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

So, today’s tip is about an email that we had from a reader who says, “No one is advocating to do everything possible to get a healthy baseline for a neurological assessment for my mother who had a spontaneous subdural hematoma. It’s agonizing and disturbing. Can you help?” Sure, we sure can. And I can only imagine that once your mom has gone into ICU, the ICU team would’ve probably given you the whole doom and gloom spiel and would’ve told you probably that your mom won’t survive. And if she survives, she may not have any quality of life. And my response to that is, well, they haven’t probably even tried.

Before I go into the details with the subdural hematoma, I just want to mention that today actually, I recorded a podcast with a former client of ours who had their 59-year-old dad in ICU and he ended up with a TBI (Traumatic Brain Injury), and the ICU team wanted to pull out on him because they said, “Well, he won’t survive.” And he had high intracranial pressures. He had multiple complications from the fall, from the traumatic brain injury.

Anyway, after successful intervention from us and after successfully advocating for this client, the client survived. And he was actually on the podcast today himself, and you can hear it from the client himself that he survived what the ICU deemed was nonsurvivable. So, stay tuned for that podcast in the next couple of weeks.

Anyway, going back to the email that we had from this particular reader, who obviously has concerns about her mother having subdural hematoma and the ICU team not wanting to do everything possible. So, let’s just quickly look at the subdural hematoma.

Subdural hematoma happens in the brain. It could be from an aneurysm. It could be from a hemorrhagic stroke. It could be potentially from a traumatic brain injury. It basically means blood is accumulating between the brain and the skull that contains the brain.

Obviously, that can cause a lot of issues. Patients most of the time become unconscious after a subdural hematoma. Their Glasgow Coma Scale drops, their conscious level drops, and they need immediate attention. And they often go into ICU, need ventilation with a breathing tube. Go into an induced coma. Often have ICP monitoring (Intracranial Pressure Monitoring), and also often have an EVD (Extra Ventricular Drain) to manage the pressures in the brain.

Sometimes, it can also end up in a craniectomy. Parts of the skull will be removed to, again, let the brain expand so intracranial pressures don’t rise to high levels, and so the brain can expand from the pressures, and that can be lifesaving.

Now, other issues that can arise from a subdural hematoma are simply seizures and therefore most patients in ICU will get started anticonvulsants, or antiepileptic medications such as Keppra or phenytoin, and that is often prophylactic. Again, like I mentioned, most patients are induced into an induced coma.

Now, if ICPs (Intracranial Pressure), so the pressures in the brain are too high, other treatment options need to be commenced, such as mannitol or hypertonic saline to drain fluids off the brain to keep the intracranial pressures low.

Other issues that can arise from a subdural hematoma is a midline shift. Basically, the brain is divided into two halves of the brain. And when that midline that divides the brain is shifting, that could cause pressure as well. And again, that’s why intracranial pressure needs to be monitored very closely, intracranial pressures. And also, CPP, the cranial perfusion pressure, which shouldn’t really go below 60 mmHg to avoid permanent and irreversible brain damage.

Now, I mentioned briefly an EVD can be inserted as well, again, to drain the brain fluids, also known as CSF (cerebrospinal fluid). And again, keep the brain pressures low. Sometimes when the subdural hematoma is being evacuated surgically, then, also there could be a surgical drain inserted into the brain as well.

Now, the most important question here, what is the long-term prognosis? Well, it’s really hard to say. It depends how big the hematoma is. It really depends on are there any other issues? What caused the subdural hematoma? Was it an accident? Are there other injuries? Or is it just an isolated subdural hematoma, maybe after a hemorrhagic stroke or after an aneurysm? So, it really depends.

Bottom line is this, if other clients can survive or other patients can survive, like I just mentioned in the beginning, the podcast interview that I’ve done today with one of our previous clients and their family, there’s no reason why your mom can’t. So, if she probably needs time and the ICU probably doesn’t want to give her the time, that’s just the unfortunate reality. But that should not stop you from advocating.

We can help you with that like we did with the other client. We can advocate on your behalf. We know the ins and outs of intensive care. We know that what the ICU team is telling you is probably only half of the story of what is actually happening. When you get us involved, for example, we can ask all the questions you haven’t even thought about asking. You haven’t even considered asking. The devil is in the detail in ICU.

If, for example, in your mom’s situation, ICPs are high, I mentioned some treatment options such as mannitol or hypertonic saline, but sometimes it could be simply managed with more sedation. There’s a number of things that can be done that you probably haven’t even considered.

Also, the question is, has a neurology team given input? Has neurosurgery given input? What’s ICU saying? It’s really a case of getting all the teams together and having a case conference, but I wouldn’t go into a case conference without having someone there that can represent you clinically and that can talk to the ICU team on a clinical level, which is what I can do on your behalf. So, that’s just some insights there.

I really hope that helps. And I really hope that by you knowing now that other patients in similar situations have survived, even though the ICU team wanted to stop life support, should give you hope. And it should give you courage that with outside intervention you can turn this situation around and give your mom a second chance, which is what every patient in ICU deserves.

And when ICU is telling you, “Well, your mom won’t have any quality of life and that we should stop life support”, it means they probably don’t have any beds and they don’t have any staff, and they don’t see maybe the financial value in continuing treatment for your mom. Just some thoughts there.

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.

Also, if you need a medical record review, please contact us as well. We review medical records for patients in intensive care in real time. Get access to the medical records from the hospital, which is your right, assuming you are the medical power of attorney. We will review those medical records for you in real time. But also, after intensive care, especially if you’re having unanswered questions, need closure, or you’re simply suspecting medical negligence, we can help you with all of it. But we strongly recommend to review medical records in real time so that you can get that crucial second opinion in real time.

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.

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