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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So today, I had a phone call with a client who has their 82-year-old father in intensive care. He’s been in intensive care for about nine days now after cardiac arrest. And he’s been in an induced coma. They tried to wake him up a number of times, but so far, he hasn’t woken up. So, one of my questions that I had is, if they have done a CT scan of the brain or an MRI scan of the brain? And he said, “No”, and I said, “Well, if they stopped sedation, he hasn’t woken up, well, they need to find out whether there has been a neurological event such as a stroke, God forbid, or anything else.” And the family hadn’t even considered that, and the ICU team hasn’t even told them that.

Again, it keeps coming back to what I keep saying over and over again that 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.

Coming back to our client, other things that I asked the client is, was his father in cooling therapy? Because he had an in-hospital arrest and most patients in a cardiac arrest situation, they have cooling therapy to protect organs, especially after cardiac arrest, and he wasn’t sure whether his father had cooling therapy or not.

Also, his father was at home on a BIPAP (Bilevel positive airway pressure) machine. He has a history of COPD (Chronic obstructive pulmonary disease) and I said to the client that that may make his weaning off the ventilator prolonged and more difficult. At home he was on a BIPAP of 10 over 28. That’s a fairly high BIPAP setting, and that might be very challenging for his father to get off the ventilator. He might need a tracheostomy as the next step to give him time to wean off the ventilator, and he might need the BIPAP even with a tracheostomy in the long run, depending on how this is going.

Now, other issues you need to consider when someone is having a cardiac arrest in ICU or is in ICU after cardiac arrest and is not waking up even though sedation had been switched off, are such issues like what sedation is your loved one getting? Are they getting short-acting sedation such as propofol? Are they getting long-acting sedation such as midazolam or Versed? Are they getting opiates such as morphine or fentanyl? And depending on how much they’re getting, depending on how long they’re getting it, there may be a delay in waking up simply by getting too many sedatives and opiates.

Other things that need to be considered is kidney and liver function. If the kidney and liver function is impaired, it might also take longer to wake up after an induced coma because simply opiates and sedatives are still in the body system and are not metabolized or excreted through the kidneys.

Now, other issues that need to be considered after cardiac arrest, potentially with a fairly long downtime is, are there any seizures? So, from what the client has been telling me is they switched off sedation for quite some time. His dad wasn’t waking up but there was no seizure activity, which is a good sign, of course. Even though he’s on Keppra which is an anti-epileptic medication, that’s often-given prophylactic in situations like this to prevent any seizures. But again, the family has not been told that seizures are a risk after cardiac arrest and potential hypoxic or anoxic brain injury. And they have also not been told that Keppra has been given as prophylaxis. And also, that Keppra also has a mild sedative effect. So, that might also delay his dad waking up.

Other things that need to be considered are like if his dad was in cooling therapy, that sometimes, patients get paralyzed. They get chemically paralyzed with paralyzing agents because when patients are cooled down, patients might start shaking, and that might trigger seizures. So, one way to prevent that from happening is to paralyze patients on top of them being in an induced coma. If that’s happening, that might also delay the waking up process from my experience.

So, I hope that helps to illustrate what to look for after cardiac arrest, what questions to ask when your loved one is in intensive care. There are many other things that I don’t want to go into too much detail now, such as, ventilator settings, medications that are given, blood results, arterial blood gas results in particular. But I hope that gives you a good framework what to look for, what to ask if your loved one is in a similar situation. I hope that helps.

If you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website, or simply send us an email to [email protected] with your questions.

Also, have a look at our membership for families in intensive care, intensivecaresupport.org. There, you have access to me and my team, 24 hours a day, in a membership area and via email, and we answer all questions intensive care related.https://www.youtube.com/channel/UCFMAw7gyY0cJxrDSTCYIEYA

If you need a medical record review (242), please contact us as well. We review medical records in real time for patients in ICU and also after ICU especially if you have unanswered questions, if you need closure, or if you’re suspecting medical negligence. But it’s much better to review them in real time so you can get a second opinion in real time.

Subscribe to my YouTube channel for regular updates for families in intensive care, share the video with your friends and families, click the like button, click the notification bell, and comment below what questions and insights you have, and then I’ll talk to you in the next video.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com and I’ll talk to you in a few days.

Take care.