Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!

This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from our readers and the question was

What To Expect During the Family Meeting for My Dad in ICU?

You can check out last week’s question by clicking on the link here.

In this week’s episode of “YOUR QUESTIONS ANSWERED”  I want to answer questions from one of my clients, Iyah, as part of my 1:1 consulting and advocacy service! Iyah’s dad is in the ICU and she is asking how to stay positive whilst their dad is in the ICU, ventilated with pneumonia. 

How to Stay Positive Whilst our Dad is in the ICU, Ventilated with Pneumonia?

You can also check out previous 1:1 consulting and advocacy sessions with me and Iyah here.

Part 1

Part 2

Part 3 

Part 4

Part 5

Part 6

Part 7

Part 8 

Iyah:  We’re still waiting for Mom to be joined via Zoom, and also my younger brother via Zoom.

Dr. Shelby:  Do you want to start without them, or wait a little bit more?

Arlene: Call Liza.

Michael: Liza? You’re going to call Liza?

Arlene:  Yeah, she told me to.

Iyah:  Why don’t we just do a call speakerphone?

Michael:   Yes.

Iyah:   There’s no need for her to see anything.

Michael:   Yeah, she would like the speakerphone thing.

Iyah:  Because it’s too much to do with Zoom.

Iyah:  While we have my friend, Patrik, on the line, Patrik, would you like to introduce yourself to Dr. Shelby?

Patrik: Yeah, sure. Thank you. Thanks Iyah. Look, I’m a family friend, and I do have a background in critical care nursing. So I’m trying to help the family making sense out of what’s happening, and trying to help them to make a decision that probably best for their dad.

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• If you want a medical record review, please click on the link here 

Dr. Shelby:  Thank you for helping.

Arlene:  Yeah, greatly appreciate you, Patrik.

Patrik:  Yeah, sure, sure.

Arlene:  Liza’s in?

Michael:  Yes, Liza’s here now.

Liza:  So, yeah, I’d just like to say, I’ve listened to Patrik and I really respect his experience and what he has to say. I really think invaluable insight into how ICU units work, and where we can go from here.

Dr. Shelby:  Yeah, great. So to introduce myself, my name is Dr. Shelby, I’m with the palliative care team, and we’re a consult service here in the hospital. And our role is to help patients and families who are going through really serious illnesses try to figure out what care makes the most sense, what the future may be like-

Iyah:  oh yeah?

Dr. Shelby:   … and what to do in case of emergencies that may come up. And so we had a consult regarding your dad’s care, and does one of you want to give me your understanding of what brought your dad into the hospital, and what’s happened since then, just so I know that we’re all on the same page?

Iyah:  Yeah, it started off with neck pain the night prior to going to the ER (Emergency Room), Tuesday night.

Arlene:  Oh, was it?

Iyah: He was up all night, did not get any sleep. He was complaining about not having comfort, his neck was hurting really bad. So I kept helping him with icing and trying to get him a little more comfortable. This was from midnight all the way to-

Iyah:  And then I had to go to sleep. So then I wake up around 7:00 AM and he’s still complaining about neck pain, he hasn’t slept at all.

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• “FOLLOW THIS ULTIMATE 6 STEP GUIDE FOR FAMILY MEETINGS WITH THE INTENSIVE CARE TEAM, THAT GETS YOU TO HAVE PEACE OF MIND, CONTROL, POWER AND INFLUENCE FAST, IF YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!”

• FOLLOW THIS PROVEN SYSTEM TO AVOID THE 3 MOST DANGEROUS MISTAKES YOU ARE MAKING BUT YOU ARE UNAWARE OF, IF YOUR LOVED ONE REQUIRES LONG-TERM VENTILATION WITH TRACHEOSTOMY IN INTENSIVE CARE!

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Iyah:  And then he said that he couldn’t breathe a couple of hours later, and when he couldn’t breathe we started giving him his asthma inhaler, and also the powdered asthma. So we just kept giving him his medicines to assist him, and none of them was helping him. So by 9:00 AM we had to call the ambulance. And he came to the ER.

Dr. Shelby:  And what was he diagnosed with, since he arrived here at the hospital?

Iyah:   He was not diagnosed with anything initially, so he came 9:00 AM at the ER, and he was given oxygen through the oxygen tank, through the nostril. I don’t recall what his O2 saturation-

Arlene:  Yeah, his diagnosis was, that he had neck pain from-

Michael:  He said because he was sitting down in his chair, that’s when he got that pain, so they discharged him around 6:00 PM, and that’s when I went there, I stayed around 7:00 and 8:00-

Arlene:  … stooping down. That was the diagnosis from the hospital, that discharged him, the ER.

Michael:   … debating while go back to the ER. Eventually tried to get him in my car, could not get him in there comfortably, so I called the ambulance to come get him. And that’s when that following night I was with him in the ER until about 3:00, my sister relieved me.

Arlene:    3:00 AM.

Michael:   And they gave him the mask, oxygen, while I was there with him the whole time.

Iyah:   That covered his nose and his mouth.

Ron:  The BiPAP (Bilevel positive airway pressure).

Iyah:   Yeah, and that caused a lot of discomfort for him because he was pleading for water, but he had fluid overload so he couldn’t drink any water. And his oxygen saturation was between 86 to 91. So, initially when he was discharged from the ER that evening the doctor did mention about some fluid in the lungs (pleural effusion), but he didn’t have any concerns about it, and because he didn’t have any concerns about it I didn’t really think to ask any questions about it. What his concerns were, his oxygen saturation was at 91, and I told him, I check his O2 saturation with the finger oximeter, is that what it’s called?

Dr. Shelby: Pulse oximeter?

Iyah:  Yeah, that. And every now and then I’d see 88, I’d see low 90. So, I did tell the doctor that doesn’t seem unusual, I’ve seen that number before. So then he said, “Well, we’re going to discharge him then.” And I should have stopped him there and said, “Let’s not. Let’s send him to a room or something and further check.”

Dr. Shelby:  Hard to know. These things change from minute to minute, so it can be hard to know.

Iyah:   And also with the doctor saying that he had fluid in his lungs, that should have been a red flag to me as well. But I’ve heard that before, when he had fractured ribs back in July of this year, he had fluid in his lungs as well, and the urgent care doctor didn’t really have concerns. He had checks at x-ray, but there was no concerns, and said, “It doesn’t seem emergency.” So I’ve heard it before, that’s why, again, didn’t throw a red flag at me.

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• The 5 reasons why you should not trust the Intensive Care team blindly if your loved one is critically ill in Intensive Care

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• “PEACE OF MIND, CONTROL, POWER AND INFLUENCE EVEN IN THE MOST CHALLENGING OF CIRCUMSTANCES THAT YOU, YOUR FAMILY AND YOUR CRITICALLY ILL LOVED ONE COULD POSSIBLY FACE IN INTENSIVE CARE!”

Dr. Shelby:  That’s fine. Well I’ll jump ahead a little bit. So from my understanding, he has longstanding history of end-stage renal disease.

Iyah:  Say that again, please.

Dr. Shelby:  He has a longstanding history of end-stage renal disease?

Iyah: Yes.

Dr. Shelby:   He had a transplant in 1998.

Iyah:   Yep, 23 years transplant.

Dr. Shelby:  Which is incredible, and he’s been on immunosuppression that whole time. Age history of atrial fibrillation, coronary artery disease and a prior stroke a few years ago with some persistent left-sided weakness. And also some mitral valve stenosis, so narrowing of one of the heart valves. And you’re right, when they-

Iyah:  Is there a heart valve that you can specify?

Dr. Shelby:  The mitral valve.

Iyah:  Mitral, yeah.

Dr. Shelby:  Mitral valve stenosis.

Iyah:  I don’t know anything, is that upper or lower?

Dr. Shelby:  So it’s the lower left. So it’s the valve that goes from the left atrium to the left ventricle.

Iyah:  And is it output or input?

Dr. Shelby:  It’s narrowed, so it’s just harder to get blood flow through that valve. So it usually causes backup pressure to the lungs, in the left atrium.

Liza:  So, my question about this narrowing of her valve, is it because she has been active? Or is it a build up-

Dr. Shelby:  It can happen just over time as you get older. There’s not usually a clear specific cause unless there’s a prior illness that may have led to it, but oftentimes it just happens. Depending on the severity, I don’t know what the severity of how narrow it is. Sometimes there are remedies that cardiology can do, but they wouldn’t do them when he’s so ill, what he is right now, so it’d have to be assessed later on in the future. But right now it’s not the top concern.

Iyah:  Correct.

Ron:  It isn’t a matter of stretching it out, it’s not like putting a stent or a balloon and stretching out an artery that has filled up with plaque, it would have to be actually replaced with probably either a pig valve or an artificial valve. Because it has to open and close.

Liza:  Okay. Good to know, thank you.

Dr. Shelby:  So, came in, and from our records, came in with sepsis. So low blood pressure-

Iyah: That’s as of four days ago?

Dr. Shelby:  Or when he came in the hospital-

Iyah:  No.

Dr. Shelby:  … after that time.

Suggested Links: 

• THE 5 THINGS FAMILIES DO WHO HAVE PEACE OF MIND, ARE IN CONTROL, FEEL POWERFUL AND INFLUENCE DECISION MAKING FAST, WHILST YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!

• FOLLOW THIS PROVEN SYSTEM TO AVOID THE 3 MOST DANGEROUS MISTAKES YOU ARE MAKING BUT YOU ARE UNAWARE OF, IF YOUR LOVED ONE REQUIRES LONG-TERM VENTILATION WITH TRACHEOSTOMY IN INTENSIVE CARE!

• FOLLOW THIS PROVEN SYSTEM TO AVOID THE 3 MOST DANGEROUS MISTAKES THAT YOU ARE MAKING, BUT YOU ARE UNAWARE OF, IF YOUR LOVED ONE IS A CRITICALLY ILL PATIENT IN INTENSIVE CARE!

Iyah:   I’m sorry, what date are you talking about?

Dr. Shelby:   Well, when he first got admitted.

Iyah:   He didn’t-

Jane:  … I’m sorry, what date are you talking about?

Dr. Shelby:  When he first got admitted.

Iyah:  He did not have sepsis.

Ella:  No, there was no sepsis.

Iyah:  Pneumonia.

Ron:  But pneumonia can also cause sepsis. Did he have low blood pressure?

Iyah:  No.

Ella:  His blood pressure was high.

Iyah: No. I didn’t see any of that.

Ella:   High white …

Iyah:  He had high white blood count.

Ron:  Yeah.

Iyah: Iron, right?

Ron:  I believe it was probably early stages.

Iyah: But then again, he did have steroid injections, cortisol injections on his right thumb and also on his right bottom foot for some things back-to-back weeks.

Ron:  Right.

Iyah: Two weeks prior.

Dr. Shelby:  But regardless, he had abnormal vitals and labs that we call sepsis. And when there’s an infection, that’s tied to that, that’s sepsis related to an infection. But he was put on IV (intravenous) antibiotics. He ended up needing to be intubated. He’s been on a ventilator for a few weeks now. He’s been back on antibiotics for the last few days as well since the 23rd.

Iyah: Because of a new bacteria.

Dr. Shelby:  Possibly.

Iyah: No, that’s what it is. He had a low-grade fever.

Ron:  Well, it could be the same one he had before.

Iyah:  Oh, it could have been the same.

Ron:  We don’t know what it is yet. But it’s a-

Iyah:  But the culture grew-

Ron:  Yeah.

Iyah:    … unlike the culture from her-

Ron:  It’s been the gram stains.

Iyah:  … initial-

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Ron:   Right. But that’s just a stain. Now, they have to grow it to see what it is.

Iyah:   But this is the first time something grew. Is that correct? Because-

Ron:   We don’t know. We don’t know yet.

Iyah:   Because of the very first culture that you guys got from his respiratory, nothing grew.

Ron:  Yeah.

Iyah:   But this one recently, after Tuesday of last week, because that’s when his low grade fever was, that one grew, the gram positive.

Ron:  That’s not a grow. That’s a stain.

Iyah:   It’s a stain.

Ron:   The gram stain is just putting a dye in the blood to be able to see the foreign living thing, bacteria.

Iyah:  Oh, okay.

Ron:  Because it is hard to see under a microscope. So we put a dye in there. And it’s called a stain instead of called a dye.

Iyah:  And the colors will indicate the type of-

Ron:  So yeah. Yeah.

Iyah:  … treatment needed.

Ron:  Yeah, it’s either positive or negative. And then it also, once you get them stained, you also can see a shape.

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Iyah:   Yeah.

Ron:   So he had gram-positive cocci, and now, we know there’s something in there. That’s all we know. Now, they’re trying to grow it.

Iyah:  Okay.

Dr. Shelby:   So it could be new, it could be recurrent that was not fully treated the first time. It’s hard to say for sure.

Iyah:  Okay.

Patrik:  Can I just ask you? So that’s in the blood or…

Ron:  Yes, he had positive blood-

Patrik:   Right.

Ron:  Yeah.

Patrik:    Okay.

The 1:1 consulting session will continue in next week’s episode.

How can you become the best advocate for your critically ill loved one, make informed decisions, get peace of mind, control, power and influence quickly, whilst your loved one is critically ill in Intensive Care?

You get to that all important feeling of making informed decisions, get PEACE OF MIND, CONTROL, POWER AND INFLUENCE when you download your FREE “INSTANT IMPACT” report NOW by entering your email below!

In Your FREE “INSTANT IMPACT” report you’ll learn quickly how to make informed decisions, get PEACE OF MIND, real power and real control and how you can influence decision making fast, whilst your loved one is critically ill in Intensive Care! Your FREE “INSTANT IMPACT” Report gives you in-depth insight that you must know whilst your loved one is critically ill or is even dying in Intensive Care!

Sign up and download your FREE “INSTANT IMPACT” REPORT now by entering your email below! In your FREE “INSTANT IMPACT” REPORT you’ll learn how to speak the “secret” Intensive Care language so that the doctors and the nurses know straight away that you are an insider and that you know and understand what’s really happening in Intensive Care! In your FREE report you’ll also discover

• How to ask the doctors and the nurses the right questions

• Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests

• How to Eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying

• 5 mind blowing tips & strategies helping you to get on the right path to making informed decisions, get PEACE OF MIND, control, power and influence in your situation

• You’ll get real world examples that you can easily adapt to you and your critically ill loved one’s situation

• How to stop being intimidated by the Intensive Care team and how you will be seen as equals

• You’ll get crucial ‘behind the scenes’ insight so that you know and understand what is really happening in Intensive Care

• How you need to manage doctors and nurses in Intensive Care (it’s not what you think)

Thank you for tuning into this week’s YOUR QUESTIONS ANSWERED episode and I’ll see you again in another update next week!

Make sure you also check out our “blog” section for more tips and strategies or send me an email to [email protected] with your questions!

Also, have a look at our membership site INTENSIVECARESUPPORT.ORG for families of critically ill Patients in Intensive Care here.

Or you can call us! Find phone numbers on our contact tab.

If you want a medical record review, please click on the link here.

Also check out our Ebook section where you get more Ebooks, Videos and Audio recordings and where you can also get 1:1 counselling/consulting with me via Skype, over the phone or via email by clicking on the products tab!

This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!

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