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

Before I go into today’s tip, if you like my video, subscribe to my YouTube channel, click the like button, click the notification bell, and comment below what you want to see next, and share the video with your friends and families, especially if you know that you have a family member or a friend in intensive care.

So, we have a membership for families of critically ill patients in intensive care and we answer questions for our members.

Today, I want to read out one of the questions from our members. She has her husband in intensive care. She has had him in and out of intensive care for the last few months. We have been helping her steering what is a difficult environment, of course when someone is in intensive care, you got to know what to look for. You got to know what questions to ask. You have to know your rights. You have to know how to manage doctors and nurses in intensive care because otherwise, they will be managing you without you even knowing that it’s happening, and that’s what we are the experts on.

We are professional intensive care counselors, consultants, and advocates. I have worked in intensive care for over 20 years in three different countries. I’ve been consulting and advocating for families in intensive care for the last 10 years here at intensivecarehotline.com.

So, let’s get into the question from our member who says,

“Hi Patrik and Team,

My husband’s back in ICU. His vital signs are good and sometimes his heart rate is a little bit elevated, and magnesium has been prescribed because all the antibiotics depletes magnesium.

Now, he’s taking Eliquis, metoprolol, gabapentin, B1, B12, D3, Vitamin C, and Zinc. He was being given Lomotil for diarrhea. The doctor has switched the medication to Imodium at my request and he will stop the magnesium oxide.

My husband is still taking the antibiotics and he was assessed by the speech therapist on Friday. Today, he was given a swallow test which he tolerated well and will have one again tomorrow.”

Please keep in mind our member’s husband has a tracheostomy, which is why he’s having swallowing test so that eventually hopefully he can have the tracheostomy removed.

“Also, the physiotherapist tried to work with him today, but he was tired as he had a bout of diarrhea after his nasogastric tube feeds. I will check with the doctor if a culture was taken out of his wounds to target the accurate source of infection, but I know blood and stool tests were taken.”

Our member’s husband also has a Stage 4 pressure sores. “The wound care nurse has dressed the wounds and the doctor states they have to treat the wounds more aggressively. What are your thoughts on the wounds?

Thank you for all your help.”

Here is my response.

“Thank you so much for your question and we really hope you and your family are well.

Thank you for your updates about your husband. We continue to pray and hope for the best for your husband’s safety and recovery.

It’s really good to know that his vital signs are good. The heart rate also fluctuates, and some factors likewise affect the heart rate. The heart rate temporarily accelerates or increases during stress, excitement, exercises, activities, emotions, medications, weather, temperature, foods, but also in hospitals with an infection.

Many patients with an infection, especially in ICU have a high heart rate, and then the heart rate usually returns to its normal range if there’s no underlying disease or illness present in your husband’s body.

Always remember that below 60 beats per minute and above 100 beats per minute heart rates are a warning sign that needs to be monitored and that something might be off. If persistently abnormal heart rate levels are noted, inform, or refer to the doctor immediately for appropriate interventions.”

Also, high heart rate could also be a sign of pain, discomfort, and sleepiness. You got to watch for all of that and given that your husband has those Stage 4 pressure sores, he might simply have a high heart rate because he’s got an infection brewing. That could be one of the first signs of an infection as well as white cell count elevation as well as the temperature.

“Now, how many days has your husband had the diarrhea? Have they taken the stool culture for investigations? It will be good if a stool analysis and stool culture are analyzed to determine the presence of microorganisms and proper treatment will be known and prescribed to your husband.

Some medications, milk feeds, food allergies, parasites, disease conditions, et cetera cause diarrhea, especially with him being on antibiotics. He might have the diarrhea simply from taking antibiotics.

Always find and search for the root cause of the problem for treatment and full recovery. Always observe precautions to avoid the spread and severity of the problem. Hand washing, wearing a mask, use of antimicrobial sanitizers, hand rubs, et cetera is very important for yourself, as well as for the doctors, and for the nurses to not spread the infection.

Also, inform the dietitian and the doctor about your husband’s diarrhea to review his diet and the medications.”

Also, if he’s having diarrhea, he might also get dehydrated quickly. So, they might have to top him up with some extra water.

“Now, let’s look at the speech therapy. Regular sessions with speech therapy, physical therapy and occupational therapy will help your husband’s recovery and prevent further complications. It’s important that he participates in the therapy and it’s a big factor in the progress and stability.”

So, especially with speech therapy, if the cuff of the tracheostomy is down and he can swallow without signs of aspiration. He’s got a good strong cough. He no longer needs any suctioning. Well, he should be able to have the tracheostomy removed. So, keep asking for that until the goal has been achieved because then going home will be so much easier.

“Now, your husband’s wound needs to be cleaned and dressings must be done aseptically by the wound care nurse or by one of the nurses that’s looking after him. The nurse can assess the severity of the wound and refer it to an infectious disease doctor for appropriate treatment.”

They should also take pictures of the wound when they take the dressing to compare to what the wound looked like the day before. Is the wound healing? It’s important that it’s actually documented.

“Furthermore, if the wound isn’t healing, then debridement might be an option and the surgeon might need to be consulted. Always observe precautions and keep the wound dressing dry, clean, and intact at all times. Observe for signs of infection, discharges, foul smell, et cetera.

Ask the doctor if honey can be applied because applying honey to most patients’ wounds, even in children and babies have good outcomes. Ask your husband’s doctor if it is possible and if there are no contraindications with your husband’s present condition.

Also, another suggestion might be platelet rich plasma, which has a high concentration of platelets and growth factors that can help with wound healing. However, it involves taking a blood sample from your husband and centrifuging it in the laboratory to separate the plasma from the red blood cell. Studies seen that the clinical effects of what’s called PRP (Platelet Rich Plasma) show a significant reduction in wound size without side effects and reduced wound recovery time.

Most of ICU patients that we’ve seen use the honey application and do not prefer their blood for wound dressing therapy. It’s also a lot simpler. They need their blood to prevent anemia, et cetera.”

So, we don’t have a lot of experience with PRP, and we would refer back to sort of traditional wound care regimes, if you will. Also, another thing that we’ve seen is Kaltostat and Comfeel dressing and keep it there for seven days a week, and then wash it out with saline every seven days. I have seen wounds healing from that as well.

Look, there are many options to get pressure sores heal. But what is also important, and we discussed this before, pressure sores in ICU are usually a sign of negligence. That means the nurses haven’t done their jobs. They haven’t done their jobs to prevent pressure sores from happening in the first place. So, that is a massive concern because that’s nursing 101, and that’s the nurse’s job to prevent pressure sores.

“Now, I know you want to go home and prior to home discharge, everything must be well planned. Ideally, the tracheostomy must be removed this time. Also, he should have a PEG tube if he still can’t eat orally. So, since you haven’t got a healthcare provider yet, you have to ask the nurse to teach and educate you on how to look after your husband at home, including mobilization, giving him a bed bath or taking him to the shower, how to give him his feeds.”

But the goal should be to get rid of the tracheostomy, get rid of the nasogastric tube. Now, if both can’t be achieved, and he’s going home once again with the tracheostomy and this time, he needs to go home with a PEG tube if he can’t eat orally, you will need Intensive Care at Home. For anyone watching and if you’re wondering what Intensive Care at Home is, go to intensivecareathome.com for more information.

With Intensive Care at Home, we’re sending critical care nurses into the home for long-term ventilated adults and children with tracheostomies. By doing so, we can eliminate long-term stays in intensive care, which is exactly what your husband is dealing with.

If you look at the evidence, if you look at intensivecareathome.com, there’s a section on the website called the Mechanical Home Ventilation Guidelines. Anyone with a ventilator or tracheostomy at home must have 24/7 intensive care nurses with a minimum of two years critical care nursing experience, otherwise it’s not safe. Patients have died not having that level of care. So, this is just that you know what needs to happen next.

You shouldn’t be worried about who’s going to pay for it. An ICU bed costs around $5,000 to $6,000 per bed day. Intensive Care at Home is about half of that cost. With Intensive Care at Home currently, we are operating all around Australia in all major capital cities including all rural and regional areas.

We are NDIS (National Disability Insurance Scheme), TAC (Transport Accident Commission), NIISQ (National Injury Insurance Scheme in Queensland), iCare, DVA (Department of Veteran Affairs) approved service provider in Australia. Also, public hospitals and departments of health have funded our clients as well, including private health insurance. So, go and look up intensivecareathome.com.

But even if you’re in the U.S. or in the U.K., please reach out to Intensive Care at Home as well. If you feel like you want home care for your loved one who’s in ICU long-term, we can point you in the right direction.

Also, even if your husband does go home without a tracheostomy, you will probably need to be very careful about that he’s not going to aspirate, and that he keeps coughing, that he’s doing breathing exercises, that he gets chest physiotherapy, deep breathing, coughing exercises. You don’t want to go home with a tracheostomy again without ICU nurses because otherwise it won’t even take you 24 to 48 hours to bounce back into ICU, which is what happened this time.

If he ends up with a PEG tube, you may not need an ICU nurse, 24 hours a day, if he doesn’t have a tracheostomy, if he can breathe without a tracheostomy. With a PEG tube, it will be easier for you to manage his nutrition, but don’t take him home with a nasogastric tube because once again, you need a registered nurse to manage a nasogastric tube at home. You can’t do that by yourself. The risk of aspiration is too high and then he’ll end up once again back in ICU with a tracheostomy because it looks like he’s halfway there to have the tracheostomy removed. Once the tracheostomy is removed because now, he can swallow, that’s also probably the first step for him to eat and drink again.

So, I hope that really helps to take your next steps here, to get your husband out of ICU, get him back home without a tracheostomy, without a feeding tube. Once again, if he does need a tracheostomy, if he does need a feeding tube, you will need Intensive Care at Home, go, and check out intensivecareathome.com.

So, that is my quick tip for today.

If you have loved one in intensive care and you want to become a part of our membership for families of critically ill patients in intensive care, go to intensivecarehotline.com, click on the membership link and you can get access there or go to intensivecaresupport.org directly.

Also, I offer one-on-one consulting and advocacy for families in intensive care. I talk to doctors and nurses directly. I talk to you and your families directly. I help you understand the landscape that is intensive care. I help educate you about how to manage doctors and nurses, what questions to ask, of course, what to look for. But I also talk to doctors and nurses directly because I ask all the questions that you haven’t even considered asking. I could break it down into the nitty-gritty.

I make sure there is complete transparency when you have a loved one in intensive care because ICU teams are often not transparent. They only tell you half of the story and they’re telling you things only that they want to share with you, and they keep a lot of things hidden from you and I can bring those things to the forefront because I know what to look for and I know what questions to ask. Now, this will help you to make informed decisions, have peace of mind, control, power, and influence.

Now, with my 1:1 consulting, I offer that over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. Now, I also represent you in family meetings with intensive care teams so that you have clinical representation there. But more importantly, I sit down with you, and we look into whether you should even go into a family meeting, meeting with intensive care teams because we have seen so many situations over the years where you’re doing yourself a disfavor by going into a family meeting with intensive care teams and we assess all of that.

I’ve been in hundreds of family meetings in intensive care, either when I worked in intensive care or when it was part of my consulting and advocacy services. I know where to go, and if you do go, go on your terms or not to go. You have to have a strategy, very important.

Now, we also offer medical record reviews in real time so that you can get a second opinion in real time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply 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 email to [email protected].

Again, 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, comment below what you want to see next or what questions you have, share the video with your friends and families.

Thanks for watching.

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

Take care for now.