Quadruple Bypass...not getting discharged?

[Marque69]

My dad had a quadruple bypass 8 days ago. He spent 5 days in the ICU, due to several days of requiring oxygen, low blood pressure and irregular heat beats. The irregular heart beat seems to have resolved itself. However, now he is experiencing rapid heart rate. He's still having low blood pressure and while he is off oxygen, he gets winded just talking to you. At some point during his stay, it was reported he had fluid on his lungs. I haven't heard anything about that in a few days now. Two days ago, they indicated he would be discharged today. Now, they want to keep him but aren't giving us any real answers as to why. Today will be his 9th night in the hospital. Obviously, if he needs to be there, I want him there. But they aren't giving us any information as to why, or where he needs to be physically in order to discharge. I just wish I knew what to expect and when he might get to come home.

[skydnsr]

I'm very sorry also to hear about your dad.  Please accept our condolences.

[Smiley2000]

I am so sorry to hear about your Dad.  You and your family are in my prayers.

[ed34]

oh my dear God, I am so sorry to hear that. I pray that you are given strength in these tough times.

[Marque69]

Dad passed away on 12/2/13. :( Turns out he had undiagnosed COPD which was compounding his lung problems. He did in fact develop pneumonia. He also had a complete blockage in one of his bypasses and had to get a stint put in. He ended up with CO2 poisoning and never recovered.

[ed34]

I don't think he is slipping mentally, it's more than likely pure exhaustion. In such a condition it is hard to concentrate for long. I'm still having trouble understanding what the surgeon could have done to cause this. He must be pretty bad if he slipped with the knife and damaged a lung. Then again this  is another point, if one lung is damaged then you can still use the other one. To damage both he would need to go in with a machete. Please keep us informed as to what they discover with the scope.

[Marque69]

He cannot take deep enough breaths on his own to properly open his lungs, which is why he is on the bipap. He had an echo done last week and it shows decreased heart function. I just talked to my dad this morning, for all of about 1 minute which is all he can muster, and he said they are going to put a scope in to look at his lungs. I will be at the hospital this afternoon and hope to get more answers as my Dad seems to be slipping mentally. :(

When they took the fluid off his lungs 2 weeks ago, there was blood in it (I just found that out 2 days ago). I don't know if they did a culture then not, but they have not drained his lungs since that I'm aware of. The lung doctor said he would only start the steroids after he confirmed no infection, how he did that, I do not know.

[ed34]

While it ICU it is very easy to take a sample of fluid from his Lungs and send it to the microbiology lab to grow cultures. They can certainly determine if it's an infection and is not down to guess work. I really can't see what the bypass surgery could have done to his lungs? Have they done any tests to check his heart has a good output on the left and right side? Don't worry about a heart rate of 115-120, that isn't dangerous. An Oxygen level of 90 is fine for recovery, but I can't understand why it would drop to 60 with a cough? Unless the cough is lasting for several minutes at a time. The Cardiac Surgeon wouldn't have done anything to the Lungs which makes it a huge mystery. One thing which does come to mind is his ability to completely expand his lungs. The diaphram as you know, pulls down to create negative pressure in the chest, inflating the lungs. It has been known for a surgeon to damage the nerves that control this, meaning the diaphram only works on one side, or very little on both. It can take many weeks for the nerve to heal again. Have they checked his lungs are fully inflating when he breathes on his own?

[Marque69]

It will be 3 weeks since Dad's quadruple bypass, and he is still in the hospital. As a matter of fact, he was just moved back to the ICU today. :( Every day he gets worse instead of better. He is now seeing a lung specialist who doesn't believe it's pneumonia, but rather a result of the heart surgery. They have begun a round of heavy duty steroids. Dad is now on 15 L of oxygen, and even then, his O2 level is 90 just laying in bed. If he coughs or tries to get up (which he is no longer allowed to do), he drops to 60 and takes several minutes on the BiPap machine to recover. His HR is staying at 115-120 just laying in bed. I don't know how long his heart can keep up that pace. He has already lost over 10lbs and he didn't have 10lbs to lose. I'm literally watching my father waste away before my eyes. :(

[ed34]

When the infection is under control, things will greatly improve. I take it he isn't on a ventilator? His heart will give the impression of failure with congested lungs because not much gas exchange can take place. I really feel for him, as if open heart surgery isn't enough he has all this to contend with :( Please keep us informed. When the infection is under control he will still have to wait for his lungs to clean themselves from dead white cells etc, and he will feel worn out.

[Marque69]

Well, he was discharged last week, only to be readmitted the following day with pneumonia. He has been back in the hospital since Thursday. Yesterday they drained 650 ML of fluid from his lungs. He is on 5 L of oxygen and hasn't yet started walking again. At the time of admission, they diagnossed him with Congestive Heart Failure. Considering he just had bypass surgery, this concerns me. His list of confirmed issues are: Diabetic. Bypass Surgery (quad). Congestive Heart Failure. Pneumonia. His blood sugar is all over the place, despite being on a heart healthy diet and insullin. His BP is still low and his HR is still high. They are hoping that with removing all the fluid, his lungs will begin to work better and ultimately his heart as well. From the sounds of it, he will be in the hospital for several more days. :(

[ed34]

In the UK, the person listed as next of kin has the right to ask for all the information, unless the patient has made it clear that it's his/her wish that this does not happen.

[Flycaster305]

You didn't mention where you live, but most countries have privacy protocols.  If you or members of your family have permission to your father's records, I suggest that you ask for them tomorrow.  Usually if you have permission, you can get them rather quickly by visiting the records department of the hospital.  With those in hand, as to discuss discharge plans. If your father didn't give anyone permission to review his records, the hospital has not just the right but the responsibility to keep his records private. Given your father's symptoms, he may have to go to an intermediate recovery facility for rehab, but you need to know.  If information isn't forthcoming, ask to speak to social services at the hospital to learn your rights.
Keep us informed, obviously it is a stressful situation.

[ed34]

You must get tough and demand to be given answers. If they can't give you answers then demand to see the consultant who can. The two obvious possibilities I can think of are a) heart failure b) infection (pneumonia) on the verge of sepsis.
It is your right to have answers and if they don't give them, ask for their names and give the reason "I am going to register a complaint because I'm being told nothing". You don't want him home if his heart rhythm is not steady and certainly not if his blood pressure is lower than normal. They need to stabilise all those things first because you are not a medical professional able to handle anything going wrong. Please, just be really firm with them, show them you are the boss.It could be that you are just bumping into the lower grade Doctors and you need to ask to see the consultant as soon as possible.