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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 a question from Anna who says,

Hi Patrik,

I don’t understand why my sister is not waking up after an induced coma. I’m also very fearful of ICU doctors pressuring me to consent to no resuscitation for my sister. Can you help me?

Okay, great. Great question Anna. And I’m very sorry to hear what you’re going through here.

Now, you haven’t shared why your sister is going to ICU and why are people not waking up after you come up? There could be a number of things. It could be simply that they are over-sedated.  And they have too many sedatives, too many opiates. Opiates are strong painkillers such as morphine or fentanyl. It also depends on whether she’s in kidney failure or liver failure because then there could also be a delay in metabolizing sedatives and opiates and they stay in the body for much longer. Same with kidney failure, sedatives, and opiates stay in the body for much longer, delaying patients waking up.

A lot of it also depends on what sedatives has your sister had. Was she on propofol? Propofol is short-acting. I.e. most patients wake up quickly after propofol has been discontinued. Someone has been on high doses of midazolam or Versed that means there could be a delay in waking up as well because they’re long-acting. It’s a long-acting sedative. Now, other patients are on Precedex or dexmedetomidine for sedation and they should wake up quicker as well. But some patients may also have had a combination of all of it.

Now, if she’s not waking up, then the next step is, has she had a brain injury? Has she had a stroke? Or did she even get into ICU because of her brain injury? You haven’t shared that. Either way, has a CT (Computed Tomography) scan of the brain been done or an MRI (Magnetic Resonance Imaging) scan of the brain been done? Has a neurologist been consulted on the matter? Has an EEG (Electroencephalography) been done. Is she getting good nursing care? Is she getting mobilized? Is she getting out of bed? Is she sitting up? Is she getting good washes? Is she getting turned regularly? Those are all questions that are important for you to contemplate.

If sedatives have been off for a few days, she’s not waking up, she’s not in kidney failure, she’s not in liver failure, she doesn’t have a brain injury as far as you know, the next step is she needs to have a brain scan, MRI scan, or a CT scan of the brain or an EEG.

If she doesn’t have a stroke or any other neurological event and she’s still not waking up, maybe they can give an antidote to the sedatives and the opiates to help her wake up. For example, if she had too many opiates, then they could give naloxone as an antidote and see whether she’s waking up from that. If she’s had too much Versed or midazolam, maybe flumazenil can be given as an antidote and see whether she’s waking up. So there are ways to go about it.

But also importantly, make sure she’s getting good nursing care, she’s getting stimulation, she’s getting turned regularly, getting good bed washes, getting good skincare, mouth care, sitting up, ideally get out of bed or at least be sitting on the edge of the bed. Very important, all of it in combination to help your sister wake up.

Now, the other question that you’ve had is fear of ICU doctors pressuring you to consent to a DNR (Do  Not Resuscitate) or no resuscitation order. Well, here is the thing Anna, that’s just your fear. You can’t be pressured by anyone. It’s your response. You can choose to ignore the pressure. So that is a choice that you’re making.

You are well aware if you’ve watched any of my videos here, you’re well aware that no one can force you to give consent to DNR (Do Not Resuscitate). No one. It’s your choice. Assuming you are the power of attorney, it’s your choice and your choice only. So the fear is just your feeling and you can control your feeling. You just decide not to react to the pressure, you just stand firm, you just stand your ground. You don’t even engage on that level with intensive care teams because you don’t have to.

So don’t give in to the perceived pressure and control your feeling, control your thinking, control how you reacted. You can’t control other people, but you will need to take 100% responsibility for how you react and you just choose not to react. It’s as simple as that. It’s not more complicated than that.

So I hope that helps and answers your questions, Anna.

We have a membership for families of critically ill patients in intensive care where you can get access to me and my team 24 hours a day in the membership area and via email and we answer your questions in our membership for families of critically ill patients in intensive care. You can get access to the membership by going to intensivecarehotline.com by clicking on the membership link or by going to intensivecaresupport.org directly.

Again in the membership, you have access to me and my team 24 hours a day and we answer all questions, intensive care related. I have worked in intensive care for over 20 years in three different countries where I also worked as a nurse unit manager for over five years. And I have been consulting and advocating for families in intensive care since 2013, as part of my intensivecarehotline.com consulting and advocacy service. Have a look at our testimonials in the testimonials section and have a look at our podcast section where we have done interviews with clients and we have saved lives with our consulting and advocacy. And I can say that without any hint of exaggeration, it’s verified in the testimonials as well as in the podcast interviews.

Therefore, I also offer one on one consulting and advocacy for families in intensive care over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly help you and handhold you through what to expect when you have a loved one in intensive care, what questions to ask, so that you can make informed decisions, and have peace of mind, control, power and influence.

Furthermore, I also talked to doctors and nurses directly and I asked all the questions you haven’t even considered asking but must be asked when you have a loved one in intensive care and it will make all the difference. The intensive care team knows that you have someone on your team who understands intensive care team inside out and they have nowhere to hide.

Once you get me on board and I can help you advocate with the intensive care team, it’s critical that you know what questions to ask. It’s critical that you know what to look for. It’s critical that you know that you don’t know everything. 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.

Now, I also represent you in family meetings with intensive care teams once again, makes all the difference if you have me there or not, so that you don’t get walked all over. It’s also critical for you to understand if you even should go into a family meeting with intensive care teams. I help you strategize around all of that.

Furthermore, we offer medical record reviews in real-time so that you can have a second opinion in real-time. We also offer medical record reviews after intensive care if you have unanswered questions if you need closure or if you are simply suspecting medical negligence and all of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected] with your questions.

Thank you for watching.

If you like my video, subscribe to my YouTube channel for regular updates for families in intensive care. Like the video, comment below what you want to see next or what questions and insights you have. Click the notification bell and share the video with your friends and family. Share it far and wide so that more families in intensive care can get help.

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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