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Quick Tip for Families in Intensive Care: Is my dad in ICU Needing Surgery or Hyperbaric Oxygen Therapy for his Ischemic Finger?

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

Today’s tip is about the question answered for one of our members. We have a membership for families of critically ill patients in intensive care and you can get access to our membership when you go to intensivecarehotline.com and click on the membership button or by going to intensivecaresupport.org directly.

So, let’s read out the question from one of our members who has their dad in ICU for many weeks now. And let’s read out our member’s question.

Hi Patrik and Team,

My dad has acute traumatic peripheral ischemia. Can you please tell me what we can do for dad? Apparently, his left middle finger has been discolored for days and all they did was wrap it in a bandage. It is now very bad. They finally told us about it today after they did a Doppler and the second ultrasound.

Vascular surgery talked to us and said something horrifying. Please, can you tell me what we can do? The surgeon said there is nothing they can do besides nitro paste to try to promote blood flow, but it is too late.

The ultrasound doctor said there is no blood flow to that finger and could have been caused by a million different things like the frequent arterial blood gas test, edema, sepsis, et cetera. My dad has been through enough, please. How can we help his finger?

I am researching like crazy because timing is of the essence. We see hyperbaric oxygen as an option but not much else. Shouldn’t the hand surgeon also be involved. What other specialties should we request? What other treatments can they do to help my dad’s finger?

So here is our response.

So, with your dad’s acute traumatic peripheral ischemia, in your dad’s left middle finger, it’s a serious condition that requires immediate medical attention. The treatment approach will depend on the severity of the ischemia and the underlying cause. There are some interventions on how it can be managed.

Doppler ultrasound helps assess blood flow and pinpoint any blockages in the finger’s blood vessels which has already been done for your dad. They can also do angiography to visualize his finger’s blood vessels more clearly. Blood tests are also essential for assessing clotting factors and for treating underlying conditions.

The doctors may prescribe antiplatelet drugs like aspirin or vasodilators like nitroglycerin/topical glyceryl trinitrate for adjunctive therapy to enhance blood flow which your dad is receiving currently. Intravenous iloprost can also be used as a treatment option for finger ischemia because it is a vasodilator and antiplatelet agent that helps improve blood flow and prevent blood clot formation. This needs to be carefully considered as this poses him for high risk of bleeding, especially if he’s already on aspirin or any other blood thinners. Blood pressure also needs to be monitored while on this medication as this can cause low blood pressure. Pain management medications can also be administered as needed.

And yes, hyperbaric oxygen therapy (HBOT) may be considered. This involves breathing pure oxygen in a pressurized chamber and can help improve oxygen delivery to his damaged tissues.

The issue with hyperbaric oxygen therapy is that, not many hospitals have it available, let alone for ICU patients who are ventilated or have a tracheostomy. It’s definitely doable. I’ve worked in an ICU where hyperbaric oxygen therapy is an option including for ICU patients. But again, it is a unique skill that not many ICUs have because what happens especially if someone is ventilated with the tracheostomy. Someone needs to go with the patient in the chamber. And doctors, nurses need to do extra courses, they need to go on diving courses to get adjusted to the pressure in the chamber. So, just for some information.

Now, you’ve asked for surgical interventions and it may be necessary depending on the severity of the extent of the ischemia. This can include thrombectomy (removal of blood clots), bypass surgery, in cases of severe vascular blockage to reroute blood flow around the blocked area, vascular repair, angioplasty, and stenting – a minimally invasive procedure that involves opening narrowed or blocked blood vessels and placing a stent to maintain blood flow. However, in severe cases where tissue damage is extensive and irreversible, amputation of the affected finger may be needed and may be considered to prevent further complications.

Aside from the vascular surgeon, a hand surgeon is crucial for assessing your dad’s finger condition and determine the extent of tissue damage and advise on the most appropriate treatment approach. They may also perform surgical procedures if necessary. Plastic surgeon may also come into play when extensive tissue repair and reconstruction are necessary. Interventional radiologists can also help with potential finger angioplasty and stenting. Specialists should collaborate immediately to ensure the best possible outcome for your dad’s case.

Additionally, it is important that the doctors and nurses are doing a thorough assessment and evaluation of your dad, every day and as necessary, and to intervene on time for any adverse conditions identified. Such incidents could have been avoided with timely intervention.

And if you could also share with us the official result of the Doppler ultrasound of his left hand and wrist and the middle finger that would be helpful and also send us an image of his hand.

So clearly you can see that when your loved one is in intensive care, complications can occur pretty quickly. And that’s why I sort of saying that you can’t do enough research and you need to do research from day one. If you’re not doing research from day one, you’re not prepared for any complications that may arise. And unfortunately, complications do arise when someone is in intensive care. It’s complicated enough if people are on ventilators have a tracheostomy, are long-term ventilated and then complications like that can just spoil everything. But this is also, if you watch my video from yesterday, you will also see that this gentleman went to LTAC (long-term acute care) right before he went back into ICU, and we strictly advise against LTAC.

I’ve made numerous videos about LTAC; why you should avoid it, how to avoid it, because this is what happens when patients go into LTAC; they go from bad to worse. This man should have never left ICU and gone to LTAC in the first place. Now he’s back in ICU. But complications are a result from the LTAC stay where he went into septic shock. That’s on my previous video.

So, if you are a member of our membership for families of critically ill patients in intensive care at intensivecaresupport.org, you have access to me and my team 24 hours a day in the membership area and via email and we answer your questions just like we answer this question today. And you get access to our membership at intensivecarehotline.com if you click on the membership button or you can go directly to intensivecaresupport.org.

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 you and your families directly. I talk to doctors and nurses in intensive care directly. And I asked all the questions that you haven’t even considered asking, but you must ask. I have worked in intensive care for over 20 years in three different countries, and I have been a nurse unit manager for over 5 years, and I have been consulting and advocating for families in intensive care all over the world for over 10 years now. And you can look up our testimonials, our client interviews that we’ve done over the years, with the testimonials there. Now, very important for you that you are in a position to make informed decisions, get peace of mind, control, power and influence and I can help you with that very, very fast.

I also represent you in family meetings with intensive care teams. And again, we have turned many situations around for families in intensive care, including saving lives with our advocacy. It is no exaggeration. Again, we’re asking all the questions that you haven’t even considered asking but must be asked when you have a loved one in intensive care, so that you can make informed decisions, have peace of mind, control, power and influence. I would also highly recommend that you don’t go into any family meetings with intensive care teams unless you (a) have a written agenda, and (b) you have an advocate by your side like me that can represent you strongly.

Now, we also offer medical record reviews  in real time so that you can get a second opinion in real time. Again, reach out to us at intensivecarehotline.com. We also offer medical record review after intensive care, if you have unanswered questions, need closure, or if you are simply suspecting medical negligence, and all of that, you get 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. Share the video with your friends and families and click the notification bell.

Thanks for watching.

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

Take care for now.