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

So today I have a question from Peter who says, “My mom has been in ICU for more than two weeks after cardiac arrest. She’s still on the ventilator and she’s not waking up. The ICU team is asking us whether we should do a tracheostomy or not. What should I do? Can you help?”

Great question Peter. What you haven’t said, but what is most likely, is that your mom might have a hypoxic or anoxic brain injury after the cardiac arrest depending on how long she needed to be resuscitated or, depending on how much “downtime” there was. Therefore, there might be delays in waking up simply because of the brain injury.

Now, having said that, she may not have a brain injury depending on whether resuscitation was effective, when a hypoxic brain injury happens, is usually when there has been no oxygen supply to the brain for over three minutes. Now, we don’t know that of course. And you may not even know that, but you should ask, you should ask for an MRI scan of the brain. You should ask for a CT scan of the brain. You should ask for an EEG, you should ask to speak to a neurologist cause from your email, I don’t think you’ve done any of it or anyone has spoken to you. It doesn’t sound to me like you have looked at the medical records. Any of those important things haven’t happened by the looks of things.

So here is the gist, there are some patients in ICU, they don’t wake up after two weeks, often in induced coma and they don’t have a brain injury. So maybe it is the latter. But you need to find out which one it is. The biggest challenge for families in intensive care is simply 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, should you be doing a tracheostomy? Potentially, but only if your mom has a brain injury, anoxic or hypoxic brain injury only then, really. Let’s just say she’s not waking up yet and she’s not brain injured, then you should be looking at getting your mom extubated. If she’s not waking up, if she hasn’t had a brain injury, well, the question is, is she potentially over-sedated? Has she had too many sedatives? Too many opiates and is that why she’s not waking up?

Another question you should be asking is, is she having seizures? Or is she at risk of having seizures as part of potentially a hypoxic or anoxic brain injury? Is she getting anti-seizure medications? If yes, that might also make her drowsy and sleepy.

So, should you consent to a tracheostomy if she has a brain injury and she’s not waking up? And that’s the very reason for her not waking up.  Possibly, yes, because that will give her time. It will give you and your family time to make a decision on what you want to do in the long run. It will buy your mother time to wake up.

Now, she doesn’t have a brain injury and she’s not waking up because she’s overly sedated. She’s potentially on liver failure, or kidney failure and she’s not metabolizing or excreting sedatives and opiates, maybe they need to give an antidote and help her wake up and then get her off the ventilator and avoiding the tracheostomy.

So really, it is so important for you to think things through, and it is important for you to get help because once again, you don’t know what you don’t know.

So that is my quick tip for today.

I hope that helps you understand what your next steps are. And we can also help you understand what your next steps are in much more detail if you join our membership for families of critically patients in intensive care.

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. And we go in much detail to explain to you what you should be doing, how you can advocate for your loved one, how we can help you, so that you do understand what’s going on and that you do end up having leverage because by question that Peter sent, it sounds to me like he has no leverage whatsoever. It’s just sort of dangling alone without having a plan.

You need to have a plan when you have a loved one in intensive care. Because if you don’t have a plan, the intensive care team will make a plan for you. And though it is often around their agenda, not your agenda. Your agenda is to help your loved one get better and get out of intensive care alive.

Now, if you want access to our membership, go to intensivecarehotline.com and click on the membership link or go to intensivecaresupport.org directly. I also offer one on one consulting over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I will talk to you and your families directly. I talk to doctors and nurses directly and I’ll make sure you make informed decisions, have peace of mind, control, power, and influence.

When I talk to doctors and nurses directly with you or I set you up with the right questions to ask, you will see that the dynamics change in your favor pretty quickly cause the intensive care team is nowhere to hide. You should also get access to the medical records as quickly as possible in situations like that.

I have worked in intensive care and critical care for over 20 years in three different countries where I also worked as a nurse manager for over five years. I have been consulting and advocating for over 10 years here at intensivecarehotline.com. Please look up our testimonial section and see what our clients say or look up our podcast section with some client interviews. I can say without any exaggeration that we have saved lives over the years with our consulting and advocacy.

We also offer 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 simply suspecting medical negligence. And I also represent you in family meetings with the intensive care team so that you have a representative there that can advocate for you and your loved one who knows how to talk to the intensive care team on a clinical level, who knows how to get outcomes and results for you just like all of our other clients get. Again, look up our testimonial and podcast section or the results we’re getting for our clients.

Now, 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, click the like button, click the notification bell. Comment below what you want to see next or what questions and insights you have, share the video with your friends and families.

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.

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