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 5 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 6)
Robert continues with his mother’s situation below
Here is another question: Right now, I don’t believe they are giving her any pain meds at all (to help increase the odds of “waking up”). Is there any risk that she goes into shock or something like that? Should she be on some pain meds?
A few days ago, they were giving her a “light” pain med that doesn’t cause sleepiness. But they stopped that too.
We don’t think my mom is in pain – she actually looks quite peaceful and comfortable.
The doctors are planning to perform the tracheostomy and PEG tomorrow.
Will keep you posted — and I’m sure I’ll have a few more questions. 🙂
I would imagine that not giving pain meds is due to them wanting to “wake up” your mother.
Normally in ICU the doctors and the nurses will assess your mother’s pain status while she’s unable to communicate properly through Non-verbal pain assessment tools as well as asking simple “Yes” and “No” questions. If she’s not ready to answer “Yes” and “No” through nodding or shaking her head they will simply assess her non-verbal responses.
Also, they will have a good idea in how she’s going with pain, depending on how well she can breathe on the ventilator.
For example a sign that she has minimal or no pain is that she’s breathing with a normal respiratory rate (=breaths per minute), as well as breathing with good Tidal volumes (=Volume in mls per breath) and Minute Volumes (=breathing volume in mls per minute) which are adequate for the size of her lungs.
It would also show up in her arterial blood gases where a low CO2 (=Carbon dioxide) would show up for hyperventilation as a sign of pain. If she’s not in pain and breathing fine, she will have normal Arterial blood gases (ABG’s).
Therefore, taking her off the pain meds such as Fentanyl or Morphine makes sense from my perspective, especially since those pain meds are long acting and also addictive. After nearly one month of being in and out of an induced coma, as well as being on and off ventilation, the sooner they can rid the Morphine/Fentanyl the better. I’m sure they would be giving some light pain meds such as Panadol/Paracetamol and/or small doses of Morphine in Tablet or Sachet form.
I do believe that if they can stop pain meds it’s a good sign as long as she can tolerate it of course.
But also important in all of this, what do you and your family think? Do you think your mother is in pain?
As long as she’s not in pain, there is no risk of shock and I would imagine that an experienced ICU nurse or experienced ICU doctor can recognize a Patient who has pain with some non-verbal pain assessment tools.
If pain goes unmanaged it can certainly cause harm, but I do have trust and faith that the staff can recognize it with their assessment tools.
I hope that makes sense.
Any questions please let me know.
One decision the family needs to make is on what level of “intervention” we would like the medical staff to do (not directly related to today’s tracheostomy, but just in general):
- Chest compressions (much beyond general CPR, which they always do).
We’ve heard that chest compressions are a final, desperate measure and all sorts of other things are going wrong at that point. And that it’s an aggressive/violent activity sometimes.
What’s your take? What do most families do?
as I briefly outlined in one of my previous emails, “Yes” to Dialysis and “Yes” to Cardiac compressions.
Most families in Intensive Care opt for full treatment. Treatment limitations are usually something that the Intensive Care team is driving for a number of reasons. In rare cases, families opt for treatment limitations and sometimes when treatment is being “futile” (=of no benefit to a Patient), a mutually agreed treatment limitation plan can be agreed upon.
- 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!”
From my perspective and from all the information that I have, I see every treatment your mother has been given and may need in the future as of benefit for her. You and your family can always re-visit this if the situation changes and the Intensive Care team are usually the first one to make you aware of it and I believe they have already mentioned this.
For now, with your mother’s heart beating strong, it also makes it less likely for her needing dialysis. Dialysis is needed for kidney failure and kidneys can fail in ongoing severe sepsis and during prolonged low blood pressure (=hypotension). People with Diabetes also have a higher risk of needing Dialysis for Kidney failure.
The Sepsis she seems to fight Ok for now and therefore hopefully she won’t need dialysis for kidney failure.
With the heart beating so strong thus far (unless there is a heart condition that I don’t know of) I would strongly advocate Cardiac Compressions (CPR= Cardiopulmonary resuscitation) especially in light of the fact that the ICU team has mentioned “withdrawing treatment” at some stage already.
By you stating that you want full treatment including cardiac compressions, you are keeping all of your options open thus far and you are showing the team that “withdrawing treatment” at this point is not an option for you and your family.
And as you have correctly pointed out, you can always change your position down the line.
One of the recurring themes in Intensive Care as well as for our client base is that if anything, Intensive Care teams can be very quick at wanting to withdraw or limit treatment. This from my perspective happens way too often and also prematurely. A lot of our work is coming from helping families when the Intensive Care team is trying to push towards a withdrawal of treatment, often without family consent.
- THE 5 THINGS YOU NEED TO KNOW IF THE MEDICAL TEAM IN INTENSIVE CARE WANTS TO“LIMIT TREATMENT”, WANTS TO “WITHDRAW TREATMENT”, “WITHDRAW LIFE SUPPORT” OR WANTS TO ISSUE A “DNR” (DO NOT RESUSCITATE) OR “NFR” (NOT FOR RESUSCITATION) ORDER FOR YOUR CRITICALLY ILL LOVED ONE!
This often early push towards withdrawing treatment from Intensive Care teams happens for a number of reasons, including financial budgets, lack of ICU beds, staffing issues, medical research interests and the list goes on.
We can help families very quickly to position their loved one’s diagnosis, prognosis as well as care and treatment that helps families to get the outcomes that they want.
Also, in light of the fact that your mother currently is only on one major life support mechanism (=mechanical ventilation) I think she’s in a fairly good position to get through this challenge and leave Intensive Care alive.
- “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!”
You are correct to point out that Cardiac Compressions are a final desperate attempt to save a life, however if there is any environment where people are well trained and have all the equipment and resources to deal with such a situation it would be an Intensive Care environment.
Yes, survival rates are not great after Cardiac compressions, however people still do survive. I also feel like 69 years of age is not very old. People above the age of 80 get resuscitated in Intensive Care all the time and some of them do survive.
Another component would be if you and your family have discussed this issue with your mother in the past? What do you think she would want?
I do strongly feel that opting for full treatment and also for full resuscitation in case of a cardiac arrest you and your family are very safe to keep this option for now. I believe it’s very important from a bigger picture point of view that the Intensive Care team knows that you want to stay in control of your mother’s destiny as much as you can.
I hope that helps Rob.
Let me know if you need further clarification of this topic.
Did the tracheostomy/PEG go well?
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 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!
Or you can call us! Find phone numbers on our contact tab.
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!
- The 10 COMMANDMENTS for PEACE OF MIND, control, power and influence if your loved one is critically ill 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!
- 5 POWERFUL THINGS YOU NEED TO DO IF THE INTENSIVE CARE TEAM IS NEGATIVE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
- 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
- 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 Ways to have control, power and influence while your loved one is critically ill in Intensive Care
- 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!
- HOW TO DEAL WITH A DIFFICULT INTENSIVE CARE TEAM, WHEN 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
- 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
- Why decision making in Intensive Care GOES WAY BEYOND your critically ill loved one’s DIAGNOSIS AND PROGNOSIS!
- 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!
- 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
- 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?