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

Today, I have an email from Lexus who says,

“Hi Patrik,

My sister is in neuro intensive care, and I would like some help understanding the situation. My sister, Tween, is 21 years old and suffered a severe asthma attack that led to cardiopulmonary arrest 27 days ago. She was just arriving at the emergency room when she went into cardiopulmonary arrest, and it took 4 minutes for the team to successfully restart her heart.

She was immediately paralyzed and sedated in order to intubate her. She was flown to a larger hospital about 2 hours after the incident and has been in neuro critical intensive care since then. She had the cooling therapy done for 24 hours and her original CT or MRI scan about a week after the admission looked very good. She has myoclonus periodically and has epileptiform discharges on her EEG – electroencephalograph.

So, the team is keeping her on Dilaudid, Dilaudid is also known as hydromorphone, until they figure out how to stop the discharges. Her pupils react appropriately to light. She has cried many times. She’s grimacing and using her full face to sob. She was also smiling when my family was talking to her a few times. She withdrew from pain twice, but all of these diagnostic procedures are not usable when she’s sedated with the Dilaudid.

I want to know if the myoclonus can be stopped in order to give her a chance to wake up and evaluate her quality of life. Have you seen myoclonus go away, lessen, or be successfully treated? All other prognostics look as good as possible except the myoclonus. The doctors and nurses are hopeful but I’m struggling because everything I research says myoclonus is bad and usually not treatable effectively. She is so young and was so healthy.

From Lexus”

Lexus, thank you so much for sharing your sister’s situation. Well, the good news is, they managed to restart her heart after about 4 minutes. That is really positive because if she had had effective CPR (cardiopulmonary resuscitation) during that period, her brain would not be damaged, which is pretty much what the CT and MRI scan are showing as well.

However, whatever led her to have the myoclonus, they should be epileptic discharges. She should be treated with anti-seizure medications such as Keppra or phenytoin, also known as Dilantin, to get those seizures under control. Sometimes some phenobarbital might help as well.

I am not sure why she’s still on the Dilaudid, which is actually an opiate. I do believe if anything, like I said, anti-seizure medications might help. Also, what might help is benzodiazepine such as Versed/midazolam, Diazepam, Lorazepam, and so forth. So that might help as well.

So, what I’m missing here is a list of the medications that she is on, but I do believe with the signs that she’s giving, pupils are reacting, she has cried, she’s grimacing, she was also smiling, she’s withdrawing from pain, that is a really good sign.

Now, waking up after such a difficult and challenging critical illness can take time that can sometimes take days or weeks. So, it sounds to me like it’s still very early days. I know you and your family would be very impatient here and I can understand that. You want her to wake up as quickly as possible, but she might just need the time to rest and heal while they are also weaning her off the ventilator.

You haven’t mentioned anything about weaning her off the ventilator, which I think is really important that they do wean her off the ventilator as quickly as possible as well. Maybe the ventilator is also irritating. The breathing tube in the back of her throat can also be very irritating at times. Maybe if she’s waking up and can obey commands, maybe once she’s off the ventilator and the breathing tube, maybe the myoclonus will stop. In any case, you should be very hopeful here. It’s hopefully just a challenge they need to overcome.

The other question here is, did you have any neurological condition before this event? Or is there something else happening neurologically where they need more neurology input? It’s difficult to say.

But in any case, she’s 21, her EEG, her CT scan of the brain and MRI scan of the brain look good overall. She needs to get off the ventilator, get on to rehabilitation, and they need to optimize anti-seizure medications here and wean her off the ventilator. That is really important. Sit her up, get her up as quickly as possible, so that she can also avoid the tracheostomy. Those are the next steps here.

Now, I have worked in critical care for nearly 25 years in three different countries where I also worked as a nurse manager for over 5 years. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I have seen many situations like this before in ICU, as well as here with my consulting and advocacy.

So, give it time, Lexus, and be patient and things will most likely turn out well in time, not in the short term. Your sister has to overcome some challenges that we talked about, but it sounds like she’s on a good path overall. The neurologist should look at the medication she’s having for the myoclonic episodes.

Now, with our consulting and advocacy here at intensivecarehotline.com, we have saved many lives, and you can verify that on our testimonial section or if you go to our podcast section at intensivecarehotline.com. You can also see some client interviews there.

That’s also one of the reasons why we have created a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link or if you go to intensivecaresupport.org directly. In the membership, 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.

In the membership, you also have access to 21 e-books and 21 videos that I have personally written and recorded for you so that you can make informed decisions, you have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.

I also offer one-on-one consulting and advocacy over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I talk to you and the doctors directly. I ask all the questions from the doctors and nurses that you haven’t even considered asking but must be asked when you have a loved one, critically ill, in intensive care. I really handhold you through this process. It’s a once in a lifetime situation that you can’t afford to get wrong. I also represent you in family meetings with intensive care teams.

We also do 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 simply send us an email to [email protected] with your questions.

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Thank you so much for watching.

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

Take care for now.