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If you want to know what to do if your mom is in intensive care with a tracheostomy, with pressure sores, and a pneumonia, stay tuned! I’ve got news for you.

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

“Hi Patrik,

My mom has a bad case of pneumonia, probably from the ventilator. She has been in ICU for about a month. She has a lot of bed sores. She got probably in the emergency department. They don’t give good care in the emergency department because they are too busy.

I left her there alone originally, because I got a call while with her that I was closely exposed to COVID, and I left there and got tested. She also has some bad wounds from a C collar (cervical collar). They made her wear around her neck. Finally, they put on a softer collar around her neck and left it undone unless they move her. 

She’s now slowly starting to wake up. They thought she would not, but I didn’t want her to have pain medications. They had to turn up the ventilator settings due to the pneumonia and allowing the pain medications.” 

I just interject there. Pain medications such as fentanyl or morphine have side effects such as respiratory depression, basically meaning, they are counteracting with trying to wean someone off a ventilator. They have respiratory depression, which means they are inhibiting patients to breathe by themselves. So, it’s contraindicated really to weaning someone off the ventilator.

By the way, my name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.

So, carrying on with the email.

“The tracheostomy site is not healing. They made a huge hole much bigger than normal for some reason. It is packed with silver nitrate. White cell count is 24 and it’s going up. They think they have her on the right antibiotics. She gets a vancomycin-resistant UTI a lot, but they don’t think it’s that. UTI stands for urinary tract infection, by the way.

The doctor this weekend thinks she’s just dying and doesn’t want to heal, and opening her eyes is the surge. They say they won’t pressure me, but the doctor says they will keep treating her, but they think she is dying. The biggest issue seems to be the wounds she got there. What do I do? What should I do?

– Valerie.”

So, one of the biggest issues here is obviously that she’s ventilated, she’s got a pneumonia, she’s got a tracheostomy, and obviously, the tracheostomy seems to be small for the tracheostomy hole they’ve made for whatever reason. That is a significant risk for an infection, by the way, if there’s openness and no bacteria can just go in there. No surprise they can’t heal the pneumonia if her white cell count is 24, that means the infection is pretty bad.

So, if the tracheostomy site is packed with silver nitrate, that’s a good thing. But if there is a big hole, maybe they need to change the tracheostomy tube size. Let’s just say he’s got a size 7, there’s a big gaping hole, maybe they need to put in a size 8, and that might fix the problem. Just saying that you might want to look into that, or you might want to ask them for that. 

With pressure wounds, that sounds pretty bad, and it sounds to me like the hospital and the nursing staff in particular, they haven’t been doing a proper job to prevent your mom from having pressure sores. So, are they giving regular pressure area care? What are they doing to treat the wounds? Where are the wounds? You haven’t really shared where the wounds are. Are they on her sacrum? Are they on her back? Are they on her arms?

You mentioned something about the collar that they are around the neck, because they probably haven’t done proper C collar care. If patients have a C collar, you need to take the collar off every 8 hours, give it a good clean and put some cream around the neck, and making sure it’s not too tight, but tight enough so the collar is also doing the job. They must be suspecting a C-spine fracture or a C-spine instability which is why she’s wearing the collar.

Now, my question for you is, why do they think she’s dying? Is she hemodynamically unstable? Is she on vasopressors, is she on inotropes? What makes you think she is dying or what makes them think she’s dying? You haven’t mentioned anything that she’s on vasopressors or inotropes, that she’s hemodynamically unstable. Yes, she’s ventilated. She’s on at least one form of life support. What are the ventilator settings?

The biggest challenge for families in intensive care is always 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. That is exactly what you are currently up against. 

Their job at the moment is to simply treat your mom, but she’s at high risk of getting a sepsis, not only because of the pneumonia, not only because she’s prone to getting UTIs, but also because she’s having the pressure sores. The pressure sores are an entry point for bacteria, and God forbid, if they can’t get the pressure sources under control, she might die from septicemia, but the same with the pneumonia. That’s why it’s so important to close those infectious sites, i.e., make sure the wounds are closing and make sure the tracheostomy site is closed, so that no bacteria can enter the lungs and cause a pneumonia. That might be one of the reasons why she’s been having a pneumonia for such a long time.

Now, like I said, in terms of their statement that she’s dying, is her heart rate low? Is her blood pressure low? Is she needing inotropes or vasopressors for life support? Are the kidneys failing? Is lactate going up? What are the signs that he’s actually dying? That’s just a statement. What does that statement mean? Is it backed up by data, by clear signs that she is dying?

Now, the other question with the wounds is, are the wound care nurses and wound care specialists involved? Is a plastic surgeon looking after her? Does she need surgery? What are the options here with the wounds? Those are the questions.

If you don’t want her to go to hospice, then you just carry on, and make sure she gets best care and treatment. If down the line your mom stabilizes, you could also think about home care, assuming she’s not getting off the ventilator. Home care with tracheostomy, you could look at a service like Intensive Care at Home. You can find more information at intensivecareathome.com.

Now, I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years. I have been consulting and advocating for families in intensive care here at intensivecarehotline.com since 2013. I can very confidently say that we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com. You can read our testimonials there what our clients say. You can also look it up on our intensivecarehotline.com podcast where we have done client interviews and they share their stories, how we help them to save their loved ones’ lives.

We have helped hundreds and hundreds of members and clients over the years to improve their lives instantly and save their loved ones’ lives. It’s all documented here on our blog at intensivecarehotline.com. 

That’s why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I talk to doctors and nurses directly. I handhold you through this once in a lifetime situation that you simply can’t afford to get wrong. When I talk to you and your family directly, I explain everything in much detail to you, just as I do in these videos, but it’s in depth for your situation. When I talk to doctors and nurses directly with you or on your behalf, whichever way you want me to go about it, I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

Also, I 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 do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link 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’ve personally written and recorded. All of those eBooks and videos 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, always.

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.

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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.