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What Causes Persistent Drowsiness And Back Pain Post A Bronchoscopy?
Question: Hi Dr. Ulabidin,
You answered a question 6 days ago regarding my dad, who is 86 and had a bronchoscopy. They gave him adavan and propoful for sedation. He's on levaquin, vancomycin and cefepine antibiotics for what they thought was viral pneumonia which they started several days before the bronchoscopy. They gave him a small dose of morphine on 12/29 for back pain following the bronchoscopy, which I'm concerned about since he has not awaken since he was put under sedation. I was assured the small dose of morphine would not interfere with the sedation drugs.
he has not had any solid food since Friday 12/23. He was admitted 12/24. They started him on low glycemic Glucerna (he's diabetic) and gave him Reglan on 12/30 to kick start the stomach and intestines.They took him off it 1/1 as they think it could have some side affects not helping with his situation.
All of his vital signs are great. The fluid in his lungs has cleared. Steroids decreased from 60mg/6hrs. to 40mg/8 hrs.
Still on a ventilator. They have not been able to do the spontaneous breathing as he is not waking up. They did a MRI of the brain and an EEG..Both are negative. He is showing brain wave function. They keep his tv going with the sound bar by his ears. They have and keep trying different stimulation. He is responding to pain as of yesterday when they push on his nail bed, he pulls his hand or foot away.
The Neurologist, Cardiologist and the Pulmonary doctors are puzzled.
My dad is clinically deaf w/out hearing aides. He looks very rested, his coloring is good, all vitals are great and have been for about a week. His sugar level was very high a couple of days ago, 273. I pointed out his norm is 97-116 and he checks it every day to reevaluate his food intake. They had him on a long lasting insulin 2x/day. They have increased w/ a dose of fast acting insulin and his reading last evening was 198, and this morning it is 177.
Any thoughts? Also any thoughts on extra stimulation. I'm going to try a cold pack and a bar he uses with rubber balls on it to stimulate his feet when he has tingling from diabetes.
Right now, we are in a wait and see mode.
You answered a question 6 days ago regarding my dad, who is 86 and had a bronchoscopy. They gave him adavan and propoful for sedation. He's on levaquin, vancomycin and cefepine antibiotics for what they thought was viral pneumonia which they started several days before the bronchoscopy. They gave him a small dose of morphine on 12/29 for back pain following the bronchoscopy, which I'm concerned about since he has not awaken since he was put under sedation. I was assured the small dose of morphine would not interfere with the sedation drugs.
he has not had any solid food since Friday 12/23. He was admitted 12/24. They started him on low glycemic Glucerna (he's diabetic) and gave him Reglan on 12/30 to kick start the stomach and intestines.They took him off it 1/1 as they think it could have some side affects not helping with his situation.
All of his vital signs are great. The fluid in his lungs has cleared. Steroids decreased from 60mg/6hrs. to 40mg/8 hrs.
Still on a ventilator. They have not been able to do the spontaneous breathing as he is not waking up. They did a MRI of the brain and an EEG..Both are negative. He is showing brain wave function. They keep his tv going with the sound bar by his ears. They have and keep trying different stimulation. He is responding to pain as of yesterday when they push on his nail bed, he pulls his hand or foot away.
The Neurologist, Cardiologist and the Pulmonary doctors are puzzled.
My dad is clinically deaf w/out hearing aides. He looks very rested, his coloring is good, all vitals are great and have been for about a week. His sugar level was very high a couple of days ago, 273. I pointed out his norm is 97-116 and he checks it every day to reevaluate his food intake. They had him on a long lasting insulin 2x/day. They have increased w/ a dose of fast acting insulin and his reading last evening was 198, and this morning it is 177.
Any thoughts? Also any thoughts on extra stimulation. I'm going to try a cold pack and a bar he uses with rubber balls on it to stimulate his feet when he has tingling from diabetes.
Right now, we are in a wait and see mode.
Brief Answer:
It can be septic or metabolic encephalopathy
Detailed Answer:
Hi! Thanks for sharing the feedback and staying in the loop. I must say that you have put all the details in a very good manner and is quite helpful to presume the situation well.
I can understand the anxiety and trouble of wait and see what you people are going through. But let me assure you that he is in good hands and they are doing optimal what could have been done so far and few tweaks can make it better.
My impression is still that his drowsiness can be due to sepsis or metabolic encephalopathy. In elderly, infections can present unlike young people and muteness or sedation or decreased food intake are the predominant features of infection instead of typical spikes of fever.
Initially the only likely source of infection appeared to be his lungs but side by side evaluation of urine by repeating urinalysis to rule out urinary tract infections as well repeated blood and urine cultures should be sent as the bug causing the problem can be caught and hence dealt with exact antibiotics cover to whom it is sensitive too.
Sugar levels aren't bad and tighter control isn't recommended in such patients with poor oral intake or on tube feeding. Meanhwile repeated electrolyte levels like of sodium, potassium, calcium, magnesium and phosphate should be monitored and coorected as these can also prolong the sedation ot drowsiness.
It's a very good sign that MRI and EEG are normal and he is responding to pain stimulus and hopefully in few days things will improve even further. Though MRI is normal still possibility of CNS infections should also be ruled out and if a little doubt exists a lumbar puncture can be done.
Along with these measures wait and see is the only policy as such ventilated patients, their stay in intensive care, can extend upto weeks before complete recovery. I must commend your patience and interest in his care.
Wishing him a quick recovery. If you have any more questions, feel free to ask. Regards.
It can be septic or metabolic encephalopathy
Detailed Answer:
Hi! Thanks for sharing the feedback and staying in the loop. I must say that you have put all the details in a very good manner and is quite helpful to presume the situation well.
I can understand the anxiety and trouble of wait and see what you people are going through. But let me assure you that he is in good hands and they are doing optimal what could have been done so far and few tweaks can make it better.
My impression is still that his drowsiness can be due to sepsis or metabolic encephalopathy. In elderly, infections can present unlike young people and muteness or sedation or decreased food intake are the predominant features of infection instead of typical spikes of fever.
Initially the only likely source of infection appeared to be his lungs but side by side evaluation of urine by repeating urinalysis to rule out urinary tract infections as well repeated blood and urine cultures should be sent as the bug causing the problem can be caught and hence dealt with exact antibiotics cover to whom it is sensitive too.
Sugar levels aren't bad and tighter control isn't recommended in such patients with poor oral intake or on tube feeding. Meanhwile repeated electrolyte levels like of sodium, potassium, calcium, magnesium and phosphate should be monitored and coorected as these can also prolong the sedation ot drowsiness.
It's a very good sign that MRI and EEG are normal and he is responding to pain stimulus and hopefully in few days things will improve even further. Though MRI is normal still possibility of CNS infections should also be ruled out and if a little doubt exists a lumbar puncture can be done.
Along with these measures wait and see is the only policy as such ventilated patients, their stay in intensive care, can extend upto weeks before complete recovery. I must commend your patience and interest in his care.
Wishing him a quick recovery. If you have any more questions, feel free to ask. Regards.
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Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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