Justin's and Lizzie's Journal 12/31/25

Maximum Last Resort Life Support of Every Form Possible 

Justin's Journal: 12/31/25

At 2 am they called for permission to place the cannula for ECMO and ran additional arterial lines. At 3:15 they asked to run lines and connect dialysis. I got up at 5:30, showered and loaded my mom and kids for the flight home. 7 am I was at the hospital but they wouldn't let me in unless I could provide "additional information." We went back and forth and I almost forced the issue. Finally they called the nurse station who got me upstairs. Lizzie stable after the overnight additions but she was "stable" with:

• Lung Failure
• Heart Failure
• Kidney Failure
• Toxic Shock from Bacteria in bloodstream

Held stable all day. Over night they increased her ECMO drastically as her lungs became much, much worse. This was beginning of peak Flu. 

Lizzie's Reflections: 12/31/25

I don't have any real memories of this time. I'm sure some of my crazy hallucinations and dreams were during this coma, but I can't be sure. 

Notes from my physicians and nurses that day:

Shift Events: Immediately upon assuming care from perfusionist the ECMO system alarmed for air bubble.  Circuit was de-aired and support was resumed without further complications.  1 RBC. 1.5L LR. Worsening lactic acidosis throughout night.  Worsening Acute Kidney Injury.  HD line dropped and kidney dialysis started.  IV thiamine for continued lactic acidosis with no clear explanation. Sacrococcygeal area with deep erythema. Ordered wound care. 

Problem list by system:

 

Neuro:

#acute pain

- tylenol, fentanyl drip 50

#agitation requiring sedation protocol

- wean sedation for neuro exam, can switch to precedex as now no longer

#ARDS requiring neuromuscular blockade

- now paused, has 4 twitches on ulnar area, wean sedation for neurological exam

#seizure disorder

- continue home vimpat

 

Pulm:

CXR: severe bilateral hazy opacities, worse in right than left

-worsening hypoxic respiratory failure 

#ARDS

#influenza B

- Continue lung protective ventilation with lung rest setting Vt <6 cc/kg

VV ECMO flow 3.4, sweep 1.5

- Continue Tamiflu (started 12/30)

- Possible cavitary lesion on CT scan lof the eft upper lobe

- Considered continuation of steroids however given equivocal data in ARDS for influenza will defer continuing methylpred for now (had decadron allergy).

 

CV:

#cardiomyopathy: unclear etiology

EF 25% at OSH and TEE with cannulation revealed moderate to severe MR and reduced LV and RV function.

- continue inotropic support; favor dobutamine given lactic acidosis

Renal:

#AKI

#metabolic acidosis

#lactic acidosis

- Check urine electrolytes

- Restart bicarb drip (arrived at 75/hr) as temporizing measure for acidosis

- nephrology consult, anticipate starting CRRT

- trend base deficit and lactate, monitor UOP

GI:

- NPO for now, start tube feeds as pressor requirement downtrends

- PUD Ppx: PPI

 

Endo:

#stress hyperglycemia

#steroid induced hyperglycemia

- SSI

#history of thyroid cancer

- thyroxin

 

Heme:

#coagulopathy

#acute blood loss anemia

#AC for MCS

#thrombocytopenia

- Heparin goal 60-90

 

ID:

#influenza B

#concern for super imposed pneumonia

- Tamiflu

- continue ceftazidime and linezolid for now

- send mini-BAL, plan for bronchoscopy when able

#GPC bacteremia

- ID consult

- continue linezolid as this typically has excellent strep coverage.

Nursing Note by Nurse Allyson G at 12/31/2025  8:10 AM

Confidential status removed from patient encounter per husband Justin's request.  He is the patient's current decision maker and was not aware of any reason for the patient to be confidential.

Attestation signed by Ryan Flood, DO at 12/31/2025 11:10 AM

I saw and examined the patient. I independently reviewed the laboratory results and notes in the EHR.  I discussed the case with  Dr. Lai and agree with the findings and plan as documented.

-Left upper extremity Ultrasound after IV infiltration given unilateral swelling; neg for DVT with c/f infiltrated IV (taken out) Bicarb was running through. If not treated immediately, would cause necrosis. Please initiate the ASKIN bundle as applicable and start appropriate measures.

 

My independent assessment includes:

 

Anuric acute kidney injury

Acute global systolic heart failure

Hypercapnic hypoxemic respiratory failure

Mixed cardiogenic shock and septic shock

New Heart Failure with c/f Infective Myocarditis

ARDS

Influenza B