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 Are the Right Questions to Ask the Doctors While My Dad is Critically Ill in the 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 ICU and is ventilated. Iyah is asking why do they need to put her dad in an induced coma in the ICU.

Why Do They Need to Put My Dad in an Induced Coma in the ICU?

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

Part 1:

Part 2:

Patrik:   Hey, Iyah.

Iyah:   Hi, Patrik.

Patrik:  Okay. So, we will be talking to the ICU doctor or nurse over the phone and ask them questions regarding your dad.

Iyah:  Okay.

Patrik:  Let’s dial them in.

Remy:  Hello, this is Rey. How could I help you?

Iyah:  Hi, Rey. My name is Iyah. I’m calling for my dad, in room 98, in critical care one, just calling her. I just wanted to-

Remy:  ICU?

Iyah:  I just wanted to call in-

Remy:  Yeah.

Iyah: Yeah, regarding my dad’s condition. I have a friend on the phone, his name’s Patrik. He’s an ICU nurse by profession. We just have some questions we want to get clarifications on.

RECOMMENDED:

• Membership for families in Intensive Care

• Book your free consultation call here

• Check out our Ebooks and video

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

Remy: Okay. Yeah. And you said your name was, what?

Iyah:  Iyah.

Remy:  Iyah. Okay. Perfect, perfect. Just making sure you were on the list. Yeah, absolutely. I’m actually his nurse this evening, so you’ve got in touch with the right person.

Iyah:  Oh, good.

Remy:  And yeah, good Patrik.

Patrik:  Hi, how are you?

Remy:  Doing well. How about you?

Patrik: Very well, thank you. So you’re the nurse looking after Iyah’s dad?

Remy:  I am, yes.

Patrik:  That’s fantastic. Thank you for taking care of him. Okay, we’re just trying to understand a bit more about what he’s going through at the moment, so obviously we can make the right decision going forward.

Remy:  Absolutely.

Patrik:  I understand he’s in an induced coma at the moment, is that correct?

Remy:  Yeah. We do have him on some sedatives right now. Not a huge amount of sedatives, but he is on Precedex, Versed.

Patrik:  Right.

Suggested Links: 

• YOU DON’T KNOW WHAT YOU DON’T KNOW WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE! (PART 1)

• YOU DON’T KNOW WHAT YOU DON’T KNOW WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE! (PART 2)

• 7 days unlimited 1:1 phone consulting and advocacy

Remy:   Precedex 1.5. Versed is at 1.5 as well.

Patrik:  Right.

Remy:  So not too much sedation, but he is withdrawing, but that’s about it.

Patrik: Right. So really, not waking up at the moment.

Remy:  Yeah. No. You said you were an ICU nurse for a while?

Patrik: Yeah. I’ve worked in ICU for 20 years, so I do have a fair good understanding of what’s happening.

Remy:  Awesome. I just wanted to make sure I wasn’t giving you too much or too little information.

Patrik: No, no, no. I will ask.

Remy:  You let me know if I’m… Yep, perfect, perfect.

Patrik:  Yeah, no, that’s great. That’s great. Why is he sedated at the moment? Is it just breathing tube/endotracheal tube intolerance? What is it that’s keeping him in that place?

Remy:  It is tube intolerance. It’s tube intolerance. Sorry, I’ve been running around just to give you all the right stuff. Yeah, so it is tube intolerance for the most part, and just asynchrony.

Patrik: And asynchrony. Right. Right, I see.

Remy:  Yep, yep, just to make he’s on ventilator synchrony.

Patrik:  Right. Well there are no issues from a neurological point of view? Brain is intact as far as you’re aware?

Remy: He is still giving me pupillary reactions, some gag. They’re probably acute metabolic encephalopathy-

Patrik: Right.

Remy:  … is kind of what we’re looking at with that. However, he has had periods of agitation, so we’ve been having to give Zyprexa once or twice, but it was working, and went well. And then he does have that baseline previous stroke on-

Patrik:  Yes. Yes. Yes.

Remy:  … The other thing, yeah, the right side is weaker in everything.

Iyah:   The left side is yeah? The left side is weaker.

Remy:   Yeah, left. Left, yes.

Patrik:  Right, I see. And what happens-

Remy:  Yeah left side, yeah. The left side moves, and then the right side… Sorry, sorry, yeah, yes, withdraw is the left side, and the right side is block.

Patrik:  And what happens if you take sedation off, is he still breathing against the ventilator is he?

Remy:  Yes. Yeah. And we have been doing daily awakening trials for minutes to make him … But yeah, he’s still been needing the sedation.

Patrik: I see. I see. Okay. And with the metabolic encephalopathy, what do you relate that back to? Where’s the metabolic disturbance coming from?

Remy: The metabolic encephalopathy?

Patrik:  Yes.

Remy: Is that what you’re asking? The phone is not very-

Patrik:  Yes, yes.

Remy:  Yeah. So it’s definitely partially related to just the medication he’s getting and secondary metabolites. But he is also experiencing fluid overload, he’s anuric with renal failure, so he’s still having all of the stuff, not excreting it.

Patrik:  Oh, okay.

Remy:  We have him on dialysis, but even so, that stuff does build up. Yeah, because he’s totally anuric, he’s not putting anything out on his own.

Patrik: Right. That makes sense.

Suggested Links: 

• WHAT IS AN INDUCED COMA AND WHY IS MY CRITICALLY ILL LOVED ONE IN AN INDUCED COMA?

• WHAT HAPPENS IF MY CRITICALLY ILL LOVED ONE CAN’T BE WEANED OFF THE VENTILATOR?

• “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!” 

Remy:  And then, he did have a positive blood culture today. They’re poked it out further, with some gram-positive cocci.

Patrik: Right.

Remy:  So, it could possibly be related to sepsis and things like that with it as well.

Patrik: Of course. Of course. And with him being anuric, is he on dialysis, or on hemofiltration?

Remy: Yes. Yes.

Patrik: Right.

Remy:  Yes, he’s on hemodialysis. Yep.

Patrik:  Right. Okay. Okay, that’s great. That’s great. And then, so moving along, is he hemodynamically stable?

Remy: He’s doing all right hemodynamically. His last blood pressure was 125 over 62, heart rate up in the 80s, up to 90, so a little bit tachycardic earlier today, at 129. But mostly hemodynamically looking all right.

Patrik:  No vasopressors, no inotropes?

Remy:  No, no pressors on right now. He was getting some norepinephrine, until the 22nd.

Patrik:  Right. Okay, that’s great. And with the infection/sepsis, does he have a temperature?

Remy:  He did, two days ago.

Patrik: Right.

Remy: His most recent was 99.4, so right on the edge.

Patrik: Right.

Remy:   So, nothing too high, but it’s still definitely a low fever.

Patrik: Sure. And his white cell count is off, or normal?

Remy:  His most recent white cell is actually looking pretty okay at 7.3.

Patrik:  Okay.

Remy:  But yeah…

Patrik:  So really, that doesn’t sort of indicate there is a sepsis. I mean, you mentioned earlier gram-positive cocci. I mean, if his white cell count is fine, he’s afebrile, he’s not on pressors, not a real septic picture, is it?

Remy:  No. It would be the beginning.

Patrik: Right.

Remy:  It’s not, yeah, full-blown. It’s just we’re seeing that, so we have his own broad-spectrum, and dialysis right now. For the cultures, we’re going to get to something more specific.

Patrik: Right. I see. I see. And with the blood results in general, are there any concerns with other blood results, like hemoglobin, or… I would imagine urea and BUN (Blood Urea Nitrogen) would be off?

Suggested Links:

• INTENSIVE CARE’S HIDDEN SECRETS AND MYTHS BEHIND THE SCENES, THAT THE INTENSIVE CARE TEAM KEEPS AWAY FROM YOU AT ANY COST AND OTHER FAMILIES OF CRITICALLY ILL PATIENTS HAVE NO CLUE ABOUT THOSE HIDDEN SECRETS!

• THE 3 WAYS ON HOW TO TURN THE TABLES IN YOUR FAVOUR AND HAVE CONTROL, POWER AND INFLUENCE WHILST YOUR LOVED ONE IS CRITICALLY ILL 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!

Remy:  Yeah, yeah, creatinine’s 2.9, BUN’s at 79. And then, a little low on his sodium, 135. Calcium is a 5.2. Magnesium and phosphorus is 5.7. So, of course with those, that’s why we’re doing the dialysis, trying to clean it out.

Patrik:  Yes. Yes.

Remy:  Yeah, and then his hemoglobin and hematocrit is 8.5 and 26, so on the low side, but still functional.

Patrik: Right. I see. And the hemoglobin is stable?

Remy: Yeah. Let me look at the full trend here.

Patrik:  Thank you.

Remy: Yeah, of course, of course. It actually is looking a little better. It was at 7.2 as of the morning of the 24th, and then the morning of today it was at 8.5.

Patrik:  Right. Okay. Okay.

Remy:  And that was after around of HD (Hemodialysis), so some fluid off. It was probably delusional anemia a little bit too.

Patrik:  Right, right, right. Yes, of course. Of course. So trending downwards a little bit. But has he had any blood transfusions in recent days?

Remy:  Let me double-check. The outgoing nurse didn’t mention anything, but I will just make sure. It looks like the last one was completed on the 11th, so yeah, nothing recent.

Patrik:  Nothing… Okay, that’s great. That’s great.

Iyah:  Oh, actually, I’m sorry, sorry. I do recall a couple days ago he did have a blood transfusion of red blood cell.

Remy:  Let me get through the whole documentation in here. Do you remember what day that was mentioned to you?

Iyah:  A couple days ago, but I recall that. I’m trying to go back to another one so that…

Remy:  Yeah, no, for sure, for sure. I’m going to get to the day.

Iyah:  Yeah it’s Friday.

Remy:  Friday?

Iyah:  Right.

Remy:  Let me take a quick prick for the-

Iyah:   blood gas.

Suggested Links: 

• THE 7 THINGS FAMILIES DO WHO MAKE INFORMED DECISIONS HAVE PEACE OF MIND, ARE IN CONTROL, HAVE POWER AND HAVE INFLUENCE, WHILST THEIR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE (PART 1)

• FOLLOW THIS PROVEN 6 STEP PROCESS, ON HOW TO BE POWERFUL, IN CONTROL, INFLUENTIAL AND HAVE PEACE OF MIND, IF YOUR LOVED ONE IS A LONG-TERM PATIENT IN INTENSIVE CARE OR IS FACING TREATMENT LIMITATIONS IN INTENSIVE CARE!

• HOW TO WEAN OFF VENTILATION AND TRACHEOSTOMY STEP BY STEP! TRACHEOSTOMY AND WEANING OFF THE VENTILATOR IN INTENSIVE CARE, HOW LONG CAN IT TAKE?

Remy:  Sorry, it is taking a moment to load up-

Patrik:  That’s okay. Thank you. Thank you.

Iyah: No worries. No worries.

Remy:    Looks like on the 23rd we gave him some…

Patrik: Right. Right. Okay.

Iyah:  It was on the day of the 23rd also.

Remy:  Yeah. Yeah.

Iyah:  I think it was in the morning.

RECOMMENDED:

• 1:1 Email counselling and consulting with Patrik

• 7 days unlimited 1:1 phone consulting and advocacy

• Membership for families in Intensive Care

• 1:1 phone and email counselling and consulting with Patrik

Remy:  Just to inform you, I’m writing down the most recent… Yeah, on the 23rd we gave some platelets.

Patrik:  Okay. And can I just ask, so with the sedatives that he’s on, what ventilation settings is he on at the moment?

Remy:  He is on VC/AC (Volume Control/Assist Control Mode), with CMV (Continuous Mandatory Ventilation).

Patrik:  Yeah. And FiO2 (Fraction of Inspired Oxygen)?

Remy:  FiO2 right now is running at 50, PEEP (Positive End Expiratory Pressure) of 10.

Patrik:  Yep.

Remy:   Rate is set at 16, but he is over breathing. Last hour he was up at 24. He’s been up in the mid-20s all day.

Patrik: Right. And target volumes (Tidal Volumes) are adequate for what you’re looking for?

Remy:  Yeah. He’s set to 380 right now, and it hasn’t been too much lower than that, 350 to 380 is right around where we’re seeing.

Patrik:  Right. And you’re happy with the ABGs (Arterial Blood Gas)?

Remy:   Let me look up yesterdays.

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!

Related Articles:

• What is an induced coma and why is my critically ill loved one in an induced coma

• How LONG does it take to WAKE UP after an induced coma?

• How LONG can someone stay in an INDUCED COMA?

• How long can you keep a critically ill Patient in Intensive Care in an induced coma

• How long can a breathing tube or an endotracheal tube can stay in

• The 10 COMMANDMENTS for PEACE OF MIND, control, power and influence if your loved one is critically ill in Intensive Care

• Tracheostomy and weaning off the ventilator in Intensive Care, how long can it take?

• Why do doctors in Intensive Care insert a Tracheostomy after an induced coma?

• How long should a Patient be on a ventilator before having a Tracheostomy?

• Why does my loved one need a Tracheostomy in Intensive Care

• What could be the cause if my critically ill loved one is removed from an induced coma but still hasn’t woken up?

• My 80 year old father is in Intensive Care with Myeloma! The Intensive Care team HAS ASKED ME TO SIGN A “DNR” AND I REFUSED! What are MY OPTIONS?

• 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

• The 5 questions you need to ask when the Intensive Care team is talking about “Futility of treatment”, “Withdrawal of life support” or about “Withdrawal of treatment”

• HOW TO STOP BEING HELD HOSTAGE BY THE INTENSIVE CARE TEAM if your loved one is critically ill in Intensive Care!

• HOW TO CONTROL YOUR POSITIVE SELF- IMAGE whilst your loved one is critically ill in Intensive Care

• How long does it take to wake up from a Traumatic brain injury or severe head injury

• 5 POWERFUL THINGS YOU NEED TO DO IF THE INTENSIVE CARE TEAM IS NEGATIVE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!

• Does my critically ill loved one in an induced coma or with head injuries feel my presence?

• My 25 year old wife has been in ICU for one month with Tracheostomy and is still in an induced coma

• My Mum has been diagnosed with STOMACH CANCER and is in ICU ventilated. CAN I TAKE HER HOME on a ventilator?

• The questions you need to ask the most senior doctor in Intensive Care, if your loved one is critically ill in Intensive Care

• A 5 step BLUEPRINT for DYING WELL and with DIGNITY in Intensive Care

• How long does it take for my critically ill loved one to be taken off the ventilator and have their breathing tube/ endotracheal tube removed

• Why you must make up your own mind about your critically ill loved one’s situation in Intensive Care even if you’re not a doctor or a nurse!

• The ELEPHANT IN THE ROOM or HOW THE INTENSIVE CARE TEAM IS MAKING DECISIONS whilst your loved one is critically ill in Intensive Care!

• MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! THE INTENSIVE CARE TEAM WANTS TO DO A TRACHEOSTOMY AND I WANT TO HAVE HIM EXTUBATED! WHAT DO I DO?

• 5 ways you are UNCONSCIOUSLY SABOTAGING yourself whilst your loved one is CRITICALLY ILL in Intensive Care and HOW TO STOP doing it!

• How to make sure that “what you see is always what you get” whilst your loved one is critically ill in Intensive Care

• 5 steps to become a better negotiator if your loved one is critically ill in Intensive Care

• 5 Ways to have control, power and influence while your loved one is critically ill in Intensive Care

• 6 phrases you should never say when your loved one is critically ill in Intensive Care

• How to REPROGRAM YOUR MIND if your loved one is critically ill in Intensive Care

• How to play a “HIGH STAKES GAME” that only the Intensive Care team knows HOW TO WIN!

• Family overjoyed as top court rules doctors must seek consent before taking a patient off life support

• How to make sure that your values and beliefs are known whilst your loved one is critically ill in Intensive Care

• My loved one has HIV, lymphoma on his brain, seizures, septic and is ventilated! The Intensive Care team is trying to TAKE MY HOPE AWAY and they are all NEGATIVE! HELP!

• MY PARTNER IS IN INTENSIVE CARE AFTER A BLEED ON A BRAIN! WE ARE WORRIED THAT THE INTENSIVE CARE TEAM WANTS TO SWITCH OFF THE VENTILATOR! HELP!

• CAN YOU GO HOME ON A VENTILATOR?

• HOW TO DEAL WITH A DIFFICULT INTENSIVE CARE TEAM, WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!

• DISRUPT before you are being DISRUPTED, whilst your loved one is critically ill in Intensive Care!

• HOW TO STAY STRONG WHILST YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!”

• What the doctors and the nurses behaviour in Intensive Care is telling you about the culture in a unit

• How to take control if your loved one has a severe brain injury and is critically ill in Intensive Care

• Family Meetings in Intensive Care or the Elephant in the Room

• How can I be prepared, be mentally strong and be well positioned for a Family meeting with the Intensive Care team?(PART 1)

• How can I be prepared, be mentally strong and be well positioned for a Family meeting with the Intensive Care team?(PART 2)

• The four DEADLY SINS that Families of critically ill Patients in Intensive Care CONSTANTLY MAKE, but they are UNAWARE OF!

• My HUSBAND had a HORRIBLE work accident and went into CARDIAC ARREST! Will he be PERMANENTLY DISABLED

• HOW TO GET AN UNFAIR ADVANTAGE whilst your loved one is critically ill in Intensive Care!

• How to MUTE your NEGATIVE INNER DIALOGUE whilst your loved one is critically ill in Intensive Care!

• Why decision making in Intensive Care GOES WAY BEYOND your critically ill loved one’s DIAGNOSIS AND PROGNOSIS!

• How to STOP being INTIMIDATED by the Intensive Care team and how you will be SEEN as EQUALS

• WHAT HAPPENS IF MY CRITICALLY ILL LOVED ONE CAN’T BE WEANED OFF THE VENTILATOR?

• The 4 ways you can overcome INSURMOUNTABLE OBSTACLES whilst your loved one is critically ill in Intensive Care!

• How to get PEACE OF MIND, more control, more power and influence if your critically ill loved one is DYING in Intensive Care!

• CAN I TAKE MY LOVED ONE HOME ON A VENTILATOR TO DIE?

• The 5 ways how RESILIENT FAMILIES in Intensive Care STAND BACK UP when life knocks them down!

• Five STRAIGHTFORWARD ways to improve Family satisfaction in Intensive Care

• The 5 QUESTIONS you need to ask, if the Intensive Care team wants you to DONATE your loved one’s ORGANS in an END OF LIFE SITUATION!

• MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! THE INTENSIVE CARE TEAM WANTS TO DO A TRACHEOSTOMY AND I WANT TO HAVE HIM EXTUBATED! WHAT DO I DO? (PART 1)

• How MEDICAL RESEARCH DOMINATES your critically ill loved one’s diagnosis and prognosis, as well as the CARE and TREATMENT your loved one IS RECEIVING or NOT RECEIVING

• 5 things NOBODY HAS EVER TOLD YOU about Intensive Care

• WHAT WOULD YOU DO if you knew that you COULD NOT FAIL, whilst your loved one is critically ill in Intensive Care

• How the Intensive Care team is SKILFULLY PLAYING WITH YOUR EMOTIONS, if your loved one is critically ill in Intensive Care!

• My father is in Intensive Care ventilated with LIVER FAILURE and KIDNEY FAILURE, I DON’T THINK HE WILL SURVIVE! HELP

• HOW TO GIVE YOURSELF PERMISSION TO HAVE PEACE OF MIND, CONTROL, POWER AND INFLUENCE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!

• My father has been weaned off the ventilator in Intensive Care and still has the Tracheostomy in. When can the Tracheostomy be removed?

• HOW LONG DO YOU NEED TO BE ON A VENTILATOR AFTER A LUNG TRANSPLANT

• HOW LONG can a critically ill Patient stay on ECMO?

• THE ULTIMATE FASTLANE TO PEACE OF MIND, CONTROL, POWER AND INFLUENCE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!