Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
Now, today’s tip is about a case study where different treatments could have possibly led to different outcomes. And I will break it down for you so that you can understand what you need to look for if your loved one, for example, is in a similar situation.
Now, first off, give the video a thumbs up, share it with your friends and families, and subscribe to my YouTube channel for regular updates for families in intensive care. I’d really appreciate your support and you help support the channel so that more families in intensive care can get help.
So, let’s look at today’s case study. So, we were working with a client a few weeks ago who had their 80-year-old father in intensive care with a massive heart attack. And the ICU was not putting their best foot forward at the time because they thought the client is old and that if he was to survive, he wouldn’t have any quality of life anyway, and therefore they were not putting their best foot forward. We called them out fairly early on. We were telling the family what should be happening? What treatment the client should be happening? What I’ve seen over the years.
I’ve worked in intensive care for over 20 years in three different countries. And I have worked in intensive care as a nurse unit manager for over five years, and I’ve been professionally consulting and advocating for families in intensive care for the last nine years. So, I see, and I have seen my fair share of what treatment can be offered, in ICU and what is appropriate and what isn’t.
So, with the heart attack the client had, and he also had a poor ejection fraction, which means the contractility of the heart was impaired due to the heart attack he sustained that made it difficult for him to get off the ventilator, which means he was in an induced coma for longer than necessary.
For example, if they had given the right treatment. For example, levosimendan is a treatment that works on the contractility of the heart, especially after a heart attack. When contractility of the heart is poor, levosimendan is one of those drugs that can improve contractility. And if contractility had improved early on, he would’ve had a higher chance of being weaned off the ventilator, of being weaned off sedation, potentially having a tracheostomy earlier or not needing a tracheostomy at all, because he was on minimal ventilation settings when we were working with a client.
So, therefore, the ideal scenario would’ve been levosimendan given early on top of the dobutamine, he’s had a milrinone. And then they could have minimized or stopped sedation, and weaned him off the ventilator. He was already breathing on CPAP (continuous positive airway pressure) and pressure support, but on high-pressure support levels. So, he was not quite ready for extubation yet. But with contractility improving, if he had levosimendan, then he could have been weaned off the ventilator, extubated, and avoided tracheostomy, and hopefully, he could have left ICU then.
What happened in this situation though, is the ICU was refusing the levosimendan. He had to be kept in an induced coma with sedatives and opiates, which then eventually led to bowel obstruction and ischemic bowels. And then he became septic, and he died within less than 24 to 48 hours after the sepsis was diagnosed.
And, he ended up on numerous inotropes such as noradrenaline and vasopressin, and they were all maxed out. So, there was no chance to save his life after he had the bowel obstruction. So, it’s really critically important for any family in intensive care to ask the right questions straight away.
The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care. And that’s what we can do here for you at the Intensive Care Hotline.
We can almost provide you with a second opinion. We can help you navigating this increasingly difficult territory that is ICU where ICU teams are often negative. They only tell you half of the story unless you know what questions to ask and what to look for. They often deliberately withhold crucial information that we can extract for you. We can look at medical records, we can give you that second opinion that you so desperately need when having a loved one in intensive care.
That’s my quick tip for today. I hope that helps.
If you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of the website or send us an email to [email protected].
If you want a medical record review for your loved one, you could have that as part of our service as well. Check out our section there.
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Thanks for watching.
This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.