Reply To: Very Sick Patient- Help wanted

  • Shelby Boone

    Member
    October 6, 2022 at 2:47 pm

    How is her cardiac function? Other organ function markers improving? Has she cleared her candida tropicalis? Lactate and cooximetry done? Is she coagulopathic as well?  Still with circulating blasts? 

    Sorry, I realize that’s all questions!

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    Shelby Boone, MSN, APRN, CPNP-AC, CPN
    Director for PACU, Inpatient Heme/Onc, and BMT Advanced Practice Providers
    Texas Children’s Hospital
    Houston, TX
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    Original Message:
    Sent: 10-06-2022 01:05 PM
    From: Kathryn Schiavone
    Subject: Very Sick Patient- Help wanted

    kathryn.schiavone@rwjbh.org!

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    Kathryn Schiavone, APN
    Cranford, NJ
    United States
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    Original Message:
    Sent: 10-06-2022 12:58 PM
    From: Kathryn Schiavone
    Subject: Very Sick Patient- Help wanted

    Hello all,

    I am a NP searching for a little bit of a discussion for my patient who currently is in the PICU with high fevers which will not subside.
    This is her 1st relapse ALL with CNS disease. She was receiving HD ARAC and was doing very well.
    2 weeks she trigged a “code sepsis” on our regular pediatric floor for fever and hypotension (which she has had many times before and totally been fine)
    She was transferred to the PICU and put on pressers, port was removed based on + fungal cultures 2 days later (Candida tropicalis).
    She since has had mental status changes, intubated, continued very high fevers, though ANC has recovered. EBM, CMV both negative,
    Currently on ambisome, and meropenem. Toci will be given today and thinking about VOD and administering Defibrotide.
    Urine output continues to decrease and BPs are worsening as well.

    SUGGESTIONS WANTED!

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    Kathryn Schiavone, APN
    New Jersey
    United States
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