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 in this series of questions from our client Robert and the question last week was PART 2 of
You can check out last week’s episode by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer the next question from our client Robert, which are excerpts from email counselling and consulting sessions with me and the question this week is
My 68 year old mother is in ICU with gastric perforation and she’s not “waking up” after the surgery! Will she need a tracheostomy? (PART 3)
Robert describes his mother’s situation as follows with those series of questions.
thank you very, very much for your thoughtful answers.
So far, her vital signs are looking stable.
Questions for you: The hospital is xxxxxx Hospital (ranked as one of the best hospitals in the U.S.). But, it is a teaching hospital, and as such, the consent form states that they can have a resident actually perform the tracheostomy — but with the attending surgeon present at all times. Is it reasonable/advisable for us to require/mandate that the actual operation be performed by the attending? Is that even an option?
By the way, a couple of answers to some of your previous questions:
- My mother is 68 years old.
- She’s diabetic
Still trying to find out which sedatives she was on as part of the surgery last week.
Here is my response
I know that xxxxxxx Hospital has a very good reputation and is one of the top ranking teaching Hospitals in the US.
In teaching hospitals sometimes residents perform the tracheostomy and from my experience it would be one of the more senior residents performing the procedure.
It’s always better to have a qualified specialist perform the tracheostomy of course, however the nature of the environment often dictates who is doing what.
Do you now if they want to do the tracheostomy in the operating theatre or do they want to do it in ICU?
Most tracheostomies are getting done in ICU nowadays and as I mentioned in my previous email it’ll be a quick procedure within 30 minutes done by an experienced Intensive Care specialist.
Therefore I’m wondering are they planning to do the tracheostomy in ICU with a registrar and an ICU specialist present or are they planning to do the tracheostomy in the operating theatre with a surgeon overseeing the procedure?
Also, if your mother is a privately insured Patient you may be able to choose who should be doing the procedure. Check out her level of cover and the small print.
I hope that helps Robert. Let me know if I can be of further assistance.
that does help, thanks.
- The procedure would be done in the ICU at her current bedside, they do not need to take her to the OR. They have said it’s relatively simple and will take 30 min.
- The attending surgeon (the same one that performed the original surgery) will be supervising and present for the entire procedure. We liked her and trust her.
- The resident performing the surgery is on the tracheostomy team — so evidently has some experience.
I think we’re likely over-thinking the resident vs. attending issue given that this surgery is common and relatively straight-forward. So, we’re going to talk to the attending surgeon in the morning, just to get some last minute comfort and have them do the tracheostomy tomorrow.
I think that given the overall situation with a couple of failed extubations, the prolonged stay in Intensive Care as well as the emergency abdominal surgery your Mom had in recent days you and your family are making the right decisions by consenting to a tracheostomy.
You have looked into it, you have done some reading and watched some videos and you have been talking to the surgeons and the Intensive Care specialists.
By now you know what to expect and given that your mother still hasn’t woken up, the best course of action is a tracheostomy to reduce/minimize or even exclude sedation.
This increases chances of your mother becoming more alert and it also increases chances to reduce or minimize the needs for vasopressors or inotropes (such as Norepinephrine/Noradrenaline or Epinephrine/Adrenaline) to maintain a physiological blood pressure.
By now you and your family also know that your mother will be way more comfortable with a tracheostomy compared to a breathing tube in her mouth.
A tracheostomy also gives Patients in Intensive Care more time to recover because of less need for sedation and therefore Patients tend to have less desired side effects that is related to sedation.
It also gives way more leeway and options to wean your mother off the ventilator in her own time.
For now, I would advise to go with the flow and to consent to the tracheostomy, it’s the right thing to do!
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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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 your 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!
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
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