Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care. One of our readers has her husband in ICU and she sends an email and she’s asking the following questions. “My husband hasn’t awakened since the intensive care team discontinued the propofol. He is now on dialysis permanently, and they have done an MRI scan to check the brain bleed. When will he wake up?”
Now, that’s a great question. I’m sure that many others watching this video would be in a similar situation, with a similar scenario. And, the reality is that intensive care all around the world is not that much different. I have worked all around the world, really. I have worked in three different countries in intensive care, and I have also worked as a nurse unit manager for over five years.
I’ve been consulting and advocating for families in intensive care for the last 10 years and intensive care is not that much different. All around the world, the issues are the same. The biggest challenge for families in intensive care all around the world 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. And that’s exactly what’s happening here.
Our reader doesn’t really know that the information she’s giving us is just a fraction, probably just 10% of what’s going on. So, for example, if your husband has been on propofol, and propofol has now been switched off, I’m assuming he’s been in an induced coma. Now, if he had a brain bleed, there’s a good chance he might have an intracranial pressure monitor. There’s a good chance he might have an EVD (Extra Ventricular Drainage). There’s a good chance he might have had high ICPs (intracranial pressure), high brain pressures. There’s a high chance that on top of the propofol, he might have had other sedatives such as potentially midazolam or potentially phenobarbital to manage any high pressures in the brain. There’s also a high chance your husband would have been or still is on morphine or fentanyl. So then there’s a high chance that your husband might be on Keppra, phenytoin to prevent seizures.
So once again, families don’t know what they don’t know, and you can’t blame them because it’s such a highly specialized area, intensive care. You need to have studied long and hard and have exposure in real life in order to understand intensive care inside out.
Now you are saying, your husband is now on dialysis, and with the dialysis they might be able to clear out some of the sedatives that are still lingering around. But let’s just assume your husband is off all sedatives. Let’s assume he’s off all opiates and let’s assume he’s ready to wake up.
Patients in intensive care sometimes don’t wake up for many days or many weeks even if they don’t have a brain injury. Now, in your husband’s case, he does have a brain injury. You can assume that it takes even longer, so be patient. Make sure they’re doing physical therapy, make sure they’re mobilizing him, make sure they’re stimulating him, that’s assuming he’s stable enough, that’s assuming he doesn’t have any other fractures that would potentially prevent him from mobilizing. So the devil is in the detail.
And then also obviously some of it also depends on what does the result of the MRI scan shows. But if your husband isn’t waking up, it’s probably a, a combination of being on sedatives, being in an induced coma and having opiates, as well as having a brain bleed, as well as potentially having kidney failure. And therefore, sedatives and opiates might not be excreted properly. And it takes time.
So I hope that helps you understand what is really going on. What will help you tremendously is if you talk to me directly and we can talk to the doctors and the nurses directly there or look at medical records to really find out what’s exactly happening. Then I can advise you and walk you through the situation step by step, and help you understand what’s going to happen next and how to manage the intensive care team so they don’t manage you. Very important.
Now, 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 24 hours a day.
If you are looking for a medical record review for your loved one in intensive care in real time, we can help you with that as well. So then you can have a second opinion, and it’s absolutely crucial for you to have a second opinion and also so that you can ask better questions because the question from today is great, but it very much is an incomplete question. You need to know what to even look for and ask for. We also review medical records after intensive care. If you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence, we can help you with that as well.
Now, 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 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.