Monday, March 23, 2015

I have some good news. His renal function continues to improve with a creatinine today of 3.6. He is in the polyuric phase of ATN with a urine output after stopping Lasix over the past 24 hours of >100 cc/hr. His LFTs have normalized. His cardiopulmonary function is good. On neuro exam today, his boardlike stiff neck can now bend by 45 degrees and his sustained clonus is now down to 5 beats. We had our ophthalmologist (Rachel Bishop) examine him today with a neat gadget hooked onto a cell phone, which together with a hand lens gave us a good look at his retina. Good news is that he has no papilledema and no evidence of clinically significant uveitis. Tomorrow morning we will attempt to stop his ketamine and fentanyl and gradually taper off his propofol. If he wakes up without being combative and is stable for a period of time, we will consider pulling his endotracheal tube. His CT is 37 and so he is almost cleared of virus from his blood. Fingers crossed. Paul Farmer called my cell phone as I was getting ready to do today and I gave him a summary of progress. Having “political issues” with the Norwegians getting upset that Cliff and I want to extend our RCT vaccine trial to Guinea since they are doing the ring vaccination there. See my comments above.