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If you want to know what to do when you have a loved one, critically ill in intensive care after a car accident with a traumatic brain injury and brain bleed, stay tuned. I’ve got news for you today.

So, I’ve got an email here from Sirbu who says,

“Hi Patrik,

My father had a car accident and after the impact, he had brain surgery as the right side of the bone was broken and the small part was touching his brain. Blood also came out. Now, after the operation he has been in an induced coma for 5 days. What can be done?”

Thank you so much, Sirbu, for writing in.

I’ve worked in critical care for nearly 25 years in three different countries where I also worked as a nurse manager for over 5 years. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. We have saved many lives with our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com or on our podcast section at intensivecarehotline.com where we’ve done client interviews.

Back to Sirbu’s question. So, here’s what happens when patients in intensive care have a traumatic brain injury, whether that would be from a car accident or people falling off ladders and roofs and everything else that I’ve seen over the years, that when there’s a bleed on the brain or traumatic brain injury, there’s a lot of pressure on the brain. There’s only so much pressure the brain can take before a patient can die or it is getting extremely life-threatening, or it is causing irreversible brain damage.

So, let me explain. When there’s brain pressure, often there’s a catheter inserted into the brain to measure ICP (Intracranial pressure), also known as the brain pressure, that should be less than 20 millimeter per mercury. Otherwise, there’s the risk of sustaining irreversible brain damage.

Also, CPP needs to be measured (Cerebral Perfusion Pressure), i.e., the perfusion that is going to the pressure of oxygenated blood to maintain oxygenated blood to the brain so that the brain isn’t getting irreversibly damaged. That needs to be about 60 millimeters per mercury. So, that means the blood pressure needs to be ideally above 85 or 90 systolic minus the ICP (intracranial pressure) so that the CPP remains above 60 millimeter per mercury. That can be difficult to achieve at times depending on what is going on in the brain.

So, several strategies that can be used here to manage the intracranial brain pressure. One would be to put an EVD (extra ventricular drain), and drain fluids from the brain, either drain CSF (cerebrospinal fluid) or blood from the brain to minimize the pressures. Another strategy is to use diuretics such as Mannitol to diurese extra fluids on the brain. Other strategies are hypertonic saline that can also be used. But another strategy is also surgery, by doing the craniectomy, removing parts of the skull to let the brain expand and deal with the extra pressure. So, those are some strategies.

Other strategies are to deeply sedate a patient, to put them in a deeply induced coma, sometimes even paralyze them to not let anything else interfere with the brain. So, what can happen there is, you can put people into an induced coma, often with midazolam/Versed or fentanyl or morphine or some in some cases, Phenobarbital to really put them in a deep coma and let them rest and heal.

Now, that comes with undesired side effects. You put patients in an induced coma, they are at higher risk of sustaining DVT (Deep Vein Thrombosis), a stroke, all sorts of things could go wrong in an induced coma. Whilst patients are also mechanically ventilated, you also often can’t give anticoagulation because again, there’s a risk for bleeding. So, there’s several things that need to be very, very closely monitored.

But the reality is that when someone has a traumatic brain injury, putting them in an induced coma and let them rest and heal is a good strategy. The problem is the longer this goes on, there is deconditioning happening, i.e., when a patient comes out of the induced coma, often they are confused, agitated, not waking up straight away and they’re deconditioned because they’ve been lying in bed sometimes for days or weeks.

So, they need to start rehabilitation and that can start with just some physical therapy in bed. It can continue with just sitting patients on the edge of the bed for a few minutes. So, there can be a very long road to recovery, but there definitely can be a road to recovery.

Also, when patients are ventilated for more than two weeks, generally speaking, in a situation like that, they also often need a tracheostomy so that they can be woken up and then slowly but surely, rehabilitate.

Now, in a situation like that, once again, having dealt with ICUs all around the world, there can also be very negative ICU teams in some situations but that shouldn’t stop you from fighting for your loved one and that shouldn’t stop you from advocating for your loved one.

That is what we are certainly doing here. Like I said, we have saved many lives in situations like that with our advocacy, with our intensive care insights, and with being the experts on patient and family rights.

What is also very important in a situation like that is that you, as a family, get support and that you feel supported, and that again is what we are here for. We are more or less handholding families in intensive care through this once-in-a-lifetime experience that you really can’t afford to be getting wrong. So, Sirbu, I hope that answers your question and helps you to manage this difficult situation.

Because we’re getting so many questions for families in intensive care, this is a question that came through last year in October. We are now at the time of this recording, it’s June 24. So, we’re getting so many questions from families, and if you want me to do your video or your question quicker, maybe a little do donation here at YouTube and donate a little bit to our course so that we can make as many videos as possible.

Click the little dollar button and that will speed up me making a video. It will help our course and answer as many questions for families in intensive care as possible so that we can help as many people as possible. Do a super chat below and I’ll get to your video as quickly as possible.

Now, because we get so many questions from families in intensive care, that’s also why we created a membership for families of critically patients in intensive care at intensivecarehotline.com. You can become a member if you go to intensivecarehotline.com by clicking on the membership link or 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.

In the membership, you also have exclusive access to 21 e-books and 21 videos that I have personally recorded and written with all my two and a half decades of intensive care and nursing experience. That insight will help you to make informed decisions, having peace of mind, control, power and influence, making sure your loved one gets the best care and treatment.

I also offer one-on-one consulting and advocacy over the phone, Skype Zoom, WhatsApp, whichever medium works best for you. Once again, I can handhold you through this once in a lifetime experience that you can’t afford to get wrong.

If you think you can do this by yourself, you are unfortunately mistaken. Many families come to us when it’s too late when they have lost a loved one and then they realize, “Oh, if I only had gotten help”, and if you think I want to scam you out of some money, you can think that. But that’s not what we do here. Yes, we do charge for our services, but it’s worth every dollar. Once again, I encourage you to look up our testimony section and our podcast section where we’ve done client interviews to verify what I’m saying.

I also talk to doctors and nurses directly if you want me to do that. I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically in intensive care once again, so that you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment. 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 offer 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 send us an email to [email protected].

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. If you want to make a small donation at the super chat button and you want to have your video done as quickly as possible, make a small donation and then I will get to your video as quickly as possible, click the like button, click the notification bell, comment below what you want to see next, what questions and insights you have. Also share this video with your friends and families.

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

Thank you 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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Quick Tip for Families in ICU: Weaning VA-ECMO for Heart Failure, Do you Need Milrinone or Dobutamine? Quick Tip for Families in ICU: Can a Tracheostomy be Done While your Loved One is on ECMO? Quick Tip for Families in ICU: What Questions to Ask When Your Loved One is in Heart Failure in ICU! Quick Tip for Families in ICU: What are Signs that My Mom can be Weaned Off the Ventilator in ICU? Quick Tip for Families in Intensive Care: Why is My Mom Not Waking Up After Two Weeks in an Induced Coma and Paralyzing Agents After Acute Respiratory Distress Syndrome (ARDS)?