Emergency services - Carbon Dioxide Narcosis

Author

Carbon Dioxide Narcosis

flotsam@sympatico.ca

2005-01-31, 11:51 am

I am looking for some help trying to solve a problem with a family
member who is experiencing sudden repeated onset of carbon dioxide
narcosis. If this is not the appropriate forum to post this query,
please would you make suggestions as to where to post as the intention
is not to offend but to get help ASAP. The excellent team of doctors at
our Toronto hospital are completely stumped as to the reason for the
narcosis recurrence.

My father has been diagnosed with COPD and was admitted to emerg in
early Dec. 04 with soaring CO2 levels over 100. Over the next six
weeks, he was intubated seven times (self-extubated twice)in the CCU
and diagnosed with sleep apnea.Even though his oxygen sat levels were
generally pretty good (around 97%) his CO2 levels were up and down like
a toilet seat at a mixed party.

A Bipap didn't work for him, he acquired MRSA pneumonia in the hospital
which he still has and three weeks ago he had a tracheotomy. Things
were going slowly uphill: stable O2, CO2 in the low sixties, secretions
fairly heavy but stable, breathing on his own with some oxygen support,
no venting, and then he was transferred to a step down ward yesterday
and only had 50% O2 through his trach tube and suddenly this afternoon
he crashed again--CO2 above 100.

He has had fairly consistent arrythmia throughout this whole situation
which we are told is "normal" and not particularly problematic compared
to his other issues. He resumed his Quinidine through his gastric tube
four days ago with no apparent problems, and he's been on lasiks to
reduce leg swelling.

Any help/ideas would be greatly appreciated. We lost our mum to cancer
in October and we'd like to keep Dad around as long as possible

Lizzie

Carey Gregory

2005-01-31, 11:51 am

Recommend you post this question to sci.med

"flotsam@sympatico.ca" <flotsam@sympatico.ca> wrote:

>I am looking for some help trying to solve a problem with a family
>member who is experiencing sudden repeated onset of carbon dioxide
>narcosis. If this is not the appropriate forum to post this query,
>please would you make suggestions as to where to post as the intention
>is not to offend but to get help ASAP. The excellent team of doctors at
>our Toronto hospital are completely stumped as to the reason for the
>narcosis recurrence.
>
>My father has been diagnosed with COPD and was admitted to emerg in
>early Dec. 04 with soaring CO2 levels over 100. Over the next six
>weeks, he was intubated seven times (self-extubated twice)in the CCU
>and diagnosed with sleep apnea.Even though his oxygen sat levels were
>generally pretty good (around 97%) his CO2 levels were up and down like
>a toilet seat at a mixed party.
>
>A Bipap didn't work for him, he acquired MRSA pneumonia in the hospital
>which he still has and three weeks ago he had a tracheotomy. Things
>were going slowly uphill: stable O2, CO2 in the low sixties, secretions
>fairly heavy but stable, breathing on his own with some oxygen support,
>no venting, and then he was transferred to a step down ward yesterday
>and only had 50% O2 through his trach tube and suddenly this afternoon
>he crashed again--CO2 above 100.
>
>He has had fairly consistent arrythmia throughout this whole situation
>which we are told is "normal" and not particularly problematic compared
>to his other issues. He resumed his Quinidine through his gastric tube
>four days ago with no apparent problems, and he's been on lasiks to
>reduce leg swelling.
>
>
>Any help/ideas would be greatly appreciated. We lost our mum to cancer
>in October and we'd like to keep Dad around as long as possible
>
>Lizzie

Dave S

2005-01-31, 11:51 am

(original article selectively snipped)
flotsam@sympatico.ca wrote:

> I am looking for some help trying to solve a problem with a family
> member who is experiencing sudden repeated onset of carbon dioxide
> narcosis.
>
> My father has been diagnosed with COPD and was admitted to emerg in
> early Dec. 04 with soaring CO2 levels over 100. Over the next six
> weeks, he was intubated seven times (self-extubated twice)in the CCU
> and diagnosed with sleep apnea. Even though his oxygen sat levels were
> generally pretty good (around 97%) his CO2 levels were up and down like
> a toilet seat at a mixed party.
>
> A Bipap didn't work for him, he acquired MRSA pneumonia in the hospital
> which he still has and three weeks ago he had a tracheotomy.
>
> He has had fairly consistent arrythmia throughout this whole situation
> which we are told is "normal" and not particularly problematic compared
> to his other issues.

He resumed his Quinidine through his gastric tube
> four days ago with no apparent problems, and he's been on lasiks to
> reduce leg swelling.
>
>
> Any help/ideas would be greatly appreciated. We lost our mum to cancer
> in October and we'd like to keep Dad around as long as possible
>
> Lizzie
>

Has anybody asked Dad what HE wants? Does he WANT to be stuck on a vent?
Does he WANT tube feeding? Does he realize that he has a progressive,
irreversible medical condition (COPD) and that his bouts of respiratory
failure (which you call CO2 narcosis) are bound to recur (as they
apparently have).

His CO2 level shoots up because he isnt breathing deeply enough to move
CO2 OUT of the body. He's not breathing deeply enough because of his
COPD and because his breathing muscles are deconditioned from being on
mechanical ventilation so frequently. Does he WANT to live the rest of
his unnatural life in a hospital, unable to walk, on tubefeeding, unable
to do all the things that he may have enjoyed?

What is the rationale to "keep Dad around as long as possible". Who is
it benefiting? Him? How is this a benefit? Modern medicine has lost
sight of its goal to improve life, and rather, seems to focus on
delaying inevitable death, regardless of the cost. So.. ask dad.. does
he WANT to be on a ventilator? Does he WANT a feeding tube? It should be
his decision, and nobody elses. And if he wants it, then fine.. honor
his wishes.. but if he doesn't.. honor his wishes as well. Let him have
some dignity in the sunset of his life.

Dave