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

So, a few days ago, I made a video about one of our clients as part of our membership for families of critically ill patients in intensive care that you can get access to at intensivecarehotline.com if you click on the membership link or if you are going to intensivecaresupport.org directly.

There, our member and client were saying that her dad earlier in the year went home with a tracheostomy, with a PEG tube, and the hospital basically just sent him home without any support. Now, that could be a death sentence because patients with a tracheostomy, they actually need intensive care nurses, 24 hours a day.

Now, at the time, we were very concerned, and we warned her not to go home, but family wanted to give it a go, only to find that he bounced back into a hospital and ICU pretty quickly because, once again, patient with a tracheostomy and the PEG tube really needs intensive care nurses, 24 hours a day.

You can actually find the evidence for that when you go to intensivecareathome.com and you go to the Mechanical Home Ventilation Guidelines, that clearly say that intensive care nurses at home are needed, 24 hours a day, for tracheostomy or ventilated patients. It can be done, but it has to be safe, of course.

Now, obviously, the client bounced back into ICU. We then were asked to look at the medical records, and I will read out what the medical records say so you can actually have an idea how bad it was to send her dad home with a tracheostomy and a PEG tube without intensive care nurses, 24 hours a day.

So, the remedy here really is you are in a situation like that where your loved one wants to go home with a tracheostomy or with a PEG tube or go to intensivecareathome.com. At intensivecareathome.com, we actually send intensive care nurses into the home, 24 hours a day, for medically complex ventilated and tracheostomy patients, adults, and children, by the way. We also send critical care nurses into the home if patients are not ventilated, have a tracheostomy, or if they’re BIPAP (bilevel positive airway pressure) / CPAP (continuous positive airway pressure) ventilated and not have a tracheostomy. We also do home TPN (Total Parenteral Nutrition) there.

So, let’s look at the details of what happened when her dad went into hospital.

“As of now, the latest doctor’s report available in the dad’s online chart is for the infectious disease progress report. Your dad is alert but not very responsive, has a wandering gaze.

His vital signs documented appear to be stable with a temperature of 36.7 °C or 98 °F, pulse of 79, respiratory rate of 18, blood pressure of 111/62 with a MAP of 78. A good oxygen saturation of 98% on aerosol tracheostomy collar, with an oxygen flow rate of 5 liters of oxygen per minute with FiO2 of 28%.

Notable findings include the sacral pressure sore, also known as decubitus, wound with surrounding infection which puts him at risk of a sepsis. He actually is diagnosed with a sepsis, infected sacral decubitus wound, anoxic brain injury.

Noted MRI had shown early stages of sacrococcyx area osteomyelitis. The plan is to treat with antibiotics at least 5 weeks more to complete the six-week course of osteomyelitis. He’s planned again for discharge home, but he does need a PICC line for a long-term antibiotic.” I will come to that in a minute, what a PICC (peripherally inserted central catheter) line is?

“Per the recent gastroenterology notes, anemia noted, likely due to chronic disease and blood loss from deep sacral decubitus ulcer. No overt signs of GI bleeding, fecal occult blood test positive, likely from sacral pressure sore, no immediate plan for endoscopy. Noted fetal impaction with green, brown stool and he has been disimpacted.

Per the physician report discharge summary notes on the 12th of April ’22, noted that your dad presented the sepsis from a sacral wound; osteomyelitis confirmed by MRI. Recommended 6 weeks of antibiotics, wound care, and monitoring. He is seen by the surgeon to evaluate the need for debridement. It is recommended that the wound has a very thin layer of necrotic tissue type and be removed by enzymatic debridement. Noted altered mental status resolved with plan for possible discharge with IV antibiotics to be arranged. He is on full code.

Per the surgery note, noted that your dad has stage 4 sacral pressure sore with mild necrotic tissue and no signs of overt infection. Necrotic tissue means that actually the tissue has died. No immediate surgery debridement is needed, collagenase ointment is recommended. The plan includes daily wound care with dressing changes.

Per the cardiology on the 4th of December, no change and appears to be comfortable.

His most recent lab report shows white cell count is normal but on the high side. His hemoglobin is 8.7 and no further monitor.

His positive for occult blood, which means now that blood has been detected in the stool sample.”

So, in a situation that like that, her dad should have never gone home with a tracheostomy to begin with. Like I said with a service like Intensive Care at Home, that would have never happened. Now, with Intensive Care at Home, we’re currently operating all around Australia. But even if you’re in the U.S. and the U.K., please contact us as well.

Now, people don’t do their research, they just trust in the hospital system blindly. You have to do your research and look at alternative options and not just trust the hospitals blindly that they can just send your dad home and not have the adequate support.

Now, he probably needs a PICC line to get long-term antibiotics. Again, the PICC line sits in front of the right heart. Again, management of a PICC line needs a critical care nurse at home as well to manage that.

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.

So now, if you want advice when you have a loved one in intensive care or you want Intensive Care at Home, for Intensive Care at Home, please check out intensivecareathome.com.

If you want to be a member for families of critical patients for daily advice, go to intensivecarehotline.com, click on the membership link or go to intensivecaresupport.org directly. You can get access to me and my team, 24 hours a day, in the membership area and via email and we answer all your questions intensive care related.

I also offer one-on-one consulting and advocacy for families in intensive care. I talk to you and your family over the phone. I talk to doctors and nurses over the phone or on video. I ask all the questions that must be asked, and you haven’t even considered asking so that you get peace of mind, control, power, and influence when you have a loved one in intensive care.

I have worked in intensive care for over 20 years in three different countries where I also worked as a nurse manager for over five years in intensive care.

I also represent you in family meetings with intensive care teams that you don’t get walked all over, and that you know what’s to come, that you know how to position your loved one’s condition to get best care and treatment.

We also offer medical record reviews in real time so that you make informed decisions, get peace of mind control, power, and influence and that you can have 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.

Now, all of this you get at intensivecarehotline.com Call us on one of the numbers on the top of our website or send us an email to [email protected]. Once again, if you need Intensive Care at Home, go to intensivecareathome.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, comment below what you want to see next or what questions and insights you have from this video.

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.