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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
Today, I have an email from Sylvia who says,
“Hi Patrik,
I want to understand why my sister is not waking up in an induced coma. I am also fearing that ICU doctors are pressuring me to consent to no resuscitation and that my sister is not provided with best care and treatment.”
Well, thank you so much, Sylvia, for your email and it’s good that you are writing in because there’s some good answers for you, I believe I can give you.
Well, number 1, why is she not waking up from an induced coma? So, a lot of it depends on why she’s in an induced coma for or why she was in an induced coma for. What medications she was on? Was she on long-acting sedation such as Midazolam/Versed or was she on short acting sedation such as propofol? On top of that, what were the opiates that were given? Most of the time, it’s morphine or fentanyl. What was the quantity of that given?
So, for example, if your sister was on low doses of propofol and low doses of fentanyl or morphine, she should wake up quickly. That’s assuming there has been no neurological event such as a stroke, or seizures. There should be a quick waking up. Now, if on the other hand, she was on Midazolam and morphine or fentanyl, and she was in an induced coma for a long period of time, like many days or many weeks, then there are often delays. Waking up from an induced coma can be like switching on a light with a dimmer and not switching on a light with a switch.
If she’s not waking up, they need to do a neurological assessment i.e. they need to do a CT scan of the brain, they need to do an MRI scan of the brain, and they might need to do an electroencephalograph/EEG. They might also need to give some antidotes to the sedatives or opiates she’s had. If she had too much Midazolam, for example, or Versed, they need to give the antidote called flumazenil, or if she had too many opiates such as morphine or fentanyl, they need to give an antidote such as naloxone.
Also, it helps to sit up your sister, give good basic nursing care, of course, and stimulate her as much as possible, that’s assuming she doesn’t have a brain injury; you haven’t shared that. If she has a traumatic brain injury, stimulation needs to be taken very, very slowly and gently. Again, you haven’t shared anything about a brain injury.
Next, is she in kidney failure or in liver failure? Because if she is, then that might also cause a delay in waking up, especially with kidney failure. If she’s not making enough urine, does she need to go on dialysis or hemofiltration? Does she need treatment for liver failure? Those are some questions to ask when it comes to her not waking up from the induced coma.
Now, the second part of your question is you are fearing that doctors will pressure you to consent to no resuscitation. You can’t control other people, forget about it, but you are 100% in control how you respond to what other people do. So, you don’t need to respond to ICU doctors pressuring you. I assume you are the power of attorney here or next of kin, that’s what I’m reading from your email.
So, it is really up to you how you respond. You don’t need to respond to that. No one can force you to kill your sister because that is what it is in essence. Nobody can force you for that, so why would you even entertain that thought? Why would you even give in to what is perceived pressure? It’s not even real. So, it’s really up to you. You can’t blame anyone but yourself to respond to even thinking that way. No one can force you; it is up to you and your sister.
Now, to prevent that from happening, regardless, is to do an advanced care plan to begin with. For anyone watching this thinking, “Oh, how can I even prevent this going forward?” It’s a case of having an advanced care plan.
Next, you’re also worried that she’s not getting best care and treatment. Yes, that is definitely something you should be worried about, but that’s also why you need a second opinion, which is what we can give you here at intensivecarehotline.com. We talk to doctors and nurses directly. We look at medical records. Get access to the medical records as quickly as possible so we can tell you whether your sister is getting best care and treatment.
Now, I have worked in critical care for over 20 years in three different countries where I worked as a nurse manager for over 5 years in critical care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can confidently say we have saved many lives with our consulting and advocacy.
You can verify that at our testimonial section at intensivecarehotline.com or on our podcast section at intensivecarehotline.com where we’ve done some client interviews.
That’s also why we created a membership for families of critically ill patients in intensive care that we can help as many families in intensive care as possible and you can become a member if you go to intensivecarehotline.com, and you click on the membership link or go to intensivecaresupport.org directly and you become a member there. 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 that will help you to manage and steer this incredibly difficult environment that is critical care and intensive care.
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. Telegram is another medium now. I talk to doctors and nurses directly as well as to you and your families. When I talk to doctors and nurses, I make sure I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one in intensive care that will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.
I also represent you in family meetings with intensive care teams.
We also offer medical record reviews in real time so that you can get 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 suspecting medical negligence.
All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send an email to support@intensivecarehotline.com with your questions.
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Thank you so much for watching.
This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.
Take care for now.