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 frequently asked question from our readers and the question last week was
You can check out the answer to last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer another question from one of our readers and the question this week is
My 32 year old girlfriend is in ICU, she stopped breathing after Heroin overdose! She’s having seizures and is in cooling therapy, will she need long-term care?
This question from Chris is an excerpt from a 1:1 email counselling/consulting session with me.
first and foremost I would like to take this opportunity and say thank you for everything, your videos have been a huge help and your help and quick response would be much appreciated.
Ok so here’s where we start, on June 8th my girlfriend was admitted to the ICU. She had a bad Heroin habit that was the cause of all this.
On June 8th she complained about breathing problems and she asked me to take her to the Emergency Room. So I did, and we left.
On the way to the hospital maybe 3 minutes away she stopped breathing. I carried her into the Emergency Room where they were able to revive her and do CPR(=Cardiopulmonary resuscitation).
My girlfriend is 32 years old and the doctors said the CT scan has come back normal. As far as how long CPR was required I’m not 100% sure and yes she did lose oxygen to her brain for more than 3 minutes but no more than 5 minutes.
So they gave her anti-seizure meds along with Midazolam. They were able to control the seizures and started to wean her off the Midazolam.
They then did a Tracheostomy two days ago and put her on Propofol, she’s now on 28% oxygen. All her organs are working fine.
Now here we are today and the doctors don’t tell us much other than that we are going to need long term care and it’s going to take longer than expected.
My worry is the state she’s in right now. Her eyes are open she jerks her head around, moves her legs, she randomly cries or smiles. But, it’s like she doesn’t hear or see us. My question to you is does it sound like my girlfriend is in a vegetative state or could the Propofol and anti- seizure medications cause her to be doing these things? Mind you we are assuming she has been withdrawing this whole time from the heroin.
I really hope you are able to answer me the best you can. Your response means a lot to me.
Again thanks for everything Patrik.
Thanks again for sending your questions through and thank you for using my 1:1 email counselling and consulting service!
It sounds like your girlfriend is in a challenging situation, however it’s also a situation that is nothing unusual when being in Intensive Care.
Let’s break this down for you so you get a good understanding and clarity of what’s happening.
Doing hypothermic therapy is quite standard therapy in Intensive Care after cardio-respiratory arrest and subsequent CPR.
Cooling therapy is protecting the brain and other major organs.
You are assuming that your girlfriend is most likely withdrawing from Heroin and that is certainly happening or has happened, which most likely led to her having seizures. The cooling therapy might be part of the issue too and I will explain why soon.
The seizures might have been prevented by using higher doses of Midazolam(Versed) from the start as the combination of cooling/hypothermic therapy and the withdrawal from Heroin are making it all the more likely to have seizures
Midazolam is certainly helping to manage seizure activities and it’s most of the time very effective to eliminate seizures altogether.
But coming out of the cooling therapy too quickly whilst withdrawing from Heroin is almost a recipe for having seizures if the “waking up” and “warming up” after cooling therapy happens too quickly.
“Warming up” after cooling therapy needs to happen gradually and slowly, usually by 0.1-0.2 Celcius(=~32 F) per hour until a normal body temperature of ~36.5 C(~97.7F) has been achieved.
Normally the body temperature in cooling therapy is being cooled down to 32- 33C(89.6- 91.4F)
On the one hand it’s good to hear that the CT of the brain has come back normal and on the other hand it’s not so good to hear that you think there may have been more than 3 minutes of no oxygen to the brain.
More than 3 minutes without oxygen to the brain can cause irreversible brain damage and it’s also more likely to have seizures, especially when withdrawing from Heroin or other drug substances including alcohol withdrawal.
Now, sometimes the first CT scan can show no changes and therefore now that your girlfriend isn’t “waking up” it would be time to do a second CT of the brain and/or an MRI of the brain to find out if there are any changes.
I’m sure they would have also gotten some results from the EEG monitoring in terms of brain activity.
It’s good to hear that they have done a tracheostomy since there seems to be a delay in “waking up”.
Again, with your girlfriend having been in an induced coma, with your girlfriend withdrawing from Heroin as well as her having had the respiratory arrest and potentially no oxygen to the brain for more than 3 minutes it’s good to hear that she’s got a tracheostomy.
A tracheostomy will give her more time to “wake up” and it’ll also give her time to be slowly weaned off the ventilator.
Especially with a delay in “waking up” and with a delay coming off the ventilator, a tracheostomy will buy time and give your girlfriend another supporting and also “time buying” device to deal with this challenge.
It’s good to know that all other major organs are working fine, however please keep in mind that the brain isn’t working 100% and the brain is one of the major organs too.
Most of the time with head and brain injuries, “waking up” can take a very long time. Having had no oxygen to the brain for >3 minutes and having the seizures would be a “head and brain injury”, therefore be patient and let your girlfriend “wake up” in her own time.
- What happens if my critically ill loved one had a period where they had insufficient oxygen supply to the brain? What is the prognosis after the brain has not had sufficient oxygen supply(hypoxic brain injury)
- THE 10 THINGS YOU DIDN’T KNOW ABOUT SEVERE HEAD OR BRAIN INJURIES (INCLUDING TRAUMATIC BRAIN INJURY AND STROKE) IN INTENSIVE CARE THAT YOU MUST KNOW, ESPECIALLY IF YOUR CRITICALLY ILL LOVED ONE ISN’T WAKING UP OR IF THE INTENSIVE CARE TEAM IS SUGGESTING A POOR PROGNOSIS OR EVEN WORSE, IF THE INTENSIVE CARE TEAM SUGGESTS A “WITHDRAWAL OF TREATMENT” OR A “LIMITATION OF TREATMENT!”
The symptoms that you are describing Chris with
“My worry is the state she’s in right now. Her eyes are open she jerks her head around, moves her legs, she randomly cries or smiles. But, it’s like she doesn’t hear or see us. My question to you is does it sound like my girlfriend is in a vegetative state or could the Propofol and anti seizure cause her to be doing these things? Mind you we are assuming she has been withdrawing this whole time from the heroin.
Now here we are today and the doctors don’t tell us much other than that we are going to need long term care and it’s going to take longer than expected.”
You have described “waking up” after a head/brain injury/seizures as well as withdrawal from Heroin very well and again it’s nothing unusual to go through this in the way you are describing this.
But it’s not a vegetative state from what you are describing and it’s more like “work in progress”.
Again, you’ve got to give your girlfriend more time to “wake up” in her own time.
This can sometimes take many days, many weeks and sometimes many months. It’s hard to predict and again, with the tracheostomy your girlfriend has more time to “wake up” in her own time.
It’s also good to hear that they’ve changed from Midazolam(Versed) to Propofol. Midazolam is a long acting sedative and Propofol(Diprivan) is short term sedative.
That means as soon as Propofol is reduced or ceased your girlfriend should “wake up” and if she doesn’t it simply means that she’s not ready.
Midazolam(Versed) on the other hand is a long-acting sedative and it takes a lot longer to “wake up” after an induced coma.
Again, on top of the Midazolam your girlfriend had in the beginning to manage the seizures she would have also had either Phenytoin (Dilantin) or Keppra(Levetiracetam) and that would have also dampened brain activity and “waking up”!
Again, I can’t stress enough in how important it is to be patient when it comes to “waking up” after an induced coma and seizures.
It’s also a good sign that they stopped using the Midazolam for now because it’s a sign that the seizures are under control with either the Phenytoin or the Keppra.
Also keep in mind that if your girlfriend takes much longer to “wake up” and also can’t come off the ventilator and the tracheostomy, keep looking at options such as INTENSIVE CARE AT HOME. Services like INTENSIVE CARE AT HOME provide a genuine alternative to a long-term stay in Intensive Care even when Patients require ventilation with tracheostomy.
INTENSIVE CARE AT HOME is a fantastic service, providing a better quality of life for long-term Intensive Care Patients and their families in their own home as a genuine alternative to a long-term Intensive Care stay. Therefore keep an open mind of what’s possible.
You are also saying that “Now, here we are today and the doctors don’t tell us much other than that we are going to need long term care and it’s going to take longer than expected.”
It’s always difficult to predict how long it’ll take for someone to “wake up” from an induced coma especially after seizures, cooling therapy and potential brain injury.
Therefore it’s no surprise to me that the doctors would say that.
The doctors in Intensive Care and the Intensive Care team always tend to be negative and therefore you need to take everything they are saying with a grain of salt.
And most of all don’t look at what 99% of the families of critically ill Patients in Intensive Care are doing that make no informed decisions, have no peace of mind, no control, no power and no influence!
99% of the families in Intensive Care don’t second-guess and they are not questioning the Intensive Care team!
It’s good to see that you are different and it’s good to see that you are taking charge and control of the situation by getting to the bottom of things!
The doctors in Intensive Care will always refer to the worst case scenario and in your girlfriend’s case they are referring to long-term care.
Why would they do that?
Well, they do that because they don’t want to put up your hopes because it keeps them in control of the meaning of the situation if you don’t question.
If your girlfriend isn’t “waking up” it means she needs more time and the Intensive Care team in this ICU may not be prepared to give her the time because of their financial budget, because of their lack of ICU beds, staff, lack of empathy and compassion etc… the list goes on.
Most families of critically ill Patients in Intensive Care don’t look at what’s really happening in Intensive Care and they don’t look at what’s happening “BEHIND THE SCENES” in Intensive Care!
Once you know and understand what’s happening “BEHIND THE SCENES” in Intensive Care, you will become much better at interpreting everything the Intensive Care team says and what they don’t say.
- THE 10 THINGS YOU DIDN’T KNOW ARE HAPPENING BEHIND THE SCENES IN INTENSIVE CARE THAT HOLD YOU BACK FROM HAVING PEACE OF MIND, CONTROL, POWER AND INFLUENCE, WHILST YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
For them it’ll be much easier to send your girlfriend to long-term care and let them deal with Rehabilitation and “waking up”.
Your job is to advocate for your girlfriend, question the Intensive Care team and their negativity and give her the best shot of recovery whilst she is in the Intensive Care environment!
Your job is to position your girlfriend’s diagnosis, prognosis as well as her care and treatment in a light that will give her the best shot at recovery no matter how long it takes!
Your job is to make informed decisions, get peace of mind, control, power and influence really quickly and I’ve just given you most of the tools and most of the empowering you need to do that.
I hope this helps Chris, now you know what you need to focus on and you also know to look for and you have more and a better context to interpret everything the Intensive Care team is saying and not saying!
Wishing you and your girlfriend all the very best!
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?
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- 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!
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!