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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, “If a patient has a TBI (Traumatic Brain Injury) and is taken off sedation and the ventilator, and you start talking or responding to commands and then aspirate the following day, why would you put someone back into an induced coma with fentanyl when they have never been on fentanyl before?”

That is a great question, Peter. Here is the answer to it. So, someone has been having a TBI (Traumatic Brain Injury) is on sedation and in a coma, and then they’re waking up. They would have possibly been on fentanyl to begin with when they were on the ventilator in the first place. So, when someone goes on a ventilator with a breathing tube, they’re often sedated most of the time. When they are sedated, they’re getting sedatives such as Propofol, Precedex, Midazolam/Versed, usually one of them plus opiates. Opiates are strong painkillers, most of the time they’re getting fentanyl or morphine.

So, it’s not any different that if your friend or your loved one has woken up, gets off the ventilator, starts talking, does everything they’re supposed to be doing, then they aspirate for whatever reason which is very unfortunate, probably they couldn’t swallow or they had difficulty swallowing from the brain injury, that’s what I’m suspecting here. Then the day back, they’re being intubated because they know they had a big shift in their oxygenation. They can’t breathe anymore because of the aspiration. They might have developed pneumonia most likely; they need to be intubated. When they’re intubated, once again, they will be sedated with either propofol, Precedex, or midazolam/Versed plus morphine or fentanyl.

The simple reason for that is that having a breathing tube and being ventilated is so uncomfortable, so distressing, that the only way, so far, medicine has found to intubate someone is with sedatives and opiates, and that is the simpler reason for it. That brings a lot of challenges with it that I’m not going into too much detail now, but waking someone up after an induced coma can be a big challenge, which is why there are so many questions around: How long does it take to wake up after an induced coma? How long does it take to wake up after a brain injury?

There are all these follow-on questions from that but for now, I would think that I answered your question. Why your loved one is on fentanyl when they are being re-intubated after aspiration pneumonia? What happens from there? They will be started probably on some antibiotics. They will be ventilated for a few days. Once the pneumonia is cleared, hopefully, they will be woken up. Fentanyl and sedatives will be weaned off gradually, and then hopefully, your loved one will wake up again, and be weaned off the ventilator. That would be the best-case scenario here and I hope that the best-case scenario will unfold for you and your family here.

So, that is my quick tip for today.

Because we get so many questions from families in intensive care, that’s why we created a membership for families of critically ill patients in intensive care that you can get access to at 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 access to 21 eBooks and 21 videos all around topics that help families of critically ill patients in intensive care to steer the difficult territory that is intensive care. It’ll help you to make informed decisions, have peace of mind, control, power, and influence that 99% of families in intensive care don’t have, and you’ll be in the 1% bracket or families of critically ill patients in intensive care if you become a member.

I have worked in critical care for nearly 25 years in three different countries, and I have also worked as a nurse unit manager for over 5 years in intensive care. I have been consulting and advocating for families in intensive care all around the world since 2013 here at intensivecarehotline.com. I can say without any hint of exaggeration that we have saved lives as part of our consulting and advocacy. You can verify that on our testimonial section or on our podcast, where we have client interviews.

I also offer one-on-one consulting and advocacy over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly and I help you one-on-one. I talk to doctors and nurses directly, one-on-one, and you will see that the dynamics would shift in your favour once you have someone on your team who understands intensive care inside out. Like I said, without any hint of exaggeration, we have saved many lives as part of our consulting and advocacy.

Have a look on our testimonial section and on our podcast section at intensivecarehotline.com.

I also represent you in family meetings with intensive care teams. I make sure there is a strategy when you go into a family meeting. Once again, 99% of families in intensive care have no strategy when they go into meetings with intensive care teams, and they often get walked all over without even noticing what is happening.

We also offer medical record reviews in real time so that you can have a second opinion in real time and so that you once again can make informed decisions, have peace of mind, control, power, and influence. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Visit our website intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected].

Like I said, subscribe to my YouTube channel for regular updates for families in intensive care. I also do a weekly YouTube live where I answer questions live. 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 will talk to you in a few days.

Take care for now.

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