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Quick Tip for Families in Intensive Care: How Can My Ventilated Brother in ICU with Cardiac Arrest, Stents & Kidney Failure be Saved? 

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

So today, I want to, again, read out a question from one of our members. We have a membership for families of critically ill patients in intensive care at intensivecarehotline.com. You just go to our membership section there and you can become a member as well if you have a loved one in intensive care so that we can answer your questions and fast-track the results that you are getting when you have a loved one in intensive care so that you can make informed decisions, have peace of mind, control, power, and influence whilst your loved one is in intensive care.

So, one of our members has shared medical records with us and we’re obviously looking at them and we are interpreting them for our members because 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 this member here is struggling with as well.

His brother is in his 70s, and has been in ICU for a few weeks after cardiac arrest. The first thing when he reached out to us was we asked him to reverse the DNR (Do Not Resuscitate) for his brother because the hospital suggested a DNR for his brother and because they were telling him, “Well, if he was to have a cardiac arrest, they would crack his ribs to revive him.” Whilst that might be the case, the question is do you want to have your ribs cracked and potentially live or do you want people not even trying?

Anyway, let’s get to our email to the member, “Thank you so much for sending through the images, the lab results, and the vital signs you sent us.

Here’s a summary and some comments. Your brother’s vital signs showed a high heart rate, which is known as tachycardia, normal respiratory rate (16), and low blood pressure (103/53) with a temperature of 36.9 °C. For any episodes of increased heart rate with low blood pressure, it needs to be addressed.

As for his blood work a couple of days ago at 4:02 a.m., his sodium level, magnesium, and phosphate levels are within normal range. His calcium level is low and needs to further await the next results. I haven’t seen a result for his potassium level. It is very important to see his potassium levels because we need to ensure that his electrolytes, particularly sodium potassium, calcium, magnesium, and phosphate are within normal limits. A drop especially in his potassium, but also a significant increase can cause heart rhythm irregularities such as atrial fibrillation, which is not good and could cause cardiac arrest.

His kidney markers: BUN (blood urea nitrogen) is high at 47.1 and creatinine (4.6) is also elevated. His liver function test results (alkaline phosphatase, ALT (alanine aminotransferase), AST (aspartate aminotransferase) are also increased. All these need to be addressed and taken into consideration.

Now, when I first spoke to the member on the phone, he also said that his brother has chronic kidney failure and that they do no longer want to dialyze him because he can no longer tolerate it, but I’ll come to that a bit later.

Carrying on, “Your brother’s albumin is low. His lactate is high, which can also indicate infection, septic shock, or sepsis and also can indicate multiple organ failure. His blood glucose level is getting as high as 308. They need to control his blood sugar urgently by giving him the right dose of insulin.” I know that you mentioned on our phone call that your brother is diabetic.

“The increased white cell count at 13.47 suggests an infection and his hemoglobin (7.3) is low where he may need a transfusion, especially considering his dialysis sessions that he had.” Usually, ICUs give a unit of blood if hemoglobin drops below 7.0.

“His platelet count is also high. His coagulation profile is prothrombin time or PT is increased at 12.0 while INR is normal at 1.07. The need is there to further monitor for further results. He is on the ventilator with FiO2 to a 30%, set rate of 12, PIP which is peak inspiratory pressure is at 38 which is high, PEEP of eight and pressure support of 30 which is also very high.

For his arterial blood gas taken a couple of days ago at 4:04 a.m., his pH is increased while his PCO2 or carbon dioxide is low, and his bicarbonate is normal. He is with partial pressure of oxygen of 124 which is higher than the normal range which indicates more than adequate oxygenation with FiO2, also known as fraction of inspired oxygen, at 30% tidal volume of around 500 mls.”

So, then we’ve broken down all the blood results in the email and also advised what questions to ask. I’ll come to that in a second.

Now, just quickly highlighting the fact that peak inspiratory pressure is at 38 which is really high, which puts our member’s brother at risk of sustaining a pneumothorax.  Pneumothorax basically means it could cause a punch in the lung, or a hole in the lung which would require a chest drain which can be life-threatening.

So, it is so important that families in intensive care do their own research from day one so that you’re not clutching at straws when you come to us. You need to start doing your research from day one. Period.

“Now, also if you do have, with your permission, you can share with us the online chart, so you don’t need to email us all the documentation. It’s much easier if you give us the username and the password. That way we can see the needed clinical information like the doctor’s progress notes, consultation notes from specialists, nurse’s notes, the complete list of medications, the most recent pathology, and other important notes. We can also track his progress and be able to provide you with our daily review and send you our feedback for anything to address further.

Otherwise, we need to gather these important clinical information about your brother. All these can possibly be available in his online medical chart. What is his complete diagnosis? What are his recent vital signs, heart rate, blood pressure, oxygen saturation, respiratory rate temperature over a period of days?”

It’s really important that, again, when someone is in intensive care, it is a very complex puzzle that needs to be pieced together by experts like us looking at all the medical records and giving you the complete picture and making sure there’s no stone that’s left unturned.

Intensive care teams often not even tell you half of the story.  They give you very selective information to create often a very negative narrative, which is the case here as well with our member because I’ve spoken to him on the phone. It’s a very negative narrative from the intensive care team with a goal to move his brother to palliative care as quickly as possible, i.e., towards end-of-life care, but that’s not what his brother wants. That’s not what he wants. So, how do you can counteract the negativity? Quite simply by getting a second opinion and by getting an advocate which is what we do here at intensivecarehotline.com.

Now, let’s carry on with the email. We advise our member what questions he should be asking, “What’s your brother’s latest Glasgow Coma Scale? Glasgow Coma Scale is a tool to know about the consciousness level of your loved one. This is important to know to give him the right amount of sedation and opiates. What sedatives and opiates is he on? Is he on long-term acting sedation, short-term acting sedation? What ventilator settings is on? Any diagnostic CT (Computed Tomography) scans, MRI (Magnetic Resonance Imaging) scans, echocardiograms or ultrasounds.” The list is long, and we can’t stress that it needs to be in as much detail as possible.

When you become a member, really, our first email or the first phone call to me is really the most important one because we can really turn your situation around pretty quickly because you realize very quickly, that you don’t know what you don’t know. By having an advocate on your side, you will find out that we can change things very quickly for you so that you can make informed decisions, have peace of mind, control, power, and influence and you can create your own narrative. You’re no longer beholden to intensive care teams.

So, that’s my quick tip for today.

If you want to become a member of our membership for families of critically patients in intensive care, go to intensivecarehotline.com and click on our membership section, you can get access there or you go to intensivecaresupport.org directly. Again, there, you have 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.

Now, I also offer one-on-one consulting advocacy over the phone, via Skype, via Zoom, via WhatsApp, whichever medium works best for you. I talk to doctors and nurses directly. I talk to you and your family members, educating you about intensive care, what to pay attention to what questions to ask, how to position yourself, how to create your own narrative, how to make sure that all the questions that you haven’t considered asking are asked and I can ask them on your behalf or I can set you up with questions that must be asked, but you have no idea you need to ask because it is such a highly specialized area. Now, that’s the only way you can get peace of mind, control, power, and influence and you can make informed decisions.

Now, I also represent you in family meetings with intensive care teams. I can be available for family meetings with intensive care teams. If I was you, I would not go into a meeting with any intensive care team without (A) having a written agenda and (B) having an advocate there that speaks the clinical intensive care language. You need to know what’s going on in those meetings. You need to be able to manage the dynamics in those meetings. Again, that’s where I can help you with very, very fast.

We also offer medical record reviews in real time so that you can get a second opinion in real time. Please contact us for that as well. 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.

Now, contact us for any of these at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected].

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 and insights you have from this video, 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.