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

So, today’s tip is about a question we had from a reader who says, “My dad is day 12 in ICU with MRSA (Methicillin-Resistant Staphylococcus Aureus), and sepsis. Propofol has been off for 24 hours, and he’s not waking up.” Now, that’s a great question to ask. Day 12 in ICU after sepsis, it means your loved one would’ve been very, very sick. Your dad would’ve been in an induced coma. He probably would’ve been hemodynamically incredibly unstable. He would’ve been on inotropes or vasopressors; he would’ve been on steroids. He probably still is on steroids. He’s probably on antibiotics such as Vancomycin. He might have been on dialysis or still is on hemodialysis for kidney failure. Often patients with sepsis or septic shock going to kidney failure. So, he might have been on dialysis or still is on dialysis. So, those are all contributing factors on top of being on propofol.

Now, like I keep saying over and over 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.

This is a classical example here, once again, where families don’t know what is actually happening because on top of the propofol, your dad would’ve also been on opiates or potentially still is on opiates such as morphine or fentanyl. They are strong opiates, strong painkillers, and that will also inhibit your dad from waking up. If he’s been in an induced coma for the last 12 days. He’s been hemodynamically unstable. He’s been ventilated with a breathing tube, they would’ve had to deeply sedate him, and therefore, it can take time to wake up.

Now, furthermore, just because you are saying he was on propofol, he might have also been on other sedatives such as Midazolam or Versed. So, the challenge here again is if he has been on Midazolam or Versed as well, that’s a long-acting sedative. It also means it takes longer for patients to wake up, and waking up after an induced coma is a process. It’s not an event. It takes time on top of the sedatives and the opiates needing to be washed out of the body system. A critical illness as such is also delaying the process of waking up because simply people are crook, for lack of a better term. They are absolutely exhausted. So, you have got to give your dad the time he needs to wake up.

Now, other things that need to happen in situations like that are simply that he needs to slowly get stimulated. He needs to slowly have some physical therapy, some movement from his arms, legs, and so forth.

So, also if, God forbid, your dad doesn’t wake up in the next few days, they need to do a CT scan of the brain or an MRI scan of the brain because, God forbid, they need to rule out a neurological event such as a stroke or that he’s had seizures because you just don’t know what might have happened in the last 12 days neurologically. So, that would be the next step, but for now, just be patient.

Now, last but not least, other things you need to consider are, especially if your dad potentially has kidney failure and is on dialysis, like many patients are during the sepsis, if the kidneys aren’t working, are the sedatives not being washed out of the body? Same if your dad is potentially in liver failure, the medications are not getting metabolized and therefore, once again, it takes longer for someone to wake up. So, I hope that helps. I hope that explains.

That’s my quick tip for today.

If you have a loved one in intensive care, go to 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.

Also, have a look at our membership for families in intensive care at intensivecaresupport.org. There, you have access to me and my team, 24 hours a day, in a membership area and via email, and we answer all questions intensive care related.

Also, if you need a medical record review for your loved one in intensive care, we can help you with that. We do medical record reviews for patients in intensive care in real time so that you can have a second opinion in real time. We also provide medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you’re simply looking for evidence for medical negligence.

Now, subscribe to my YouTube channel for regular updates for families in intensive care, share the video with your friends and families, click the like button, click the notification bell, and comment below what questions and insights you have from this video.

Thanks for watching.

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

Take care.