Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

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

So, today I have an email from Peter who says,

“Hi Patrik,

My brother, who’s 73, has been on dialysis for over a year, twice in a week now. He had a heart attack 12 days ago. The ICU team implanted two stents in his artery. During the procedure, he had a cardiac arrest for about eight minutes before they were able to resuscitate him. He hasn’t been able to wake up two weeks from now. He sometimes opens his eyes and squeezes his hands if we ask him to. The neurologist said he will need a longer time to recover, but his brain is good. What should we be expecting?” Well, thank you, Peter, for sharing your brother’s situation in ICU with me.

By the time of me recording this is April 2024, this is a question that came in October last year, that’s how much of a backlog we’re having with questions here. We’re getting questions every day, so if you wanted quicker responses, you just need to go to intensivecarehotline.com and you need to call us on one of the numbers on the top of our website or you email us to support@intensivecarehotline.com. The quickest way, obviously, is to book a free 15-minute consultation with me over the phone, Skype, Zoom, and WhatsApp. But obviously, I do also have paid consulting and advocacy options, which is the quickest way to get your questions answered.

So, let’s come to Peter’s question. So, what you should be expecting? It’s good that the brain hasn’t taken any damage. The CPR and the resuscitation after the cardiac arrest must have been successful, but I think your biggest challenge might be now that your brother’s heart might be very weak if he had a heart attack.

So, one of the things that I would be asking for is, what is his ejection fraction? What I mean by that is the contractility, or the pump function of the heart which they can easily ascertain by doing an ultrasound of the heart. Also, is he on inotropes or vasopressors, or any other cardiac medication after the heart attack? Because he might not be waking up quickly because his heart is weak. If the brain is intact, he might not wake up because his heart is weak. He might also not be able to wake up because of kidney failure. I would also ask if he’s potentially in liver failure now, which can also happen at times.

So, the other question is, has he been sedated and in an induced coma for a period of time? You have not mentioned here anything that he’s intubated or ventilated You have not mentioned that but if for example, he is ventilated still with a breathing tube in particular, he might still be on sedation and opiates, which would delay waking up. If, on the other hand, he’s not ventilated, then also, it’s easier for your brother to get mobilized, to get out of bed if his heart is strong enough. He might not be able to get mobilized because his heart is so weak, and he might still be on inotropes or vasopressors.

Once again, 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 is what you are dealing with here to a degree, you don’t know what questions to ask.

So, him not waking up could, again, if the brain is intact, if they’ve done the CT scan, the MRI scan, the EEG (Electroencephalography), he could either be still too weak, could still be on a ventilator with a breathing tube. If he’s on a ventilator with a breathing tube, that means he might still be sedated and on opiates and that will delay him waking up.

If he’s on a ventilator with a tracheostomy which you haven’t mentioned, so I presume that is not the case, but I obviously can’t be certain, then he should be off all opiates and sedatives. Once again, you should be able to wake up, but mobilization and physical therapy and stimulation, gentle of course. If he’s so weak, gentle. You can’t throw out the baby with the bath water, but you should be moving towards gentle rehabilitation and gentle mobilization, if possible, at all. I would also seek some input from the cardiologist and find out what is the heart doing? Is the heart very weak? What is his ejection fraction? That might be one of the biggest questions here, so I hope that helps Peter.

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 all over the world since 2013 here at intensivecarehotline.com. I can say without the slightest hint of exaggeration that we have saved many lives as part of our consulting and advocacy.

Because we’re getting so many questions for families in intensive care, that’s why we created a membership for families of critically ill patients in intensive care and you can become a member and you can get access to our membership 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 exclusive access to 21 eBooks and 21 videos that I have exclusively written and recorded for families in intensive care that are exclusively available for our members only. With those eBooks and videos, it gives you a very good overview of how to make informed decisions, get peace of mind, control, power, and influence so that your loved one gets best care and treatment. It addresses all the issues that need to be addressed for families in intensive care and how to get results.

I also offer one-on-one consulting and advocacy over the phone, Skype, Zoom, whichever medium works best for you. I talk to you and your families directly. I talk to doctors and nurses directly, and when I talk to doctors and nurses directly, I ask all the questions you haven’t even considered asking but must be asked when you have a loved one in intensive care so that once again you make informed decisions, you have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.

I also represent you in family meetings with intensive cares if you want me to.

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 send an email to support@intensivecarehotline.com.

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

I also do a weekly YouTube live where I answer your questions live on the show and you get notification when the show is on if you are subscribing to my YouTube channel.

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.

Related Articles:

Quick Tip for Families in Intensive Care: Unanswered Questions and Vague Answers from the ICU Team! Quick Tip for Families in Intensive Care: ICU Keeps Telling Me that they Can’t Take My Loved One Off the Ventilator Due to Agitation! Help! Quick Tip for Families in ICU: Is Nitric Oxide a Treatment Option for My Dad with COVID ARDS in Intensive Care? Quick Tip for Families in Intensive Care: How Should I Deal with Rotating ICU Doctors and Them Aggressively Changing Treatment Plans? Quick Tip for Families in Intensive Care: Is BIPAP (Bilevel Positive Airway Pressure) Considered Life Support?