital, possible resp crisis. Couple questions

Post by Julie » Wed Sep 17, 2014 3:59 am

You need to talk to the doctor (& hopefully cardiologist/respirologist), not just the nurses, because he has too many things going on, some conflicting, and whatever the reason for his state of mind, it's obviously not very good now and you can't depend on him for info or awareness of what he's doing. But if he were my father I'd fight to keep him in hospital until things are sorted out.

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RicaLynn
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Re: Father in hospital, possible resp crisis. Couple questions

Post by RicaLynn » Wed Sep 17, 2014 4:00 am

Agree 110% Julie and that's my plan. As soon as I get my daughter off to school I'm headed straight for the hospital to hopefully intercept the doctor shortly after rounds

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Sludge
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Re: Father in hospital, possible resp crisis. Couple questions

Post by Sludge » Wed Sep 17, 2014 4:41 am

What specific drugs is he on for the ETOH Protocol? They're just about all significant respiratory depressants.

A blood gas is most appropriate, please post results.

And ABG can change at the drop of a hat, so unless (until) he's real stable, have to keep an eye on that.

Too much O2 may be detrimental (discussion re: oxygen-induced respiratory failure to follow). Consider continuous pulse oximetry.

IIWY I would have a REAL low threshold to go to BiPAP because chronically, he sounds like an Overlap Syndrome, or presently pending/actual respiratory failure (is the change in neuro due to drugs, DT, or rising pCO2?).
You Kids Have Fun!!

jnk
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Re: Father in hospital, possible resp crisis. Couple questions

Post by jnk » Wed Sep 17, 2014 7:22 am

Sludge, above, speaks (and types) valuable words of wisdom and truth. IMO.

And besides following through with what Sludge suggests, and in support of what he suggests, I would also think that the RT at the hospital would be the person to speak to directly, and soon, if at all possible:
"Treatment for OLDOSA [obstructive lung disease and obstructive sleep apnea] also falls squarely into the realm of the RT, specifically, any approach involving administration of inhaled pharmacotherapy or respiratory therapy appliances or devices . . . RTs must be proactive . . . Push for protocols . . . There is no greater responsibility than saving lives. . . . As RTs, we can make a huge difference in these areas of overlapping respiratory problems that carry on through the day and strike hard at night." - http://www.rtmagazine.com/2014/05/deadl ... a-overlap/
For a patient with that history, if my family member, I would personally want the pulse oximeter to be recording, with an alarm, and with medical personnel within earshot (hospital or home) at least until the end of the ethanol withdrawal protocol. But hey, just me. Or actually, not just me:
"Consider admitting the patient to an ICU if withdrawal symptoms are severe, if vital signs are unstable and/or if there is risk of respiratory distress." - http://www.nahq.org/uploads/apps/files/ ... deline.pdf
Hospital BiPAP might be called for over a home CPAP, given the circumstances, in order for the hospital RT to be comfortable with it all.

The hospital RT might even be willing to talk over the phone.

Just sayin'.

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RicaLynn
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Re: Father in hospital, possible resp crisis. Couple questions

Post by RicaLynn » Wed Sep 17, 2014 8:39 am

Again, I'm with you all to the letter, and I very much appreciate the pertinent links.

He is on "a pretty good dose of" Ativan - not sure what that translates to in mg but I'll be finding out very shortly. He has in the past taken both lorazepam and alprazolam (at different periods, never alternating or overlapping) for anxiety. My cousin, an LPN, weighed in this morning via Facebook and suggested ruling out TIA since his bp has been so elevated. Not sure if it's even been considered or if they've just written him off as a sot.

He has been ventilated for poor perfusion twice before and I am seeing many of the same signs. Was perturbed to hear they hadn't been monitoring abg more closely but if he's not improved, and not yet on bipap, I will be seeing the RT ASAP. Thank you all again for your support and I will keep you updated

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RicaLynn
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Re: Father in hospital, possible resp crisis. Couple questions

Post by RicaLynn » Wed Sep 17, 2014 1:44 pm

Saw dad this morning prior to my appointment and he is MUCH improved. Alert, oriented, aware he's missed some time but looking overall much perkier. Didn't ask about abg results but will be following up shortly

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Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Backup/travel unit is an identical S9 AutoSet for Her w/Eson nasal mask

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Re: Father in hospital, possible resp crisis. Couple questions

Post by Guest » Wed Sep 17, 2014 1:54 pm

RicaLynn wrote:Saw dad this morning prior to my appointment and he is MUCH improved. Alert, oriented, aware he's missed some time but looking overall much perkier. Didn't ask about abg results but will be following up shortly
That is Good News.

Demerit

Re: Father in hospital, possible resp crisis. Couple questions

Post by Demerit » Wed Sep 17, 2014 3:59 pm

Some hospitals don't allow pt owned Pap's in the hospital. You may want to consider looking into a Trilogy verses a standard bipap. Glad he is doing better! Turning up o2 can cause co2 retention, be careful upping it.