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If you want to know what to do after Day 4 of your family member having a cardiac arrest in ICU, stay tuned! I’ve got news for you.
My name is Patrik Hutzel from intensivecarehotline.com and I have another quick tip for families in intensive care today.
So, I’ve got an email here from a reader who says,
“Hi Patrik,
Thank you for all your videos. My dad had a heart attack and cardiac arrest, and my mom woke up in the middle of the night with him struggling to breathe. She thought he was having a nightmare and tried to wake him for a minute or so, and then she called the ambulance. They told her to start CPR (Cardiopulmonary Resuscitation) immediately. He started to turn blue when she started. The paramedics were there within 11 minutes of my mom doing CPR. Here we are at Day 4 with all organs doing fine but waiting on an MRI (Magnetic Resonance imaging) scan of the brain. Your videos give me hope. I’m not sure if he’s in an induced coma or not. What’s the difference?
Thank you so much.”
The good news is that if he’s alive after Day 4, after cardiac arrest at home, that’s a good sign. If all organs are doing fine, that in my mind includes the brain.
So, the question is why are they still waiting for an MRI scan of the brain? Normally, an MRI scan is done on admission, or at least a CT (Computed Tomography) scan of the brain is done on admission, or if it can’t be done on admission, then it’s done the next day. So, I’m wondering whether there’s a delay or why there’s a delay. Is it because they potentially don’t have the skills, expertise, and the staffing levels to take someone from an ICU bed to an MRI? It is quite an undertaking, and it takes some preparation. It takes some manpower if you will, 3-4 people, doctors, nurses to get someone on a ventilator to an MRI scanner and the patient also has to be hemodynamically stable, of course. But irregardless of that, an MRI scan should be done as quickly as possible.
Now, with all his organs are fine, again, I would include the brain into all major organs. Maybe they’ve already ruled out brain damage. If they have ruled out brain damage, and if all organs are working fine including the brain, then I argue your dad must be in an induced coma because otherwise he would be awake if he wasn’t in an induced coma. That means he’s on medication such as propofol, fentanyl, morphine, midazolam/Versed or Precedex to keep him sedated keep him comfortable on the ventilator, and keep him stable. But then, if all the organs are working fine, why are they not waking him up? If it stays for an hour, why not wake him up to see what he can and or what he can’t do? They need to make a proper and thorough assessment of what he’s able to do, so wake him up as quickly as possible. And yes, he would be in an induced coma.
So, what else needs to happen? He needs to have a review by a cardiologist. Maybe he needs to have an angiogram, or maybe he’s had the angiogram already to screen his heart what led to the heart attack and the cardiac arrest, that is certainly something that needs to be done.
What else? Is he having any seizures? If all organs are working fine, I argue he shouldn’t have any seizures. But again, those are very important questions to ask. Does he have any seizures? Is he on anti-seizure medications such as Keppra, phenytoin, valproate, or any others? Was he in cooling therapy?
Is he in an irregular heart rhythm such as AFib (atrial fibrillation) or any other irregular heart rhythms? If so, is it being treated? If it’s being treated, is he treated with amiodarone? Is it treated with the Digoxin? Is he treated with beta blockers? Has he had a cardioversion? Does he need an ablation? What is it that he needs if he is in an irregular heart rhythm?
Another question that often needs to be asked in a situation like that, are the kidneys working? Once again, you are saying in your email that all organs are working fine. Once again, I would include the kidneys in that.
So, I hope that shed some light on this.
It sounds to me like your dad is in a safe space. But by the same token, you will need a second opinion here. You need to have a medical professional to Look at the medical records or to talk to the doctors and nurses directly and ask all the questions that you haven’t even considered asking. I’ve given you some ideas now.
Other questions are, can he be extubated? What ventilation settings is he on? Is he already breathing somewhat spontaneously? Can he breathe spontaneously even more once he’s taken off the ventilator and the breathing tube, once he’s taken out of the sedation and the induced coma? That would be next.
I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for 5 years where I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can confidently say that we have saved many lives with our consulting and advocacy. You can verify that on our Testimonial section at intensivecarehotline.com and you can verify it on our podcast section at intensivecarehotline.com where we have done client interviews who can verify the work that we’ve done with them and for them.
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Thank you so much for watching.
This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.
Take care for now.