Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

Quick Tip for Families in Intensive Care: My Dad’s Been in a Coma for 17 Days with Brain Bleed, Tracheostomy & Ventilation, Can He Improve?  

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

So today’s tip is from Amber who says, “My father has been in a coma for 17 days with blood draining from the brain, high blood pressure, they have a tracheostomy in his throat and he won’t wake up. He’s breathing on his own with the help of the tracheostomy. What is going to be the outcome?”

So, it looks like Amber’s father was in an accident and if blood is draining from the brain, he must have got some sort of brain injury and it’s been 17 days. Now, it’s clear to me that the old adage, what I’ve been saying over and over again, that 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. And it’s clear to me that Amber is in that situation where the question is great Amber, but there’s so much information missing.

He’s got blood draining from the brain. What did he have? Did he have a traumatic brain injury? Does he have an ICP (Intracranial Pressure) monitor? Are they measuring his brain pressures? Is he still in an induced coma because of the brain injury? Has he had a midline shift? How are they treating the brain injury? Is he on mannitol? Is he getting hypertonic saline? Is he paralyzed potentially? Probably not paralyzed because he’s now breathing on his own. But was he paralyzed because if he was paralyzed because of the brain injury or potentially other injuries that might delay him waking up. And when I say paralyzed, I mean, chemically paralyzed with medications.

So after a significant trauma in ICU, 17 days is actually not a long time and if he’s now breathing on his own, but he’s not awake yet, that is the first sign of getting him awake. Now, the next step here should be that if your dad is stable, can they start gently mobilizing him. Physical therapy, sitting him up in bed very gently to begin with, especially if he had a brain injury, then continuously wean him off the ventilator.

17 days in ICU after such a massive event is not a long time, you got to give this time and I know the ICU team might be putting pressure on you saying, “Oh, you got to make a decision. Do you want to continue treatment? Or do you want to just stop everything?” You haven’t shared how old your dad is. You haven’t shared, does he have any premedical history? The more you can share here, the more the better our answers will be. But with the information that you’ve given Amber, you got to give this time, people recover from brain injuries in their own time, and lo and behold, they may never recover. You don’t know.

But one thing is for sure if you’re not trying, well, you have 0% chance of your father recovering. So you haven’t shared that the intensive care is pushing towards the end of life which I take is a good thing. But they might, if your dad isn’t improving in a time frame that is convenient for the intensive care team or that they think is appropriate, they might try and keep pushing you towards the end of life, But it’s also a good sign that they put in a tracheostomy. That buys your dad’s time to wake up in his own time. Wean off the ventilator in his own time. If he’s then not able to swallow or cough because of the injury, he still has more time than to manage an unsafe airway, with the tracheostomy.

So it looks like he’s in a reasonably stable position at the moment. He’s just not waking up in the time frame that you might expect him to wake up. And he may not wake up in the time frame that the intensive care wants him to wake up.

So be patient here, please, and again, given that he is breathing on his own now, that is also a sign that he must be a little bit more awake compared to before he was probably in an induced coma and maybe he still is, maybe they’re slowly lowering, sedation and opiates. Those are the type of questions you need to ask when he’s breathing on his own. What does that exactly look like? Does he breathe on a CPAP (Continuous Positive Airway Pressure) or on a pressure support level? What medications is he still on? What do chest x-rays  show? What do arterial blood gas show? Have they done a CT (Computed Tomography) scan of the brain? MRI (Magnetic Resonance Imaging) scan of the brain? An EEG (Electroencephalography) of the brain because he had a brain injury. Is he having seizures? If he’s having seizures, what anti-seizure medication is he on? And is that still keeping him sedated? If he doesn’t have any seizures or he didn’t have any seizures, he’s probably still at risk of seizures because of the brain injury. And again, they’re probably giving anti-epileptic or anti-seizure medications that also often have a sedative effect even though it’s mild.

So those are all the types of questions you need to ask and the easiest way here to get to the bottom of things is for us to look at the medical records or for me to talk to the doctors and nurses directly and ask all the questions that need to be asked. But you haven’t even considered asking.

Also, how did he get to this point? Did he have brain surgery? Like I said before, have they measured or checked his ICPs (Intracranial Pressure), also known as brain pressure and his CPP is (Cranial Perfusion Pressure). Are they still monitoring that, is that still an issue? So those are all the questions you need to ask   and then come back to me again. But the quickest way to deal with a situation like that is really for me to talk to the doctors and nurses directly and ask all the questions that you haven’t even considered asking. And depending on their response, I can ask counter questions straight away. I have worked in intensive care for over 20 years in three different countries where I also worked as a nurse unit manager for over five years. And I’ve been consulting, advocating for families in intensive care for over 10 years now with excellent outcomes, really making a difference to families lives, getting great outcomes, saving lives. You can look that up on our testimonial section or on our podcast section where we have client testimonials and client interviews.

Now that is my quick tip for today.

If you have a loved one in intensive care and you need help, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send an email to [email protected]. 

Also, we have a membership for families in intensive care at intensivecarehotline.com. Go there and click on the membership and you can get access to the membership area there or you can get direct access to the membership by going 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. Now, I also offer one-on-one consulting over the phone, via Skype, via Zoom, via WhatsApp, and I talk to intensive care teams directly. And I ask all the questions that you haven’t even considered asking, but you must ask so that you can make informed decisions, get peace of mind, control, power and influence.

Now, I also represent you in family meetings with intensive care teams as a professional advocate. So again, that you are represented well, and that intensive care teams can’t just do whatever they want if you don’t have an advocate by your side. Once again, I worked in intensive care for over 20 years, exactly what’s to come, exactly how to position your critically ill loved one’s position and condition. Families in intensive, they have no idea what’s happening. And once again, they don’t know what they don’t know.

We also offer medical record reviews, in real time if you have a loved one in intensive care, so we can give you a second opinion in real time. We also offer medical record reviews after intensive care. If you have unanswered questions, if you are suspecting medical negligence, or if you are simply needing closure.

Now, 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 or what questions and insights you have.

Thanks for watching.

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

Take care for now.