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

Today’s tip is about, “Five ways that you need to position yourself if your loved one is in intensive care, in an induced coma, and is not waking up!”

So you might be wondering, why should I position myself if it’s my loved one that is not waking up? Well, it’s critical that you position yourself as an advocate for your critically ill loved one. And that you know what you’re talking about when you have a loved one in intensive care, because otherwise, the intensive care team will play yoyo with you. And because you don’t know what you’re up against, you don’t know the right questions to ask.

The biggest challenge for families in intensive care is 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.

So, let’s dive right into it. Five ways you need to position yourself when your loved one is not waking up after an induced coma in intensive care.

Number one, it can take a lot of time to wake up after an induced coma, simply because of the nature of the critical illness, of the amount of sedatives, and the opiates the loved one had in intensive care. It can simply take a long time. There are no hard and fast rules for someone to wake up after an induced coma. It’s not as simple as, you switch off sedation and you switch off opiates now. And someone is awake within three hours, three days, three weeks, sometimes three months, no hard and fast rules.

Number two, when patients, after an induced coma wake up, as I said, it can take a long time. Sometimes patients with a head or brain injury, traumatic brain injury, and anoxic brain injury, they can take a long time to wake up after an induced coma. Sometimes, even for someone without a head or brain injury can take equally as long, even though they don’t have a head or brain injury. So don’t get discouraged, if it takes a long time. It just takes a long time. As long as other things are happening, such as physical therapy, I’ll come to that as a separate item, your loved one should be on their way to probably a slow recovery, but still a recovery.

Next number three, it depends on what sedatives or opiates your loved one has been on. For example, have they been on benzodiazepines, such as midazolam or Versed? They are long-acting sedatives. Whereas, if you take sedatives such as propofol, it is short-acting. That means if you stop propofol, someone should wake up. But even that is not guaranteed.

If someone is on midazolam or Versed for long periods of time, they may not wake up straight away because it’s a long-acting sedative. Also, benzodiazepine, such as midazolam or Versed, which is commonly used for an induced coma in intensive care, or for sedation, is addictive in nature. So that means, if they’ve been on maximum doses of midazolam or Versed, they’re coming out of the induced coma, they might now be addicted to the substance and they may need A) to go through withdrawal and B) they need to be slowly weaned off the sedative.

So that in and of itself can cause a delay in waking up. The same applies to fentanyl or morphine, which are opiates, and pain relief. They can be addictive in nature too, and they knock people out too. So, therefore, coming off the opiates such as fentanyl or morphine can take equally as long, because it makes people drowsy as well.

Another issue here is that, depending on your loved one’s liver function, and kidney function, that may be an inhibitor for waking up after an induced coma, because medications are not getting metabolized as fast as they should do with a healthy liver or with a healthy kidney.

Next, if your loved one is not waking up, make sure they’re having a CT (computed tomography) of the brain. Why should they have a CT of the brain? It is to rule out a neurological condition, such as a stroke, seizures, or any of that. Very important to rule out that there’s nothing wrong with the brain, that the brain is healthy and intact. Because that means if the brain doesn’t show there’s a stroke or any other neurological condition, that there’s simply just a delay in waking up because of the critical condition, and all of the medications that have been given.

Last but not least, I mentioned briefly physical therapy. So if your loved one is not waking up, it’s critically important that they still get physical therapy and physiotherapy to stop the deconditioning. Deconditioning happens very fast in intensive care. It happens on day one. The longer you are in an induced coma, the longer you’re not waking up. There’s massive deconditioning muscle wastage and the recovery time takes longer. So, therefore, if your loved one is not waking up, make sure there’s physical therapy and physiotherapy happening.

And as part of that, if they’re not waking up also, find out whether tracheostomy might be the next step, because if they’re not waking up, they will still be on a ventilator.

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 the website, or send us an email to [email protected].

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

If you need a medical record review for your loved one while they’re in an intensive care, click on the link below, or contact us for a medical record review.

If you like this video, give it a thumbs up, subscribe to my YouTube channel for updates for families in intensive care, click the notification bell, and comment below what you want to see next or what questions and insights you have from this video.

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