Diary Prequel Package — page 433

he continued to be tachypneic at 35-38 resp/min. During the day, his OxSats were in the low nineties and he responded first to increasing nasal O2 from 2 to 4L/min. However, as we got into the evening, his OxSats dropped into the high 80s. His resp. rate was 3840. We considered elective intubation at that point, but watched him for another hour to see if he would stabilize. Instead, his OXSats dropped to 78-80 despite increasing the nasal O2. His resp. rate went to 40+. At that point we did an elective intubation performed by Bob Danner of the Clinical Center ICU. It was uneventful and now he is paralyzed with deep sedation and on the respirator. His OxSat is now 99-100% and the machine is set at 15; he is breathing on his own at 20/min. We spoke to our colleagues at Emory and Nebraska who had taken care of Ebola patients in an intensive care setting. They said that this was exactly what they had seen, i.e. a patient seems to be doing well with good numbers and then goes into an ARDS picture. They intubated them and after a variable period of time, the patients (2 in number) recovered. Hopefully, that is what we will see with He went through the night without incident. March 16, 2015 - Spent 2 hours in the SCSU "Hot Zone" with Bob Danner (ICU specialist) and Kwan (ID Fellow). went into renal shutdown likely due to Acute Tubular Necrosis (ATN). We spent the time trying to balance the pushing of fluids with giving Lasix diuretic. Now at 24 hours after intubation, his pulmonary situation is fine. He is on 35% with 5 PEP and his Sats are 95-100%. His BP and cardiovascular function are fine. Labs are all about the same and a little better except for one disturbing trend. His creatinine has gone from 0.8 to 1.0 to 1.3 to 1.6 to 1.9 just 1 hour ago. From 6:00 to 7:00 PM he put out no urine after having put out about 40 cc the prior hour. We pushed fluids and he has only put out about 25 cc/hour over the past 3 hours. Diarrhea is still profuse. We are going to continue to push fluids to see if he opens up. Looks like ATN, which is puzzling since he has always had good perfusion with good BPs. The people at Emory tell us that this is exactly what they saw with their sickest patient, i.e. patient's numbers look good, then unexpected ARDS, the latter corrected by intubation/respirator, then unexplained ATN requiring dialysis, followed by prolonged and slow recovery. Strange disease this Ebola. We will continue to push fluids during the night and then (depending on his creatinine), consider the option of dialysis. Hopefully, we will not have to go there. March 17, 2015 - Went to morning report at 8:00 AM. Bob Danner reviewed what happened after I left the Unit last night. Creatinine now up to 2.5. Patient clearly in renal shutdown. Larry Altman gave very nice James C. Hill Memorial Lecture at the Lipsett Auditorium on the Journalistic Hx of AIDS. Decided not to go to the Wilson Center for the Tom Daschle/Bill Frist dinner since renal function continues to deteriorate and I want to go to the "sign off" meeting in the SCSU at 6:30 PM. At SCSU, Creatinine up to 3.3. . I am looking for a silver lining, but the upward trajectory of the creatinine is slightly less than it was yesterday. We may need to dialyze him, but I am hoping that his creatinine stabilizes at 3.7 to 3.9 and then starts to slowly come down without dialysis. Having said that, we