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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 Lisa who says,

“Hi Patrik,

I’ve watched several of your videos and they’re very helpful. My brother is in ICU with complications due to diabetes and dialysis. While in ICU, he had a stroke, then a cardiac arrest and then on the ventilator for at least five days. The doctor did the test for the brain with no improvement, but my brother has blinked his eyes, moved his head and his legs. They also moved to close his mouth when the nurses were suctioning him. What should we tell doctors to do? One doctor doesn’t see him improving and another has more hope.

Thank you.”

Well, thank you so much, Lisa, for sharing your brother’s situation. Those situations are always very tricky, and it is very difficult to look into the future in those situations. But one thing that you should not lose is hope. I’m glad to hear that some ICU doctors here have hope and others maybe not so much, but the reality is this, you got to look at it very rationally here.

If you don’t continue treatment and you give them permission to potentially withdraw life support, whether that’s dialysis or ventilation, you know the outcome i.e. your brother is going to die, very simple. If you do continue, well, you give him a chance, there’s plenty of time to talk about what you can do in case he’s not improving.

So, there’s actually no rush to make a decision besides continuing, it’s only been five days which is not a long time in intensive care and that’s potentially not what they want to make you believe in. They may want to make you believe that it is actually a long time, but five days is not a long time, not in a situation like your brother is in right now.

So, what should be done? So, he’s obviously on a ventilator after cardiac arrest. He’s possibly in an induced coma with sedatives and opiates going in, that is most likely the situation. With the cardiac arrest, he may also be on inotropes or vasopressors. He may have had an angiogram or an angioplasty to screen the heart to make sure there are no blockages that probably might have been a blockage to lead to cardiac arrest.

Next, with the cardiac arrest, did he have any “downtime?” I.e. how long did the cardiac arrest take? Is there reason to believe that there might have been some brain damage because of the cardiac arrest? How long was there no oxygen consumption to the brain potentially because of the cardiac arrest? How effective was CPR (cardiopulmonary resuscitation)? So then, have they done a CT scan of the brain? Have they done an MRI scan of the brain? Have they done an EEG/electroencephalograph of the brain? Why is he not waking up? Is he too sedated? Does he have too many sedatives and too many opiates on board? Or is he not waking up because simply the brain is damaged? Or is he not waking up because he’s simply so ill that he hasn’t woken up yet?

So, there are a number of specialists and specialist reviews that need to happen here. One would be from the cardiologist and the other one would be from a neurologist. So that would need to happen here too. What are they saying? Is the cardiac arrest likely to happen again? What is the neurologist’s outlook on the prognosis? The other thing you need to think about here is, is this potentially a real or a perceived end of life situation?

Well, what’s the difference? A real end of life situation is that no treatment, no surgery, no equipment, no medications can save your brother’s life, that is a real end of life situation. A perceived end of life situation, on the other hand, is just that it’s a perception. I argue that in your brother’s situation, he’s in a perceived and not in a real end of life situation. Bear in mind, approximately 90% of intensive care patients survive. So why would your brother be 1 out of 10 not surviving? You got to ask those questions. You got to ask the hard questions.

Now, let’s just say he survives and let’s just say his quality of life is not as good as you were hoping for, were wishing for, that is certainly a risk that you are taking by continuing treatment. But once again, if you stop treatment, you know the outcome. I would strongly recommend you make a decision today that you don’t regret in 12 months’ time, in 24 months’ time, because if you stop today, you might regret that in 12 months’ time, in 24 months’ time. You will have second thoughts, and you will say, “Oh, but if I had only let my brother live and give him a chance.” You don’t want to be in that position. So always make decisions that you don’t regret in 12 months’ time and do not let anyone dissuade you from what you think is the right thing to do here for your brother. You know him best. What would he decide if it was up to him? These are questions you need to ask, Lisa.

But what is also important in a situation like that, what are blood results? What are ventilator settings? What did the angiogram show? Did he have a cardiac ultrasound? Is he on inotropes/ vasopressors for the weakness of the heart and the dialysis? Because that would also put strain on his heart, and fluids are being removed. What medications is he on specifically? Sedatives, opiates, inotropes, vasopressors would be very important to know because then we could even dig deeper.

Once again, 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. That’s exactly what you’re up against here, Lisa, you don’t know what you don’t know.

That’s also why it’s important to get access to the medical records as quickly as possible so we can look at the medical records and let you know what’s exactly going on. Remove all the medical jargon and explain it in layman’s terms. That’s what we do, and then we can guide you even further.  I’m also happy to talk to doctors and nurses directly, which means I can also put pressure on them, and I’ll make sure I ask all the questions that you haven’t even considered asking.

So, with all of that said, I have worked in critical care nursing for nearly 25 years in three different countries where I worked as a nurse manager for over 5 years and where I’ve been consulting and advocating for families in intensive care since 2013. I can confidently say that we have saved many lives with our consulting and advocacy here at intensivecarehotline.com. You can verify that on our testimonial section at intensivecarehotline.com. You can also verify it on our podcast section where we’ve done client interviews. All of that you get at intensivecarehotline.com. I’ve looked after thousands of critically ill patients and their families in intensive care and also here at the Intensive Care Hotline.

That’s why we created a membership for families of critically ill patients in intensive care and 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 exclusive access to 21 eBooks and 21 videos that I have personally written and recorded that will help you to make informed decisions, have peace of mind, control, power, and influence, making sure you can influence decision making fast so that your loved one gets best care and treatment.

I also do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you cannot afford to get wrong. I also talk to doctors and nurses directly, holding them to account and I ask all the questions that you have not considered asking even.

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 do medical record reviews after intensive care if you have unanswered questions, if you need closure or if you are 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.

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, what questions and insights you have, and share the video with your friends and families.

I also do a weekly YouTube live where I answer your questions live on the show and you will get a notification for the YouTube live if you are a subscriber to my YouTube channel or if you are a subscriber to our email newsletter at intensivecarehotline.com.

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.

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