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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 Christian who says,

“Hi Patrik,

My dad was resuscitated after a cardiac arrest in ICU because he had an upper gastrointestinal (GI) bleed, and now he is two days out of sedation and his eyes are open, but he is not moving. When is he going to wake up?”

Christian, thank you so much for your email and for sharing your dad’s situation.

So, let’s look at this. He had a GI bleed, which means he had bleeding in his gastrointestinal tract. It could have been a stomach ulcer or an upper bowel ulcer leading to a GI bleed, and your dad would have probably had multiple blood transfusions. He probably would have ended up on a Pantoprazole infusion. Not sure what led to the GI bleed, of course, but obviously he was very sick to begin with to go into ICU, then he ended up with a cardiac arrest.

Now, what you haven’t shared, if he had a cardiac arrest in ICU, that’s probably the best place to have a cardiac arrest because you’ve got a highly skilled critical care team around your dad who should be able to resuscitate him very, very quickly and also much more effectively, as opposed to someone having a cardiac arrest out in the community. So, that should stand in your dad’s favor. In terms of, he should have had a successful and an effective resuscitation, which means his brain hopefully and other organs would have had enough organ perfusion. Also, they might have started some cooling therapy straight away. Again, he would have been in the right environment to do that, and that might have protected his brain and his other organs as well.

Now, the first question here is if he’s out of sedation for two days, here is the bigger picture, Christian. So, some patients in ICU didn’t have a cardiac arrest, and the risk for your dad is that he might have a brain injury, but I’ll come to that in a minute. But bear in mind sometimes you have patients in ICU, they didn’t have a cardiac arrest, they don’t have a brain injury, they come out of the induced coma, they’re not waking up and it just takes time for them to wake up. They’re critically ill, and no one with a critical illness will just wake up like you’re switching on a light with a switch, it’s more like switching on a light with a dimmer.

Now, in your dad’s case, the risk is there that he might have sustained a hypoxic or anoxic brain injury. So, the next step for the ICU team is to a do a CT scan of the brain, potentially do an MRI scan of the brain, potentially do an electroencephalograph, and get a neurology consult, that’s one thing that needs to happen most likely.

Another thing that needs to be assessed is, is your dad potentially in kidney failure or liver failure because if that is the case, it might just simply be that his kidneys are not working, that means sedatives or opiates take longer to get out of the body. Same with if he’s in liver failure, it might just simply mean that sedatives and opiates are not getting metabolized fast enough, that means sedatives and opiates are lingering around in the body tissue delaying waking up.  So, those are things that you need to consider in a situation like that. Is he simply not waking up? Because again, he’s critically ill, give him some time. But in order to determine where this is going, probably a CT scan of the brain, MRI scan of the brain, and EEG should be done.

Also, they might give your dad or might have given your dad some anti-seizure medication to protect him from not having any seizures, maybe he’s had seizures already. If he does have seizures, that might also be an indication that he might have sustained some brain a brain injury. So, if he’s on medication such as Phenytoin, Keppra, sodium valproate, but also Midazolam, which is a sedative as well as anti-seizure medication, there could be other delays of him waking up. So, I hope that explains where your dad is at and what the next steps might be.

Also, are they sitting up your dad? Is he lying flat all the time, or are they at least sitting him up? Head up 45°, tilting the bed forward so that he gets in a position that is making it more likely for him to wake up. Is he getting stimulation? Is he getting good nursing care? Are they washing him? Are they turning him? Are they doing good mouth care? Those are all questions that need to be asked.

Also, what’s the GI bleed doing? Have they done a gastroscopy? Have they found out the cause of the GI bleed? Is his hemoglobin still low? If his hemoglobin is still low, again, he might be very weak and that might also delay waking up. Is he at risk of further GI bleeds? The bigger picture needs to be looked at here. So, I hope that helps Christian, to having answered your question.

If you have a loved one in intensive care and you have similar questions, we actually have built a membership for families of critically ill patients in intensive care where we answer your questions. 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. You can get access to our membership for families of critically patients if you go to intensivecarehotline.com if you click on the membership link or go to intensivecaresupport.org directly. In the membership, you have access to me and my team, in the membership area and via email, and we answer all questions intensive care related.

You also get access to 21 eBooks and videos in the membership area that are specifically written and recorded for families in intensive care that give you guidance that help you in steering this incredibly difficult territory that is intensive care but we are here to handhold you in the membership, as well answer all of your questions.

Now, I have worked in intensive care for nearly 25 years in three different countries where I also worked as a nurse manager for over 5 years. I have been consulting and advocating for families in intensive care since 2013. I can say without any hint of exaggeration that we have saved lives as part of our consulting and advocacy.

You can see that, verify that on our testimonial section and on our podcast section, where we’ve done interviews with clients.

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 doctors and nurses directly. I help you to make informed decisions, have peace of mind, control, power, and influence. You will see when I either set you up with the right questions to ask, or when I talk to doctors and nurses directly, you will see that the dynamics will change in your favour very, very quickly.

So, 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. I also represent you in family meetings with intensive care teams so that you can ask the right questions, you have clinical representation, you have advocacy, and you have someone that can talk to the intensive care team on the same level so that you don’t get walked all over. I also assess with you whether you should go into a family meeting to begin with. Sometimes, it’s not the best strategy to even go into a family meeting.

Now, all of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send 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, share the video with your friends and families, and comment below what questions and insights you have or what you want to see next.

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

Take care.