Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So, we’ve got this email from a reader who says, “My husband has been in ICU for seven days now. He had a cardiac arrest and sustained a hypoxic brain injury. The intensive care team is putting pressure on me to either let him pass away or do a tracheostomy.” What a great question to ask and this is obviously something we are encountering here all the time at intensivecarehotline.com. I have seen these situations hundreds of times when I work in intensive care all around the world for over 20 years.
So, here is what you should be doing. Number one, you should not agree to end of life, unless it’s your or your husband’s explicit wish to die. But it doesn’t sound to me like that’s what you want to do. First question is, does your husband have an advanced care plan? If he has an advanced care plan that explicitly says that he wants to have everything done to save his life, then the ICU team must act on that. If he has an explicit advanced care plan that says, “Look, in a situation like that, cardiac arrest, hypoxic brain injury and I don’t want to live on a ventilator with a tracheostomy,” for example. Then, you need to think about withdrawing treatment and potentially let your husband pass away. So that’s the first question, you need to ask yourself, which direction do you want to go?
Next, project yourself one year out from today and think about it. Would you regret in a year’s time, the decision you would make today? Now, bear in mind once your husband has passed away, there’s no return from that as far as we know. So, you got to think about, would you regret that decision in 12 months’ time?
So next, if you are to proceed to a tracheostomy, your husband can be woken up after the induced coma, assuming he was in an induced coma, depending on what his Glasgow Coma Scale is like. And then, he can be woken up and hopefully gradually be weaned off the ventilator. Now, if he can’t be weaned off the ventilator with a tracheostomy, you may want to start thinking about services such as Intensive Care at Home. If he can be weaned off the ventilator, he may still need a tracheostomy because he may not be able to swallow as part of the hypoxic brain injury. He may not have a cough. Those are all questions and issues you need to consider before even making a decision.
Now, the best next step is to contact us here at [email protected] or call us on one of the numbers on the top of our website at intensivecarehotline.com. If you have a similar question or this particular question, we are professional consultants and advocates for families in intensive care.
And, if you want a medical record review for your loved one, in or after intensive care, we can do that as well. And this is typical for this situation. We would talk to the doctors and nurses and find out what’s exactly happening. What is the exact clinical condition for your husband? What medications is he on? What do X-rays show like? What does an MRI (magnetic resonance imaging) or CT (computed tomography) scan of the brain show? Has there been an EEG (electroencephalograph) done? And the list goes on.
Again, 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.
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Thanks for watching.
This is Patrik Hutzel from intensivecarehotline.com and I’ll talk to you in a few days.