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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, “A slow recovery in intensive care after cardiac arrest and anoxic brain injury.” So, we have many families in intensive care coming to us that say things like, “Look, my mom, my dad, my spouse has gone into intensive care after a cardiac arrest. They had a prolonged downtime.” Downtime is the technical term for no oxygen to the brain during cardiac arrest, during CPR (cardiopulmonary resuscitation). And they say, “Look, they’re not waking up. It takes a long time.” ICUs are putting pressure on us saying, “Look, we either need to proceed to end-of-life because it’s not in the “best interest” for their loved ones to survive.” Whereas in reality, patients after an anoxic brain injury simply need time to recover, to wake up.
And also, the question that you need to ask yourself is, what is quality of life? What is it? It’s a subjective measure, a subjective term, not an objective measure. Quality of life for you might be very different compared to what I perceive as acceptable for quality of life.
And in many situations, you also need to think about the quality of end-of-life. If someone after cardiac arrest and anoxic brain injury wants to approach end-of-life, maybe it’s part of their advanced care plan, then you need to think about the quality of end-of-life. Do you want to end life in intensive care on the intensive care team’s terms? Or do you want end-of-life, for example, at home, in a family environment with services like Intensive Care at Home? So, these are all questions that you need to ask yourself.
From an ICU perspective, it’s often a one size fits all. Here is what we offer you, “One option is end-of-life in intensive care or option two is tracheostomy.” Well, I can tell you that after 20 years of having worked in ICU in three different countries, it’s often not black and white. It comes down to your wishes, to your own truth. And your truth might be very different compared to what the ICU team is perceiving as the truth.
But let’s just look at cardiac arrest, anoxic brain injury, maybe it’s been determined now in an MRI (magnetic resonance imaging) scan or a CT (computed tomography) scan of the brain, that there’s been anoxic brain injury. Maybe an EEG (electroencephalogram) has been done for follow-up with little brain activity. Glasgow Coma Scale (GCS) is often 3, to begin with. Patients initially might be in cooling therapy. They’re sedated, sometimes even paralyzed. And then they’re woken up, they sometimes end up with seizures, and they’re being started on Keppra or phenytoin to treat or prevent seizures. That’s also sedatives. So, on top of midazolam or Versed, propofol, morphine, and fentanyl, you often have anti-seizure medications as well that delay patients from waking up. So, you’ve got an anoxic brain injury, you’ve got sedation, opiates, plus anti-seizure medications. So, that would even sometimes take time for a patient that doesn’t have an anoxic brain injury to wake up.
So, you got to give it time. How much time? Sometimes we’re talking about days, sometimes we’re talking about weeks, sometimes we’re talking about months, I don’t know. But you have to project yourself out by making decisions and think about how would I make that decision in one or two years’ time when looking back? You got to project yourself out. Would you regret in a year or in two years’ time making a certain decision today? That’s how I would approach it if I was you. And the reason I’m telling you that is simply, we have so many families coming to us after one year or two years, after they lost their loved ones in ICU. And they’ve given in and said things like, “Yup, let’s stop treatment.” They’re giving in to the ICU team’s wishes without second guessing them and without thinking about, “Okay, what are alternatives?” What is the quality of life? Do I want my loved one to live with an anoxic brain injury? What goal do we want to achieve? And you got to educate yourself about services such as Intensive Care at Home. And, you can check that out at intensivecareathome.com .
So, you got to give it time. If your loved one doesn’t wake up after anoxic brain injury, you might have to think about doing a tracheostomy if they can’t come off a ventilator. Sometimes they can come off a ventilator, but they still need the tracheostomy because they can’t protect their own airway. They can’t cough, they need suctioning, need humidified air, humidified oxygen with a tracheostomy. And sometimes they do need to stay on the ventilator for prolonged periods as well.
So that is my quick tip for today that you need to give it time when it comes to anoxic brain injuries, and you need to think about what quality of life is acceptable for you and for your family and for your loved one. Maybe they do have an advanced care plan where it’s documented what they want and go from there.
So that’s my quick tip for today.
If you have a loved one in intensive care, go and check out intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected].
Also, check out our membership for families in intensive care at intensivecaresupport.org.
We also offer medical record reviews for patients in intensive care during their intensive care stay or after their intensive care stay. The most effective work we can do is helping you review medical records while your loved one is in intensive care and give you real-time updates and real-time education of what is actually really happening.
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Thanks for watching.
This is Patrik Hutzel from intensivecarehotline.com, and I’ll talk to you in a few days.