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

Today, I’ve got an email from Kevin who says,

“Hi Patrik,

My girlfriend in ICU had a patch done to seal the hole in her heart. She got a staph infection. The doctors keep giving her the wrong antibiotics. During this time with infection and the hole in the heart, she was unconscious. I convinced them to use a stronger antibiotic. They won’t do any treatment unless someone pays in advance. It took me around one week to get the money. The infection cleared and they did the patch again. It has been a couple of days after the surgery, and she is still unconscious. During the last operation when she took a long time to wake up, they did a CT scan for brain function, and all was well. They didn’t do that this time around and she’s still not conscious. Do you have any suggestions?

From, Kevin.”

Well, thank you, Kevin for writing in.

Now, with a staph infection and the doctors using the wrong antibiotics, they need to do another test so that they can isolate the infection, the bug and then target it with the right antibiotics. It’s not so much using a stronger antibiotic; it’s using the right antibiotic for the right infection. That’s the crux of the matter here.

Now, if, when the infection cleared, obviously they did the patch again. So, she had two surgeries within a few days, that can often hinder waking up. Especially if someone is ventilated in an induced coma, then you’ve got two surgeries on top of that, which means more anesthetics and more opiates, and that can simply hinder people waking up in a “normal time frame.”

Now, on top of that, she is critically ill. Patients that are critically ill do not wake up in a heartbeat, often they just simply take their time. As far as the CAT (Computed Axial Tomography) scan, this time around for brain function hasn’t been done. I believe it should be done if sedatives and opiates have been off for a few days. You haven’t shared that here whether she’s completely off sedation and completely off opiates, because it comes down to that as well, and then it comes down to what sedatives and opiates did she have and how much.

So, for example, propofol is a short-acting sedative, that means when propofol is switched off, patients should wake up pretty quickly. On the other hand, you’ve got midazolam/Versed who’s a long-acting sedative. It’s also a benzodiazepine; therefore, it is addictive in nature. So, that means patients after midazolam use, especially if they took a lot of midazolam, may not wake up straight away and it might take a few days.

Also, your girlfriend would have had opiates. With opiates, it’s the same. It can knock people out, morphine or fentanyl, for example. Depending on how much of the morphine or fentanyl she had, again, there might be a delay in waking up and she might still be in pain, and she might still need morphine or fentanyl because of pain control, and that might also delay waking up even if she’s off the sedatives.

So, you have to make a distinction there between sedatives and opiates. Also, the risk with opiates such as morphine or fentanyl is they are also addictive in nature. So, she might actually go through withdrawal when waking up. You can’t rule that out.

Now, there’s a third sedative that I haven’t spoken about, which is Precedex or dexmedetomidine, it sort of sits in between propofol and midazolam. It is not addictive in nature; it’s got clonidine in there and it’s reasonably short-acting. People wake up reasonably quickly after use. Also, the research suggests that if people use Precedex or dexmedetomidine, the pain medication is minimized because it also has some analgesic effects. So, just some food for thought. But as you can see, the devil is absolutely in the detail here.

Also, is she hemodynamically stable after heart surgery; she’s had a hole in her heart. Is she hemodynamically stable? Does she have a normal blood pressure and normal heart rate and normal heart rhythm? What is her ejection fraction, also known as the pump function of the heart? Have they done an ultrasound of the heart? Are the kidneys working? Is the liver working? Is there potentially hypoperfusion to other organs because of the heart failure? So, these are all questions you should be looking at. Is she on inotropes or vasopressors to stabilize the heart to help the heartbeat and heart pump? What medications is she on? What are blood results saying? And lastly, once again, if sedation and opiates have been switched off for a few days, definitely need to go down the track of CT (Computed Tomography) scan of the brain or MRI (Magnetic Resonance Imaging) scan of the brain to make sure there is no neurological damage.

So, I hope that explains, Kevin, what you need to do next and what you should be looking for. I would also strongly encourage you to get access to the medical records so that you can get a second opinion that we can give you here at intensivecarehotline.com.

Now, I have worked in critical care for nearly 25 years in three different countries where I also worked as a nurse unit manager for over 5 years. I’ve been consulting and advocating for families in intensive care all around the world since 2013 and I can confidently say we have saved many lives as part of our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com. You can also verify it on our podcast section where we have done some client interviews.

That’s also why we created a membership for families of critically ill patients in intensive care and you can become a member if you go to intensivecarehotline.com if you click on the membership link at the intensivecarehotline.com or if you go 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 eBooks and 21 videos that I have personally written and recorded from all my extensive experience as a critical care nurse. Those eBooks, videos, as well as the access to me and my team, will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.

Also, I do one-on-one consulting and advocacy for families in intensive care over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I also talk to doctors and nurses directly or case managers asking them all the questions that you haven’t even considered asking but must be asked when you have a loved one in intensive care. I handhold you through this once in a lifetime situation that you simply can’t afford to get wrong.

I also represent you in family meetings with intensive care teams. Once again, all with the goal of making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.

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 simply send us an email to [email protected] with your questions.

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, what questions and insights you have.

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Thank you so much for watching.

Also, if you want your email read out quickly and your questions answered quickly, leave a small donation on the YouTube super chat button. Then, I will read out your email and answer it very quickly within a couple of days. I have email sitting in my email inbox from late last year, that’s how many questions we get, and I can’t keep up, so I understand there’s some urgency sometimes. Also make a small donation if you like, it will help us to publish as many videos as possible for families in intensive care.

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.