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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, I’m talking to this client at the moment who has their 58-year-old dad in ICU after cardiac arrest about 10 days ago. And her father is not waking up after the induced coma. They’re now lowering the sedation, but he’s not waking up even though he’s sort of slowly taking steps towards coming off the ventilator. Now, here are some questions that she asked me, and I want to go through them in this video.

So, she’s asking me, “As trembling or shaking is one of the side effects of phenytoin, what evidence is there to show this is not the case?” Now, let me just elaborate on that. When someone had a cardiac arrest and had, potentially, hypoxic brain injury, there’s always the risk of seizures. And phenytoin is simply a prophylactic medication that’s being given to prevent seizures after hypoxic/anoxic brain injury, which is the case in her dad’s situation. Other medications that can be given to prevent seizures are Keppra. In this case, they’re obviously giving phenytoin.

Now, what I can tell you from experience is that after cardiac arrest, a lot of patients are trembling or shaking also called jerking movements. And it’s hard to distinguish whether they are seizures or just other signs of the hypoxic or anoxic brain injury. I don’t know whether there is any evidence that phenytoin is causing shaking or trembling. I think it’s probably the seizures causing shaking or trembling. I think, if anything, maybe they need to increase the phenytoin, but then a lot of it depends also on what else is your dad on or was he on? Like, for example, was he on propofol? Was he on midazolam? Is he still on any of those medications? Is he still on fentanyl or morphine? Because they could take away the edge from the trembling as well. It could be as simple as that he’s waking up slowly because sedation has been completely switched off, which is what you’re telling me is probably the case.

Let’s get on with your questions, “Before he was put on this medication, phenytoin, he was a lot more stable, but since the medication has started, he deteriorated. This suggests the medication is not right for him?” Now, it doesn’t necessarily suggest that. It really depends what other medications he’s on as well. Is his heart stable? Is he on inotropes? Is he on vasopressors? So, it all depends on that as well.

Next, “What evidence does the ICU team have to show? He will not recover, especially after the progress he has shown over the last few days.” Well, I guess that’s where the rubber hits the road. There is no evidence that he’s not making any progress. I mean, it’s 10 days in ICU, it’s not 10 weeks in ICU. As you’ve heard me say over and over again, they’re trying to be in control of the narrative. And they’re trying to talk you out of a recovery of your dad and the recovery for your dad will need to take time, but we need to take time. But we will come more to that in a moment.

“After there is no significant evidence to suggest that severe brain damage has been done and his heart has been stable for his condition and is also coming up to 50% of breathing on his own. These are all positive signs for recovery. This would suggest he’s showing signs of recovery, but he needs to be given time. Therefore, withdrawing treatment at this stage would be neglectful to him and he will not have been given enough time for his body to recover.” So, you have mentioned to me that there is some brain damage from what you told me on the phone and that the ICU team has suggested there is some brain damage. So, there’s a little bit of conflicting information there. But there is a very good chance that if you had a cardiac arrest, which you told me that he did, that there has been some “downtime” of the brain and that his brain may have not had oxygen for more than three minutes, which then most likely confirms that there’s been some irreversible brain damage. But again, that doesn’t mean your dad shouldn’t be given time to recover. He should be given all the time in the world to recover.

“I want the doctors to advise, please, which negative factors in his condition are influencing the decision to stop his treatment because as a family, we don’t see any negatives. The only negative here is that you are not giving him enough time after such a traumatic cardiac arrest, to be able to heal.” That’s bingo, from my perspective, that you’re summarizing exactly how intensive care teams approach such situations. They want to stay in control of the narrative. They don’t want to give him enough time. They are painting the doom and gloom picture and telling you that he won’t have any quality of life. And they wouldn’t do it to their own family members. I’ve heard it all before. So, you’re asking the right question that he should be given all the time in the world to heal.

Next, you’re saying that, “Tears from his eyes would suggest his brain is sending signals in order for its his emotions to show us.” Yes. Yeah, absolutely. It’s hard to read what’s going on, but you know, tears are a sign that he is probably not in a happy place and that can only be changed by moving forward, really.

This client is actually in the U.K. and the client says, “The NHS website suggests recovery from a coma can take several weeks. Therefore, to give up on him less than a week would be neglectful.” 100%. Again, ICUs want to manage beds. They want to manage staff. They want to manage their budgets. And that’s why they want to stay in control of the narrative and telling you that there’s no hope. There’s always hope, and they need to give him time if he’s not waking up. If he needs more time on the ventilator, if he’s not in a CPAP (Continuous Positive Airway Pressure) or a pressure support mode yet. He needs to be given time. And if he can’t be weaned off the ventilator in the next few days, he needs to be given a tracheostomy and then he’ll have all the time in the world to recover and hopefully get out of intensive care alive.

So, that is my quick tip for today.

If you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected].

Also, have a look at our membership for families in intensive care at intensivecaresupport.org and join us there.

Also, if you need a medical record review for your loved one, in intensive care or after intensive care, please contact us as well. We can help you with that.

And, subscribe to my YouTube channel for regular updates for families in intensive care, share the video with your friends and families, give it a like, and comment below what you want to see next, or what insights and questions you have from this video.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.