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If you want to know what questions to ask to a critical care doctor, to the oncologist, to a neurologist and infectious disease when your loved one is critically ill in intensive care with a tumor, intubated, and in an induced coma, stay tuned! I’ve got news for you.

Today, I want to dive into what questions you should be asking when you have a loved one critically ill in intensive care who’s intubated, who’s ventilated, who’s in an induced coma, who’s got fractures, who’s got a spinal tumor and who’s on high doses of opiates, which is the scenario that we have worked with a client in the past. I just want to dive into that today.

So, the email from our client says, 

“Hi Patrik,

I will be meeting with the following physicians today. I want to ensure that I’m well equipped and asking them all the correct questions. Can you all please compile a list of questions and topics to ask or discuss with each physician? (1) Infectious disease, (2) neurologist, (3) oncologist, and (4) critical care doctor.”

This is how we help our clients, let’s dive right into it.

So, the situation is that a 64-year-old lady is in intensive care, intubated, and ventilated. She has a tumor on the spine. She had radiotherapy and chemotherapy for it. She’s in a weakened condition. She was on BIPAP (Bi-level Positive Airway Pressure) on and off before she got intubated. Now, she’s intubated. She is on high doses of opiates for tube tolerance as well as for pain that she’s sustaining from the tumor and it’s difficult to wean and extubate her because of the high doses of opiates that she needs. One thing with opiates is, one of the main side effects of opiates is respiratory depression which works contradiction to trying to wean someone off the ventilator.

Let’s dive right into it. So, what questions should our client be asking to the critical care doctor? With regards to airway and ventilation, are your mom’s lungs getting better? Is there a chance to gradually wean your mom off the ventilator? How often do you need to monitor and take the blood gas, chest X-ray, and the lactate? Lactate acid is high, which is something we’ve seen whilst reviewing medical records.  With abnormal blood results of white cell count, very high, which indicates an infection. Low hemoglobin, lower blood, low red blood cells, which means she needs a blood transfusion. Hematocrit, high glucose levels and potassium levels are high. What are the actions they’re doing to correct these abnormal values? The hemoglobin is very low, 6.6. When are they getting transfused blood to your mom?

It also turns out that this particular client has a GI (Gastrointestinal) bleed probably a stomach bleed which has been treated by a pantoprazole infusion as well as with blood transfusions. So, do they need to do a gastroscopy to find out where the bleed is? 

Next, prophylaxis for eyes, eye lubricant, DVT (deep vein thrombosis) prophylaxis, GIT prophylaxis. Like I said, wound skin care and mobilization at least every two hours needs to be done. She needs to be turned every two hours to prevent pressure sores. Are they doing this? Have they ordered all of these? What about intravenous access? Sedation and analgesia? Are the medications reviewed and assessed according to your mom’s requirements? Medications like Levophed, inotropes, vasopressors? Your mom’s blood pressure is low, any adjustment in the dose? Is it also going down as they are giving blood transfusions? Is sedation needed really? Or can sedation be reduced or completely switched off or shifted to PRN (as needed) when needed instead of giving a continuous infusion? How often do they do the medication reconciliation and medication review? Are they doing the intake and output hourly and fluid balance every 24 hours?

Following up with the critical care doctor regarding the management and interventions for the low hemoglobin, which is 6.6, needs an urgent blood transfusion. Once again, they should also bring down the inotrope and vasopressor requirements. High glucose medication to lower, and control the high glucose, which is nothing unusual in intensive care. A lot of patients have a high glucose, even though they’re not diabetic. They might need insulin infusion temporarily. It’s just a stress response from the body.

Also, high potassium needs to be treated, and regular repeat potassium levels tests need to be done to avoid any cardiac complications. Your mom has a low blood pressure and needs immediate intervention. Follow up with the ICU doctors for blood pressure medications may need to be checked and adjusted. Also, if your mom needs insulin to get the glucose down, that should also get the potassium down. It goes hand in hand. Other questions for the critical care doctor as well are, are the kidneys working? Is the liver working? Do they suspect any brain damage?

Now, next infectious disease doctor. Your mom has an infection with a very high white cell count. Can the doctor specify the source of the infection from respiratory, gastrointestinal, kidney, urine, blood, etc.? What specific microorganism your mom is positive for? What antibiotic does the infectious doctor plan to prescribe to your mom? How long is the duration? The dose of the antibiotic, antiviral, or antifungal? Whatever it needs to be. Does it need to be given intravenously? Through the nasogastric tube? Does it need to be given in any other form? So, it is really important that they do the septic screening so that they can really target the antibiotics. 

In terms of the neurologist, your mom is getting Keppra (levetiracetam medication). Does your mom have seizures? Is it now controlled by the Keppra? Why was she getting the Keppra in the first place? What is the root cause of her seizure? When is your mom going to have an EEG (Electroencephalography), CT (Computed Tomography) scan of the brain, MRI (Magnetic Resonance Imaging) scan of the brain?

Next, the oncologist. What is the plan of treatment for your mom with the tumor in the spine? Are they planning to start chemotherapy or radiation again? Is it potentially a tumor that can be operated on? What about blood investigation results? Hemoglobin, red blood cells, white cells are on abnormal levels. What is their plan? Are these blood levels caused by your mom’s cancer and tumor?

So, I hope that helps.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com. You can see what our clients say there. You can also verify the results that we’re getting for clients in intensive care at our intensivecarehotline.com podcast where we’ve done interviews with clients and where they share their success stories.

That’s why we created a membership for families of critically ill patients where you can get access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded to help you to make informed decisions, have peace of mind, control, power, and influence so that your loved one gets best care and treatment always. We have helped hundreds and hundreds of members and clients over the years improving their lives instantly, including saving their loved one’s lives. 

I also do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. I also talk to doctors and nurses directly. When I talk to doctors and nurses directly, I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. 

I also represent you in family meetings with intensive care teams, holding them accountable there.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence. 

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, share this video with your friends and families, and comment below your thoughts and insights, what you want to see next.

I also do a weekly YouTube live where I answer your questions live on the show and you will get notification for the YouTube live if you are a subscriber to my email newsletter at intensivecarehotline.com or if you are a subscriber to my YouTube channel here.

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.

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